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Health Insurance - Everything You Want To Know

A health insurance policy is an agreement between an insurance company and a policyholder. In this agreement, the policy provider offers financial assistance for medical expenses to the policyholder in return for a premium. The policyholder can get reimbursement for medical treatments, hospital bills, surgical bills, etc. or choose the cashless claim feature. The cashless claim feature allows the policyholder to avail treatment on a network hospital without worrying about the payments. The insurance company and the network hospital have an association through which they settle the bills of the policyholders.

You can compare multiple health insurance plans online. Buying medical insurance online helps you to choose the one which best fits your requirements.

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Different Types of Health Insurance Plans in India

There are 2 types of health insurance plans:


An indemnity health insurance policy would pay for the hospitalisation expenses that are incurred when treatment is taken. In simple words, it is the actual hospitalisation expense that is covered up to your plan’s sum insured limit. This kind of health insurance is the most common and is opted for a basic or comprehensive health plan for families, individuals and senior citizens.

Such plans cover in-patient treatment expenses, doctor’s fee, ICU charges, surgery, room rent, medicines, pre and post-hospitalisation expenses etc. In addition, most health insurance companies offer cashless treatment under indemnity based health insurance plans.


In a fixed benefit health plan, a fixed sum is paid as a cover for certain predetermined illnesses or conditions. The pay-out is done in the form of a lump sum, irrespective of the actual medical expenses. Such policies are considered helpful if you are looking for accidental covers or protection against specific critical illnesses.

In Details

Types of Indemnity Health Plans:

There are several types of offline and online health insurance plans that are available in India:


 Disease Specific Plans


Such fixed benefit health plans cover certain specific illnesses such as:

  • Cancer-specific health plans

  • Dengue related health plans

  • Diabetes specific health plan

  • Heart ailment related health plans, etc.

When you are diagnosed with any of the listed illnesses, you may receive the sum insured in a lump sum and/or indemnifies the hospitalisation expenses. Lumpsum benefits are paid out once in the policy lifetime, and indemnity benefits are paid in hospitalisation expenditure claims.

Daily Cash


Also called hospital cash plans, in such plans, in case of hospitalisation, a certain amount is paid daily to help you manage the everyday expenses. Most plans offer daily cash up to a specific number of days.


A personal accident cover, as the name suggests, covers you for an accident. If you suffer disability or death in an accident, your medical expenses would be reimbursed. You would ... receive the lump sum amount as compensation depending on the severity of the disability. Full sum insured is paid in case of Death and Total Permanent disability.

Key Benefits of Health Insurance Policy in India

When the medical bills pile up, your savings drain quickly out of your pocket. A regular health check-up may also cost you more than you can afford. This doesn’t mean that you cannot have access to the best treatments available for you and your family. A health insurance policy comes to your aid in such a scenario. It covers your medical expenses so that you can lead a long and healthy life. Here are some key benefits you should look out for while buying online health insurance:

Does A Health Insurance Policy Cover Coronavirus (COVID-19)?

If you have an existing health insurance policy, a coronavirus claim will be handled by the insurance company. As per the IRDAI guidelines, the claims need to be expedited. The claim review committee will go through a thorough review and decide if it will be accepted. If you want to buy a health insurance policy online, most of them now offer insurance against coronavirus. Certain insurance companies have also rolled out medical policies centred around COVID-19. Two new policies for Coronavirus have been launched under the guidelines of the IRDAI namely, the Corona Kavach Policy and Corona Rakshak Policy.

Health Insurance Companies


Most insurance policies are customizable and you can choose which one suits your requirements. However, there are certain common inclusions and exclusions which you can choose from. They are:


  • In-Patient Hospitalization expenses
  • In the case of organ transplant, donor expenses up to a certain amount
  • Overnight hospitalizations in cases of serious injuries
  • Pre-existing diseases after a set incubation period (Usually 2-4 years)
  • Pre and post hospitalization expenses for the same illness and for a specified number of days
  • Ambulance charge up to a certain amount, and for a specific number of hospitalisations
  • Room rent up to a sub-limit
  • Free health check-ups
  • Maternity and newborn expenses are not covered unless opted as an add-on
  • Most daycare treatments are covered
  • Doctor-prescribed home treatment or domiciliary hospitalization


  • No coverage for expenses incurred during the waiting period (30 days) unless it is an accidental emergency
  • Pre-existing diseases are not covered in the incubation period. (Usually 2-4 years)
  • Illness and injuries caused by war or nuclear activities
  • Suicide attempt or self-inflicted injuries
  • Cosmetic/Obesity/Aesthetic surgeries
  • Replacement of hormones or sex-change operations
  • Dental or Eye Surgeries, unless covered under the plan
  • Non-allopathic and experimental line of treatment
  • Certain treatments or diagnostic tests, listed in the policy document
  • Treatment abroad or beyond geographic limitations as specified in the policy
  • Doctor-prescribed home treatment or domiciliary hospitalization


You need to fill up a form that asks for your basic details depending upon the insurance type you’re looking for.

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  • The form will lead you to a host of policy options customized according to your insurance needs.

  • The list contains the health insurance quotes and the basic details of every policy.

  • You can click on each policy to view their detailed information.

  • On the page with the list, you can select the policies you want to compare by clicking the ‘Compare Product’ box.

  • You can select up to 4 products at a time and click compare.

This will lead you to a comprehensive table that lists all the benefits of your shortlisted medical policies. You can take your time and choose the best one for you and your family.


It is crucial to compare medical insurance plans online before finalizing one. It helps narrow down the best plan which offers the maximum coverage. There are several plans that offer more services at a low premium. So, you can choose the one that suits your requirements and is also affordable. You don’t have to simply accept amongst a couple of choices handed to you by an agent. Comparing health insurance policies gives you the power to choose the best plan according to your particular needs.

Accurate Information

Access to Accurate Information

When you compare health insurance plans, you get access to all the information you need to purchase a policy. You don’t have to rely on agents and middlemen who may be offering their (mostly) biased opinions. You can easily log on to a website and read all the services, features, terms and conditions.

Time Efficient and Convenient

Time Efficient and Convenient

With the pandemic scare, buying things online has become the new normal. When you buy through PayBima, you don’t have to meet agents or set up calls with insurance companies to buy a policy. You can get a comprehensive table that lists all the benefits and shortcomings of every policy when you check online. Post-buy tasks such as paying premiums or renewing policies are also now available at the click of a button.



Many insurance companies offer a variety of services and coverage at a low premium. You can view them online and choose the one which fits your needs.

Factors to Consider Before Buying Health Insurance Policy

If you don’t have the experience of buying a health insurance policy, all the information available can be a little confusing. There are several factors that you need to consider before buying a health insurance plan. Such as, the premium, if you want an individual plan or a family floater plan, sum assured, etc. You need to know how to choose a robust plan which covers all your requirements. Here are a few factors which you should keep in mind:

Scope of Coverage

Always look for a health insurance policy that offers you maximum coverage. Don’t simply compare premiums with sum assured. A low premium plan might not cover all your needs. So, when comparing health insurance plans, always shortlist the ones offering you more services and benefits.

Tip: Go for a plan that offers maximum benefits at the lowest prices.

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Caps and Sub-limits

All insurance companies want to reduce their liability. To do so, they apply caps and sub-limits on certain services. For example, a room rent sub-limit can be Rs 5000 per day or an ambulance fee can be up to Rs 2000. Any expenses incurred above this limit on either of the services will be borne by you. Avoid paying inflated charges

Tip: Avoiding plans that put caps can be beneficial in the long run.

Lifelong Renewability

When you buy medical insurance online, always check its renewability. The usual plans have a yearly contract that gets renewed when you pay the premium. Many insurance companies offer a discount on premiums if you pay for a two or three-years premium in advance. If there is a break in renewal, you might lose all the accumulated benefits.

Tips: There are also some medical insurance policies that offer a 10% to 50% of renewal benefit for every claim-free year. Carefully compare medical insurance plans as some of them also offer the advantage of lifelong renewability which allow you lifelong security against the high treatment and healthcare costs.

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Cashless Hospital Network

Every medical policy insurance company has a list of network hospitals that offer cashless claims. Check if the hospitals around you or in your city feature on such a list of the insurance company you are planning to choose. This helps you to get treatment without worrying about the payments and reimbursement claims.

Tip: Try to go for a plan that has maximum network hospitals in your neighbourhood/ city.

Health Insurance Claim Procedures

You can file a claim if the illness, injury or accident is covered by your health insurance policy. In case of a Planned Hospitalization, you need to inform the insurance company about the claim 72 hours prior to admission.

Remember, in case of planned hospitalization, after receiving the authorization, you must take the treatment within a period of 15 days.

In case of Emergency Hospitalization, you need to inform the insurance company within 48 hours of admission or before discharge whichever is earlier.

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There are two ways in which you can make claims:


You can avail of this facility if you get treatment in a network hospital of the insurance company. Network hospitals have an association with the insurance company where they settle your bills amongst themselves. When you are at the hospital Help Desk, you would have to submit your Insurance company-issued Health Card/ Policy Papers.

Documents for a Cashless Claim:

  • Policy health card
  • Identity proof of the insured
  • Doctor’s advice for hospitalisation
  • For a planned hospitalisation, a Pre-Authorisation form would be required
  • Treatment-related documents, previous diagnostics, etc.

The remaining claim related documents would be sent directly by the hospital to the insurance company. Once the claim is verified and accepted, the money would be paid directly by the insurer to the hospital. At the time of discharge, you would be required to pay the differential amount that is not admitted in the claim.


At a non-network hospital, you cannot avail of cashless treatment. The payment has to be made upfront, for which you can later make a reimbursement claim of your expenses. After seeking the treatment, you would have to pay the bill to the hospital. Once done, you can submit all the documents including medical bills, discharge card, consultation papers and prescriptions to the insurance company. The company will review your claim and release the reimbursement amount if approved.

Remember: While leaving the hospital make sure to ask for Original Copies of all the treatment-related documents and the bills and receipts. These documents are crucial when making a reimbursement claim.

Documents Required for Health Insurance Claim Reimbursement

If you make a reimbursement health insurance claim for your medical expenses, you need to submit the following documents:

  • Discharge card issued by the hospital
  • Doctor’s consultation bills
  • Signed/Stamped In-patient hospitalization bills
  • Copies of Insurance policy
  • Prescriptions and medical store bills
  • Government authorised Photo ID Card
  • Duly filled and signed claim form
  • Doctor prescribed consumables and disposables
  • All Investigation and Test reports

Any other document asked by the TPA/Insurance company

FAQs About Health Insurance

Health insurance or a mediclaim policy is an insurance contract that covers the medical expenses incurred by an individual in case of hospitalisation. The policy covers the financial implications incurred at the time of medical contingencies and pays either the actual medical expenses incurred or a lump sum benefit depending on the plan’s coverage features

A Health Insurance policy is not a financial priority anymore; it has become a necessity in today’s age due to the continuous rise in healthcare risks and price inflation. Any unplanned hospitalization would lead to numerous expenses such as medical treatment or surgery costs, diagnostics test charges, pharmacy, doctor’s visits, room rents, ambulance transportation charges etc. These costs can easily cripple a family’s financial health in a flash. But with the right health insurance cover, you can protect yourself and your family from these medical expenses without causing many dents in your savings. Do not let the massive costs of treatment become a hindrance in seeking the right care for a loved one. A health emergency will not knock on your door before entering your life. Especially with physical fitness featuring low on our priority list, diseases are becoming more common. Medical treatments, especially in a private hospitals can lead to inflated bills. And if you find yourself in such a situation, it can completely drain your savings if you don’t plan. A health insurance plan will offer you a cushion in times of medical emergencies. It provides you and your family with financial assistance that will cover your family’s urgent medical needs. Apart from this, when you buy a health insurance policy can also offer you tax benefits under Section 80D of the Income Tax Act. 1961. Get health insurance for your family now.

Following are some of the key coverages and benefits you get when you buy a health insurance policy:

  1. Cost of hospitalization:All the hospitalization expenses incurred due to illness or accident injuries
  2. Pre and post hospitalization expenses: Expenses incurred during a certain number of days before and after hospitalization as long as they are related to the illness/injury
  3. Daycare procedures: Surgeries and treatments that do not require 24- hour hospitalisation, due to technological advancements, are also covered
  4. Ambulance cover: Transportation of the patient to the hospital
  5. Income Tax benefit: Save Rs 25,000 for self and family & additional 50,000 (if senior citizen parents included) under section 80(D) of Income Tax Act
  6. Organ donor expense: Medical expenses of an organ donor during an organ transplant.
  7. No Claim Bonus: A bonus is given to the insured during renewal in case no claims are filed in the previous policy year. The bonus can be in the form of an increase in the sum insured.
  8. Cashless treatment: Can be availed when hospitalised in one of the network hospitals of the insurance company
  9. Sum insured recharge: Sum insured gets replenished on exhaustion of entire health cover
  10. Alternative treatments (AYUSH Benefit): Alternate therapies like Ayurveda, Unani, Siddha and Homeopathy get covered
  11. Free health check-ups: Free health check-up facility is given to the insured members up to the pre-defined limit in the policy.
  12. Domiciliary hospitalization (Health homecare): Treatments availed at home on doctor’s recommendation
  13. Convalescence Benefit: Lumpsum amount is given to the insured person as a recovery benefit in case of a long duration of hospitalisation

It is important to realize that inclusions will vary from one provider to the next and from plan to plan.

Some of the exclusions under a health insurance policy are as follows:

  1. Expenses due to pre-existing disease incurred during the waiting period
  2. Expenses incurred during the waiting period for the disease/ailments having a mandatory waiting period
  3. Cosmetic and Dental surgery expenses
  4. Sexually transmitted diseases
  5. Self-inflicted injuries, adventure sports, abuse of drugs and intoxicants
  6. Injuries caused due to war

A detailed list of exclusions can be found in the policy wordings of the respective health insurance product.

Choosing the right health insurance plan is the most important step while purchasing a policy. Following are some of the factors that should be kept in mind while looking for health insurance:

  1. Sum insured: Determining the right coverage is the first step when opting to buy health insurance. Individuals residing in metro cities may go for a higher sum insured. If looking for family health insurance plans, a sum insured above 10 lacs can be considered so as to cover multiple claims in a year from different members without exhaustion.
  2. Sub-limits: Policies that do not have sub-limits on room rents i.e. no higher limit on the rent charges are always recommended.
  3. Co-payment: Policies that have co-payment options have lesser annual premiums because the insured individual pays a fraction of the hospital expenses and the rest is borne by the insurance company. Though the premiums are discounted the co-payment amount could be a significant amount in case of high-value claims.
  4. Waiting period: Some insurers have shorter waiting periods for pre-existing ailments. Specific covers like maternity benefits are covered after 3 years under policies of a few insurance companies. The shorter the waiting period, the better for the insured person.
  5. Cashless hospital network: Insurance companies have tie-ups with hospitals across the country. One should always look for the insurer that has more hospitals under their cashless service.

There are numerous health insurance plans available in the market. Each plan has its own inclusions and exclusions list, benefits and features, cashless hospital network, sub-limits, waiting periods for certain illnesses etc. Hence it becomes imperative to compare these plans first and then choose the one which suits your requirements the most. PayBima helps you choose the right plan by showing a detailed comparison of all the health insurance policies available based on the data provided and hence assists you in making an informed choice.

You can compare and buy health insurance online in a few easy steps. Visit the PayBima website and select health insurance. Then you will be asked to enter a few basic details like age, sum insured amount, area of residence, number of members to be insured etc. Based on the details submitted, health insurance quotes from various health insurance companies will be displayed. You can select multiple plans and compare the benefits and coverages provided along with the premium.

Once you compare health insurance plans and decide on a particular policy that fulfils your requirements, you can select the plan and proceed to the proposal form stage. You have to provide accurate and correct information in the proposal form. After the form is filled, you can review all the details shared till now on the summary page. After reviewing, you can proceed to buy health insurance policy online and make the payment online through various modes like credit/debit cards, internet banking, wallets etc. Post successful payment, a health insurance policy will be generated and emailed to you instantly.

When it comes to buying Health Insurance Plans for Senior Citizens, you need to consider several things to choose the best plan. Below are some of the top health plans available for elderly in India:

  • Star Health Red Carpet
  • National Insurance Varistha Mediclaim
  • Bajaj Allianz Silver Health:
  • HDFC Ergo My Health Suraksha Plan
  • Oriental Senior Citizens HOPE Insurance Plan
  • IFFCO Tokio Individual Medishield Plan
  • Kotak Health Care Plan
  • New India Assurance Senior Citizen Mediclaim Policy

As per the regulations of the Insurance Regulatory Development Authority of India (IRDAI), any individual up to 65 years of age can procure health insurance. In case of comprehensive Health Insurance Plans for Senior Citizens, individuals between the age of 65 and 80 years can get insurance.

Below are the top health insurance companies in India on the basis of their claim settlement ratio as per FY 2019-2020:

  • IFFCO Tokio General Insurance (96.33%)
  • Care Health Insurance (95.47%)
  • Magma HDI Health Insurance (95.17%)
  • The Oriental Insurance Company (93.96%)
  • New India General Insurance (92.68%)

Yes, health insurance renewal can be done. Normally a health insurance plan stays valid for one year, and it needs to be renewed upon expiry. If you miss to renew the policy and it expires, you still can renew it within the 30 days grace period offered by insurers. However, after the grace period it cannot be renewed.

Health Insurance Renewal of your lapsed health insurance policy can be done online/offline within the grace period that is allowed by your insurer. You can enjoy the continuity benefits in terms of waiting period and no claim bonus if you renew the policy during the grace period. This can be easily done online through the insurer's website and for offline renewal, you can visit the nearest branch of the insurer.

There are many factors that the Health insurance premium calculator takes into account to calculate the premium of a health insurance policy. The premium calculator considers factors such as age of insured, his/her income, city where the insured is residing, type of coverage etc. to calculate the premium of a policy.

The amount paid every month by the insured towards his/her health insurance every month is the monthly health insurance premium. It is calculated by using a Health insurance premium calculator that takes into account several factors like age, income and other information of the insured.

Below are the three top Coronavirus Health Insurance plans among many others

  • Corona Kavach Policy for Covid-19
  • Corona Rakshak Insurance Plan
  • Coronavirus Group Health Insurance

A pre-existing disease is a disease or a condition existing in a person before he purchases the policy. When you are going to buy health insurance policy online, you should declare all such known diseases in the proposal form. The insurance company may verify medical test reports and agree to cover such pre-existing diseases after a certain waiting period.

Yes, but after a certain waiting period as specified in the policy wordings. The waiting period can range from 2 to 4 years depending on the underwriting policy of the insurer. Also, the insured member should declare his medical history accurately in order to claim any expense arising out of the treatment for such diseases, else the claim might get rejected.

  • There is a 30-day waiting period that follows the inception of the policy when you buy health insurance online. Any disease, injury or sickness that arises in these 30 days are not covered by the policy.
  • Any pre-existing diseases, which are conditions existing in a person before he purchases the policy, are not included in the policy cover.
  • Other diseases that health insurance plans do not cover are HIV or AIDS, pregnancy or childbirth complications, aesthetic, cosmetic or obesity treatments, alcohol or substance intoxication, treatment for war, riots, strike, nuclear weapon injuries

You can compare various health insurance plans to know which covers your requirements.

No, there is a waiting period of 30 days from the day of the inception of the policy. Any treatment of illness undergone during this period is not covered in the policy except for injuries from accidents.

Before an individual is hospitalized, there are preliminary expenses which are incurred on doctor’s consultations for diagnosing the illness, medical tests for finding out the reason for illness, medicines, etc. These expenses are called pre-hospitalisation expenses. Similarly, there might be treatment costs incurred after the individual is discharged from the hospital. These are called post hospitalisation expenses. Both pre and post hospitalisation charges up to a certain number of days are covered in most health insurance plans, provided the hospitalisation expenses claim is covered by the insurer.

If the sum insured is exhausted in the treatment of a member, no further claims would be paid by the health insurance policy in that policy year. If another claim occurs within the same policy year, it would be denied. But from the next policy year, the full sum insured would be available for subsequent claims. In case Sum Insured Recharge benefit is opted for while purchasing the policy, then the sum insured will get replenished upon exhaustion in the same policy year however it can only be availed for a different treatment.

A health insurance portability is a provision given by IRDA that allows the insured to switch their health insurance policy to a different insurer while retaining all the accumulated benefits from the old insurer like waiting period, no claim bonus, etc. In order to avail of this facility, the policyholder will have to intimate the new insurer where he/she wishes to port at least 45 days prior to the policy renewal date.

The premium in a health insurance policy is the amount of money that you pay to the insurance company to buy the health coverage. The premium depends on a number of factors that the proposer declares at the time of buying insurance.

The premium for health insurance is calculated based on a number of factors. Some of them are listed below:

Age: One of the most important factors that decide your health insurance premium. The older you get, the more you have to pay for insurance as the probability of getting ill is high.

Number of members to be covered: Depending on the number of members you want to include in your policy, the premium is calculated. For a family of four including children, the premium will be high whereas for insuring an individual, the premium would be low.

Pre-existing ailments: Premium will be high for individuals who have a history of illness e.g. diabetes, hypertension etc.

Location of residence: Depending on the place you live, the premiums vary. The cost of treatments in metro and tier-1 cities are high, hence the premium is high for individuals residing in such locations. Whereas tier 2 and tier 3 cities will have a lesser premium for the same individual.

BMI: Your body mass index also plays a role in deciding your health insurance premium. Individuals with high BMI will have to pay more for insurance cover as they are assumed to be more prone to serious ailments. If you have a BMI in a healthy range, the premium would be lesser.

You can pay premium online through one of the various modes of payment offered by insurance companies. Once you have shortlisted a health insurance plan and filled the proposal form, you will be redirected to the payment page of the insurance company. You can then choose to pay through credit or debit cards, net banking, wallets or UPI. Some insurance companies also provide EMI facility on select credit cards.

When you buy health insurance, the premium paid up to Rs 25,000 for self, spouse and dependent children are considered tax-free under section 80D of the Income Tax Act. There is an additional benefit of Rs 25,000 for a premium paid towards dependent parents. However, the limit goes up to Rs 50,000 if you/your parents are more than 60 years of age.

  The premium for self, spouse and dependent children The premium for dependent parents Total deduction U/S 80D
When you are < 60 years of age Rs. 25,000 0 Rs. 25,000
When you are < 60 years of age and your parents are < 60 years Rs 25,000 Rs 25,000 Rs 50,000
When you are < 60 years of age and your parents are > =60 years Rs 25,000 Rs 50,000 Rs 75,000
When you are > =60 years of age and your parents are > =60 years Rs 50,000 Rs 50,000 Rs 1,00,000

Yes, you would be required to pay a premium again. However, you can avail the benefit of the No Claim Bonus if it is being offered by your insurance company. Through this benefit, your sum insured amount may get enhanced further by a fixed amount for every claim-free year.

Yes, you can cancel your health insurance and get your premiums refunded. Every health insurance policy has a free lookup period of a certain number of days. If you are not satisfied with the terms of the health insurance policy purchased, you may apply for cancellation. In such cases, the insurance company will refund your premium amount after some deductions made for processing costs incurred by them. In case of cancellation after the free look period, a prorated amount will be deducted.

A claim is defined as the demand made on the insurance company to compensate for the financial losses suffered by the policyholder when the insured event occurs. A health insurance policy claim occurs when the insured suffers a medical contingency and demands compensation for medical costs which are covered under the policy.

Cashless claim settlement is a process where the insurance company takes care of the medical bills itself without you having to pay for the medical cost yourself. A cashless claim is allowed only when you get admitted to a hospital that is tied up with the insurance company. In such cases, the insurance company settles your medical bills directly with the hospital and you don’t have to bear the financial burden of your medical emergency.

In a cashless health insurance policy, your medical costs are handled directly by the insurance company. They are paid by the insurance company to the hospital and you can avail of treatments without having to bear the financial burden. As such, a cashless health insurance policy provides you financial relief in medical emergencies.

Moreover, since your medical bills are met by the insurance company, you don’t have to draw on your savings to pay for hospitalisation. You can also avail quality healthcare when you know that the subsequent costs would be borne by the insurance company and not you.

Claim assistance is the help offered at the time of a health insurance claim. Insurance companies have a dedicated claim assistance team to help their policyholders with their health insurance claims. They guide the policyholders with the required steps to be followed in order to get their claims settled. PayBima also provides claim assistance services to its customers. In case of a claim under your health insurance policy, you can contact PayBima at our toll-free number 1800 267 67 6 or drop us an email at Our claim experts will help you get your health insurance plan claims settled at the earliest.

There are two procedures for claims:

  1. Planned: If a member of the family knows of a forthcoming hospitalization, they need to call on the helpline number mentioned on the Health Identity Card. The next step is to upload the required documents such as doctor’s certificates, medical bills, etc. The service provider of the online health insurance plan or TPA should approve your claim.
  2. Urgent: If there is a sudden sickness or injury, the patient needs to be immediately admitted to the hospital where they avail treatment. Friends or family then contact the service provider or TPA to make a claim.

Cashless claim facility can only be availed at network hospitals in the medical insurance plan. For non-network hospitals, claims can be availed in form of reimbursement upon submission of relevant bills.

The essential documents required for filing a Reimbursement Claim are:

  • Discharge card issued by the hospital
  • Signed/Stamped In-patient hospitalization bills
  • Prescriptions and medical store bills
  • Duly filled and signed claim form
  • All Investigation and Test reports
  • Doctor’s consultation bills
  • Copies of Insurance policy
  • Government authorised Photo ID Card
  • Doctor prescribed consumables and disposables
  • Any other document asked by the TPA/Insurance company

No, you are not allowed to claim twice for a single payment even though there are two separate service providers offering you a medical policy.

Cashless hospitalization allows a member of the medical health insurance policy to get admitted to a hospital and undergo their treatment without worrying about the payments. The hospital will have a procedure to settle the payment directly with the medical insurance policy provider. However, this facility is only available in any network hospital. For non-network hospitals, standard procedures for insurance claims will apply.

The members of the policy can pay for the expenses incurred in the treatment themselves and then later claim for the reimbursement of those expenses from the policy provider. This is called a Reimbursement Claim.

A Pre-authorization is issued by the insurance company or the service provider of the health insurance policy. It states the value of medical treatment and cover provided by the company that a member can claim under the health insurance policy. A pre-authorization is needed for planned cashless hospitalisation at least 3-5 days prior to hospitalisation.

  • Network Hospitals: A hospital that is in association with the insurance company is known as the network hospital. This is done primarily to enable a Cashless Claim process. A Cashless Claim process is where the hospital settles the payment for the treatment of a member directly with the insurance company. The network hospitals list can vary from one company to another. This can be viewed on the website of the service provider or TPA when you buy medical insurance online.
  • Non-Network Hospitals: These are the hospitals that do not have an association with the insurance company, hence, they do not offer Cashless Claims. If a member undergoes treatment in these hospitals, they may either file for a reimbursement claim or contact the service provider in case of an emergency.

A network hospital offers you the Cashless Claim feature while a non-network hospital does not. But a member can choose either of them for treatment. A member can file for a Reimbursement claim in such a case. However, the non-network hospital should be compliant with hospital facility definition and geographical limits as defined in policy documents. This information is available when you compare health insurance plans.

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