How to make a Reimbursement Claim in Medical Policy

If you are having a Mediclaim Policy, you would surely want to know how to raise claim for the same in future. Below discussed are the two ways how you can make claim:

  • Cashless wherein the Insurance Company makes payment to Hospitals directly. In this case, you shall need to bear the Non-Medical expenses and other charges if there is any capping as per policy terms and condition.
  • Reimbursement wherein you need to pay to the Hospital for the treatment taken and submit the documents to Insurance Company/TPA for reimbursement of medical expenses incurred for the treatment.

We have already covered Cashless Claim Procedure in our previous post hence let's have a look at the Reimbursement Claim Procedure in this post:

In case of reimbursement you can visit to the Hospital of your choice, which is a Non-network Hospital. The Insured need to initially pay to the Hospital for treatment and submit the Claims document to the TPA/Insurance company for Processing of the claim.

To take reimbursement facility, you need to first intimate the claim to your Insurance company or TPA i.e provide information to the TPA/Insurance about the admission of Insured person to the Hospital. (*Time frame for Intimation is as Per your policy's terms and conditions).

At the time of Discharge, collect all the Documents in Original as it must be submitted to the TPA/Insurance company for processing of the claim.

Document Check list for Submission of reimbursement of claim.

  • Duly filled claim form. (Claim form will be available on TPA or Insurance Company website)
  • Original Discharge Card
  • Original Investigation report.
  • Original Prescription for Investigation
  • Original Medical Bills If medicine purchased from Outside Medical
  • Original Prescription for Medicine
  • Original Hospital bills
  • All Deposit receipts
  • Original Paid receipt of final Hospital Bills with Break Up of charges
  • Invoice and sticker of lens, stents, Implants
  • Indoor case papers If required
  • Consultations Papers
  • FIR/MLC in case of accidents
  • Adhar Card/Pan Card
  • Any other document as required by TPA/Insurance company

*Time frame for submission of claim would be as per your policy's terms and condition.

Keep Photocopy of all the document submitted for ready reference.

Best of Luck on the purchase of your Mediclaim Policy!