Steps of medical insurance claim settlement process

Buying health insurance is one of the first steps to making sure that you or your family’s medical expenses are covered. A health insurance policy is a contract signed between you, the insured, and a valid insurance provider wherein the insurance provider will settle medical expenses incurred by you in exchange for an annual premium. A medical insurance policy will allow you to get the treatment done or get the insured person hospitalised and your insurance company will pay all the expenses for the same.

But getting the health insurance policy is only the first step towards securing your family’s health. Everyone who has a health insurance policy must also understand the actual claim settlement process that will allow them to use their health insurance when the time comes. Given below are the steps required to successfully claim a health insurance settlement for you or any person included in the policy.

Types of health insurance claims

There are two main ways that an insured person can claim their health insurance.

Cashless Claim

When you get a health insurance policy, the insurance provider gives a list of authorised hospitals in their network that allow cashless insurance claims. If you approach such a hospital for treatment or hospitalisation, you can get the same done without paying anything because the hospital will communicate all the expenses with the insurance provider and the provider will settle the payment after proper authorisation. This is called a cashless claim.


The other type of insurance claim is the reimbursement claim. If the hospital of your choice is not within the network of your insurance provider, then you will have to pay all expenses out of your own pocket initially. After the treatment is done and the patient is discharged, a claim form along with all relevant documents pertaining to the treatment must be submitted to the insurance company, which will then reimburse the amount that was originally paid by you.

Steps to claim cashless insurance

For planned hospitalisation

Step 1 : Call the insurance provider and initiate proceedings to claim health insurance

Step 2 : Fill out the pre-authorization form and submit it to the insurance provider along with all medical documents like doctor’s prescription, consultation notes, radiographs, scans, blood tests and anything that points towards the requirement of the claimed medical procedure.

Step 3 : Get the authorisation letter from the insurance provider and approach the hospital with it. You will also need to show the proof of insurance, which will usually be an ecard with the insured person’s name on it.

Step 4 : Proceed with the treatment while your insurance provider will settle all the expenses.

For emergency hospitalisation

Step 1 : Take the patient to the hospital and approach the insurance help desk

Step 2: Show the proof of insurance (ecard or policy document) and submit relevant medical documents, including a duly filled pre-authorisation form.

Step 3: The hospital will gather all documents and send them to the insurance company.

Step 4: The insurance company will go through all the documents, cross-check their validity and eligibility, and if everything is in order, send an authorisation letter to the hospital within 24 hours. The patient can be admitted to the hospital and treatment done during this time.

Step 5: The insurance company will pay all the medical expenses pertaining to the treatment.


Thus, the process of claiming your health insurance can be smooth if you already have a clear understanding of how it works. This will ensure that when the time comes to actually claim your insurance, which can very likely be a time of emergency, you do not have to run from pillar to post to get what is rightfully yours. Follow the above steps and get your insurance claimed in a jiffy. You can always contact your insurance provider if you have any doubts or confusions.

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