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Claims guidance that starts with the next practical step.

Understand the general process for cashless and reimbursement claims, what documents may be requested, and when to inform the insurer or claims administrator.

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A customer smiling at the billing and insurance desk after his cashless claim is accepted

The hospital settles directly with the insurer or its claims administrator, subject to approval.

  1. 1
    Choose a network hospital

    Confirm the hospital is on your insurer’s network list before admission.

  2. 2
    Inform the insurer

    For planned treatment, inform the insurer or claims administrator in advance. For emergencies, do it as soon as possible after admission.

  3. 3
    Pre-authorisation

    The hospital submits the request. The insurer reviews it and confirms what it will pay.

  4. 4
    Treatment and discharge

    At discharge, the final bill is reconciled. Non-payable items, if any, are paid by you.

What IRDAI generally requires of insurers

IRDAI’s Master Circular on Health Insurance Business (29 May 2024) requires a Customer Information Sheet with every policy, a 30-day free-look period, a cap of 36 months on pre-existing disease waiting periods, protection from claim contests for non-disclosure or misrepresentation after 60 months of continuous cover (except proven fraud), and targets of 1 hour for cashless authorisation and 3 hours for discharge approval. Rules can change — confirm current terms with your insurer or IRDAI.

How life and general insurance claims differ

The cashless and reimbursement process above is specific to health insurance. A life insurance claim is a death claim made by your nominee, supported by the policy document, death certificate and identity proof — see our guide on term insurance for how insurers assess these. A motor insurance claim usually involves a surveyor assessing vehicle damage, either through a cashless network garage or reimbursement — see our car insurance guide. Home, travel and personal accident claims follow the specific process in each policy's Customer Information Sheet.

Frequently asked questions

Which health insurance plan is best?

There is no single best plan. The best health insurance plan is the one that fits your age, family, city and health history — with enough sum insured, short waiting periods, manageable co-payment and sub-limits, good cashless hospitals nearby and a reliable claims record. Compare plans on those points rather than on a ranking.

Which is the cheapest health insurance plan?

The cheapest plan is the one with the lowest total cost over time — premium plus what you pay at claim time — not simply the lowest premium. Buying early, choosing a floater, adding a super top-up and comparing co-payment and sub-limits can reduce cost without cutting the cover that matters.

How do I choose the best health insurance advisor?

Choose an IRDAI-licensed advisor who explains exclusions and waiting periods first, is open about how they are paid and which insurers they offer, and supports you at renewal and claim time. Ask for the licence number and verify it before sharing documents or paying.

What is a cashless claim?

In a cashless claim, treatment at a network hospital is settled directly between the hospital and the insurer or its claims administrator, subject to approval and policy terms. If you use a non-network hospital, you would normally pay first and claim reimbursement.

Do I need to declare my medical history?

Yes. Always disclose pre-existing conditions accurately. Non-disclosure can lead to a claim being rejected or a policy being cancelled, and it is far easier to sort out before you buy than after you claim.

Official resources

General education only — not a recommendation of any product or a guarantee of claim approval. Claims are assessed and decided by the respective insurer under the applicable policy terms, IRDAI regulations and Customer Information Sheet. Insurance is the subject matter of solicitation.

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