Written By: Simran Kaur Vij

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Health and Term Insurance

Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.

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Reviewed By: Anchita Bhattacharyya

Anchita Bhattacharyya

Health, Term & Life Insurance

Anchita has over 6 years of experience in content marketing, insurance, and healthcare sectors. Her motto to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.

Updated on Mar 07, 2025 3 min read

Himanshu Kumar

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Content Manager with heart, mind, and soul dedicated to creating impactful content that exceeds the market standard, delivers and reaches the readers conveniently. Besides producing high-ranking content, my focus lies in creating content that solves user queries and adds value.

Written By: Himanshu Kumar

Updated on Jan 15, 2025

Anchita Bhattacharyya

Term Insurance, Content Manager

Content Manager with heart, mind, and soul dedicated to creating impactful content that exceeds the market standard, delivers and reaches the readers conveniently. Besides producing high-ranking content, my focus lies in creating content that solves user queries and adds value.

Reviewed By: Anchita Bhattacharyya

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Written By: Rhishabh Garg

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Rhishabh Garg is the Business Unit Head of Term Insurance at Policybazaar.com. He has over 10 years of experience and currently plays a crucial role in shaping the future of term insurance in the company. Rhishabh also has experience in customer services and crafts new strategies for organizational success, one of which is Policybazaar’s claim assistance program.

Reviewed By: Santosh Agrawal

Santosh AgrawalChief Business Officer

Santosh Agarwal is the Chief Business Officer of life Insurance at Policybazaar.com and has over a decade of experience in the insurance domain. She has helped shape Policybazaar's life insurance vertical and ensures the effective execution of the company's overall strategy. Santosh is also responsible for the Term Insurance for Women domain at Policybazaar.com and educates the masses about its importance and benefits.

Reimbursement Claim Process

Navigating the healthcare landscape can be complex, especially if unexpected medical expenses occur. The reimbursement claim process empowers you to receive financial compensation for medical expenses that you have already paid out of pocket.

If you receive treatments at a non-network hospital your insurer will reimburse you for the medical expenses. The reimbursement claim process involves submitting necessary documentation, including medical bills and claim forms, to the insurance provider for review and approval.

Let us understand more in detail

traordinary Facts

IRDAI announces the Cashless Everywhere initiative, under which policyholders are eligible to receive cashless treatments at any hospital, even if that hospital is not on the insurer’s network list.

How To File A Reimbursement Claim Online?

The reimbursement claim process online is an easy one. Here’s a general guide:

• Step 1: Gather all your documents required for mediclaim reimbursements like claim forms, medical bills, discharge summaries, reports, and more.
• Step 2: Intimate your health insurer about your hospitalization as soon as possible, even before you are discharged.
• Step 3: Scan and upload all your documents on the official website of your health insurer.
• Step 4: Fill in all your reimbursement claim process details about your hospitalization, treatments, and more.
• Step 5: Let the insurer verify your claim.
• Step 6: Your reimbursement claim amount will be transferred to your bank account once verified.

Benefits of Reimbursement Claim Process

Here are the key benefits of medical reimbursement claim:

• Flexibility to select your place of hospitalization as you can select a healthcare facility where you are comfortable.
• You do not need to wait for approval from your health insurance provider. With a reimbursement claim, you have the flexibility to get immediate access to the best hospital in your vicinity without any location constraints.
• Avail immediate treatment with a reimbursement mediclaim facility, without the hassle of navigating through the insurance-related procedure.
• A hassle-free reimbursement claim process post your discharge is offered by your healthcare provider.

Documents Required For A Reimbursement Claim Process

Other documents needed for a medical reimbursement claim apart from the claim form are:

• Discharge summary
• Hospital bill
• Pharmacy bills
• Diagnostic test reports
• Invoice copies, if any
• Doctor prescriptions
• NEFT form filled by policyholder

In case the policyholder passes away in the hospital during treatment other additional documents will be required.

Can Medical Reimbursement Claim Be Denied?

Yes, your health insurance company can deny the claim due to several reasons. Broadly, the claim may be rejected if it does not fulfill the following requirements:

• Undergoing treatment that was not covered by your health plan
• Misinformation of a medical fact by the policyholder
• Fraudulent claims
• Claims made during the ongoing waiting period

What To Do In Case Your Reimbursement Claim Is Rejected?

Here are some steps you can take in case your reimbursement claim is rejected:

• Review the rejection reasons carefully and understand the specific reasons for rejections mentioned by your healthcare provider.
• Connect with your healthcare provider’s claims team to seek further assistance regarding the reason for your reimbursement claim’s rejection.
• Review your policy documents and read the terms and conditions carefully for coverage benefits.
• File a grievance or re-apply for your reimbursement claim in case you feel the rejection is unjustified.
• Consult insurance aggregators like PolicyX and seek expert advice regarding rejected reimbursement claims.

Factors To Consider Before Selecting Reimbursement Claim Process

Before you go ahead and pick a health insurance plan providing you reimbursement claim here are a few things to consider:

• Understand your policy coverage and terms and conditions carefully. Your expenses must align with your coverage features.
• Consider waiting periods and deadlines for reimbursement claims, as untimely submission of documents could result in rejections.
• Maintain all your medical records carefully after discharge as they will come in handy when filing a reimbursement claim.
• Keep in mind the exclusions of your health insurance plan.
• Understand the reimbursement claim process of your health insurer carefully to undergo a smooth claim process.

Wrapping It Up

Knowing the correct process to file a reimbursement claim process is a boon. Understanding the medical reimbursement claim process is necessary along with being diligent with documentation, and knowing your policy inside out. In this article, we highlight all the essential details you must know to undergo a smooth reimbursement claim process.

Know why your health insurance claim is rejected?

To know more about individual, family, senior citizen, and group health insurance, schedule your appointment with PolicyX advisors today!

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