Filing a Reimbursement Claim Under Health Insurance: A Step-by-Step Guide

What is a Reimbursement Health Insurance Claim?

A reimbursement claim is when you pay for your treatment expenses upfront and then request your insurance company to repay the amount later, as per the policy terms. This is different from a cashless claim, where the insurer settles the bill directly with the hospital.

You may opt for a reimbursement claim when:

• You get treated at a non-network hospital.
• The hospital does not support cashless facilities.
• The cashless claim was denied at the time of admission (but the treatment is covered under your policy).

Step-by-Step Guide to Filing a Reimbursement Claim

Step 1: Inform Your Insurance Provider Promptly

Always inform your insurance company or your advisor at Jio Insurance Broking within 24 to 48 hours of hospitalisation (as per the policy terms), even if it’s a planned procedure. In case of emergency hospitalisation, notify them as soon as possible. This ensures smoother processing and avoids any future discrepancies.

Pro tip: Keep the customer support number and email of your insurer handy at all times.

Step 2: Collect All Original Documents

Post-treatment, you need to gather the following original documents for the reimbursement process:

• Discharge summary
• Final hospital bill and payment receipts
• Diagnostic and pathology reports
• Prescriptions and pharmacy bills
• Consultation papers
• Doctor’s certificate for hospitalisation
• FIR or Medico-Legal Certificate (in case of accidents)
• Identity proof
• Health insurance policy document

Without these, the claim may be delayed or rejected. So, be meticulous and preserve every bill and document, no matter how small.

Step 3: Fill the Reimbursement Claim Form

Download the health insurance reimbursement form from the insurer’s website or get it from your insurance advisor. Fill in all the sections accurately. Incorrect or incomplete forms are among the most common causes of claim delays.

At Jio Insurance Broking, our advisors can guide you on how to fill it correctly and attach supporting documents for a stronger submission.

Step 4: Submit the Documents

Once all forms and documents are ready, submit them to the insurer or your Jio Insurance Broking advisor within the specified time limit—usually within 7 to 30 days after discharge.

Some insurers allow online submissions, but originals are typically required for final approval. Make sure to take photocopies or scans of everything for your own record.

Step 5: Wait for Claim Processing

After submission, the insurer’s claims team will evaluate your documents and may request:

• Clarification on treatment
• Additional medical reports
• Doctor’s declaration
• Hospital verification

The turnaround time varies but is typically 10 to 15 working days if all documents are in order.

Pro tip: Track your claim status online or through your Jio Insurance Broking account for real-time updates.

Step 6: Claim Approval and Reimbursement

Once approved, the insurer will transfer the eligible amount to your registered bank account. The reimbursement may not be 100%—deductions for non-payables, room rent capping, or policy exclusions may apply.

At Jio Insurance Broking, we help you understand the breakup of the reimbursed amount and ensure that any unjustified deduction is clarified or challenged on your behalf.

Common Mistakes to Avoid During Reimbursement Claims

• Delayed intimation to insurer
• Missing original bills
• Not taking pre-authorisation (for planned surgeries)
• Mismatched documents (like incorrect patient name or hospital name)
• Skipping follow-ups after submission

With the right guidance from Jio Insurance Broking, you can avoid these common pitfalls.

Why Choose Jio Insurance Broking?

• End-to-end assistance with health insurance claims
• Claim support helpline with real people, not bots
• Transparency in process and timely updates
• Expert guidance on policy coverage and exclusions
• Trusted partner for families across India

We understand that health issues are already stressful, and insurance shouldn’t be. With Jio Insurance Broking by your side, filing a health insurance reimbursement claim becomes a stress-free and seamless experience.

Filing a reimbursement claim may seem like a tedious process, but with the right approach and timely action, it can be smooth and hassle-free. Always keep your policy documents handy, maintain thorough medical records, and reach out to experts like Jio Insurance Broking for personalised support.

Because when it comes to health, every minute and every rupee matters.