Reimbursement Claims

Name: Reimbursement Insurance Claim
Brand: IndusInd General Insurance
Rating: 4.9 (310 reviews)

Health insurance adoption in India has surged in recent years, driven by rising medical costs and greater awareness. According to the IRDAI, during 2023-24, general and health insurers settled 2.69 crore health insurance claims, a strong indicator that people are not just buying insurance, they are actively using it.

While purchasing a health insurance policy is a smart and necessary move, knowing how to use it by raising a claim is equally vital. Among the two types of claims, reimbursement claims are particularly important, especially when a cashless claim is denied due to reasons such as delayed intimation or policy-specific exclusions. They ensure that you can still get the coverage you need even when cashless settlement is not an option.

Recognising this need, IndusInd General Insurance (previously Reliance General Insurance) offers broad health coverage of up to ₹5 crores* along with the convenience of filing reimbursement claims digitally via the IndusInd Insurance app. Our reimbursement claim process is simple, transparent and well-supported, ensuring quick settlements without the usual back-and-forth.

What is a Reimbursement Claim in Health Insurance?

A reimbursement claim in health insurance refers to the process where a policyholder pays for medical treatment out of pocket and later submits a claim to the insurance company for repayment. The insurer reviews the claim and reimburses the eligible expenses, provided the treatment is covered under the terms of the policy and all necessary documents are submitted.

For example, suppose you develop a sudden stomach infection and consult a doctor at your nearest clinic. After undergoing some diagnostic tests and receiving outpatient treatment, you pay the consultation and pharmacy bills yourself.

Once the treatment is complete, you can file a reimbursement claim by submitting the required documents, such as medical bills, test reports, doctor’s prescription, etc. If the treatment is covered under your policy, the insurer will verify the documents and disburse the benefit amount to you.

How to Raise a Reimbursement Insurance Claim?

Inform us about the medical incident within 24 hours (for emergencies) or 48 hours (for planned treatments) via the IndusInd Insurance app or our helpline, or email.
Get the required medical procedures or treatments at any hospital of your choice. Once the treatment is complete, pay the medical expenses and collect all relevant documents.
Fill and sign the claim form and submit it to us along with supporting documents, such as bills, prescriptions, discharge summary, payment receipts, etc., within 15 days of treatment.
Upon submission of documents, we will review your claim for approval. During this time, you can track your claim status.
After approval, we will reimburse you for the applicable expenses as per your policy terms and conditions, usually within 30 days.

Disclaimer: Before selecting a hospital for treatment, refer to the list of blacklisted/notified hospitals, as any treatment undertaken at such treatment facilities shall not be covered under the policy, and all associated claims (including cashless and reimbursement claims) will be rejected.

Documents Required for a Reimbursement Claim in Health Insurance

Before initiating your reimbursement claim, ensure you have the following documents for faster claim assessment and approval -you for showing interest in IndusInd General Insurance Company Ltd.

General Documents

Claim Form - Needs to be duly filled and signed.

Proof of Identity - A copy of the insured person’s voter ID card, driving license, passport, PAN card or Aadhaar card.

Original Prescription - Medical practitioner's prescription advising drugs/diagnostic tests/consultation.

Treatment-Related Bills - Original bills with itemised break-up and payment receipts.

Discharge Summary - Discharge card from the hospital or medical practitioner.

Cancelled Cheque - To enable direct credit of the claim amount into your bank account.

Additional Documents

FIR - First Information Report in case of claims arising out of an accident.

Invoice of Implants - Stickers and invoice of implants in the case of surgery.

Legal Heir Certificate - Needed in the event of death.

Passbook or NEFT Details - Duly attested scanned copy of the first page of the passbook or NEFT statement in case the name is printed on the cheque leaf.

Post Mortem Report - If available.

Other documents as required by the insurance company to assess the claim.

Disclaimer: This list is not exhaustive. Refer to policy wordings for the complete list of documents required based on your health insurance plan.

Benefits of Reimbursement Claims in Health Insurance

Extensive Financial Protection

At IndusInd General Insurance (formerly Reliance General Insurance), our reimbursement claim facility ensures you are financially protected against various medical expenses. Whether it is inpatient treatment, daycare procedures, AYUSH treatments or pre- and post-hospitalisation expenses, you can file a reimbursement claim, and we will reimburse the incurred costs, saving you from significant out-of-pocket costs.

Backup for Cashless Claims

If your cashless claim gets denied, due to late intimation or any other policy-related conditions, IndusInd General Insurance offers the flexibility to submit a reimbursement claim. This serves as a valuable backup, allowing you to receive treatment first and complete the claim formalities at your convenience after recovery.

Easy Claim Process

Raising a reimbursement claim with IndusInd General Insurance is simple and convenient. All you need to do is fill out and sign our claim form, submit the required documents, and we will take care of the rest. This means you do not need to worry about claim approvals or paperwork during a medical emergency.

Health Insurance Reimbursement Claim: Inclusions & Exclusions

What is covered?

Inpatient Treatments - Pays for medical care and other related expenses if you are admitted to a hospital due to an illness or injury.

Pre and Post Hospitalisation Expenses - Covers treatment-related costs before and after hospitalisation.

AYUSH Treatments - Ayurveda, Yoga, Unani, Siddha and Homeopathy treatments are covered.

Daycare Procedures - Covers minor treatments not requiring long-term hospitalisation.

Ambulance Charges - If an ambulance is required during a medical emergency, we cover the resulting costs.

Domiciliary Treatments - Home care expenses (for medicines, injections, nursing services, etc.) are covered.

Rehabilitation Services - Covers costs for speech therapy, physiotherapy and occupational therapy if needed post-hospitalisation due to an accident.

What is not covered?

External Anomalies - Outpatient consultations, congenital conditions and unrelated OPD visits are not covered.

Unapproved Treatments - Treatments not approved by IRDAI or WHO, like stem cell therapy for anti-ageing, are not included.

Elective Treatments - If you undergo non-essential treatments like fertility treatments or vision correction, the costs will not be reimbursed.

Waiting Period - Claims made during the waiting period (unless due to an accident) will not be accepted.

High-Risk Events - Claims arising from war, nuclear activity or legal violations are not covered.

Wellness Treatments - Expenses for cosmetic procedures, dietary supplements and wellness therapies are excluded unless medically necessary.

Disclaimer: The inclusions and exclusions mentioned are for general reference only. Refer to the policy wordings for complete details.

Things to Know Before Opting for Reimbursement Health Insurance Claim

Reimbursement Process

Review the claim settlement process offered by the insurer. This includes checking the documents required, the time limit for notifying the insurer, the convenience of online claim submission, etc. Go for an insurer that offers an online process for faster claim settlements.

Policy Inclusions and Exclusions

Always check the policy inclusions and exclusions carefully to file the right claim. This will help you avoid filing claims for non-eligible treatments, reduce the chances of claim rejection and ensure a smoother and faster claim settlement.

Take Note of the Waiting Periods

Most health insurance plans have waiting periods during which claims cannot be made. Understanding the waiting period that is applicable to your policy will help you set the right expectations and avoid claim denials due to early claim filing.

Assess Financial Capabilities

When you opt for reimbursement, you are required to pay the medical expenses upfront before getting the financial reimbursement from the insurer. So, assess your financial situation to ensure you can afford the out-of-pocket expenses.

Check the Insurer’s Claim Settlement Ratio

18-65 An insurer's claim settlement ratio (CSR) reflects its reliability in processing claims. A high CSR indicates quick and efficient claim settlements. IndusInd General Insurance has a quick claim settlement , ensuring fast and smoother processing of your reimbursement claims.

Reasons Why Your Reimbursement Claim May Get Rejected

Hey, If the claim form has wrong or mismatched details, such as name, policy number or treatment date, the insurer may reject the claim.

Missing bills, prescriptions, diagnostic reports or payment receipts can lead to claim denial.

Informing the insurer after the stipulated time frame can result in claim rejection.

If the treatment falls under an exclusion in your policy, such as cosmetic surgery or weight loss treatments, your claim will not be accepted.

Claims made for health issues not declared at the time of policy purchase may be rejected.

Submitting forged documents or misrepresenting facts can lead to rejection and even legal action.

If the insurer concludes that the treatment was not medically necessary, the claim may not be approved.

Key Takeaways

Health insurance can be a financial lifesaver during medical emergencies, but understanding how to use it effectively is just as important. While cashless claims are preferred for their convenience, they are not always an option.

This is where IndusInd General Insurance steps in to save the day. Whether your chosen hospital rejects the cashless settlement or you prefer handling bills yourself, we have got you covered with our reimbursement facility, allowing you to raise a claim in just a few minutes.

With a quick claim settlement and the user-friendly IndusInd Insurance app, IndusInd General Insurance ensures your reimbursement claims are processed quickly and efficiently, providing you with the support you need without delay.

Because when it comes to your health, we believe in making every step as seamless as possible.

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Which is better, cashless or reimbursement?

It depends on the circumstances. Cashless claims are suitable for you if you need convenience and want to avoid upfront payments, as the insurer settles the bills directly with the hospital. On the other hand, reimbursement claims are ideal when the hospital does not accept cashless settlement or if you fail to inform the insurer within the required timeframe for a cashless claim. In such cases, you pay the medical expenses out of pocket and then raise a reimbursement claim. Both claim types offer distinct advantages and serve different needs, providing you with flexibility depending on your situation.

Is medical reimbursement exempt from income tax?

Medical reimbursements received from health insurance companies are not subject to income tax and therefore do not require any exemption. Only medical reimbursements provided by an employer to an employee may qualify for tax exemption under the Income Tax Act, subject to prescribed conditions.

How much time does it take for reimbursement?

At IndusInd General Insurance, reimbursement claims are typically processed within 30 days from the date of receiving all required documents. To avoid delays, ensure that all documents are complete and accurate.

What is the waiting period for health insurance claims?

Health insurance usually has a 30–90 day initial waiting period (unless the claim is due to an accident). Pre-existing conditions generally have a waiting period of up to 3 years, while maternity benefits may require a 1–2 year wait.

Does IndusInd General have 24/7 customer support to assist with reimbursement claims?

Yes, IndusInd General offers 24/7 customer service for all its customers. If you have any doubts or queries about a reimbursement claim, you can reach out to them.

How will I receive the reimbursement?

You will receive the applicable reimbursement for the claim settlement directly into your bank account. This is a standard practice applicable to all insurers.

Do I have to visit a network hospital for a reimbursement claim request?

No, there is no network hospital limitation applicable to health insurance claims. You can go to any hospital of your choice and get the required treatment before filing a claim.

What are the two types of insurance claims?

The two main types of insurance claims are cashless claims and reimbursement claims. In a cashless claim, the insurer pays the hospital directly for eligible expenses. In reimbursement claims, you initially pay the medical bills yourself and then submit a claim to the insurance company to get your expenses reimbursed.

How Does Reimbursement Work in Health Insurance?

You buy a health insurance plan that meets your specific coverage needs and budget. During medical emergencies, you go to the nearest hospital for treatment. Once treatment is over, you pay the medical bills. After payment is made, you collect all relevant documents and file a claim. The insurer assesses the claim to determine its approval. Upon approval, the insurer will reimburse you the applicable claim settlement amount into your bank account against your bills.

Is there a time limit for filing a health insurance claim?

Yes. For planned hospitalisation, you should inform IndusInd General Insurance’s claims team at least 48 hours before admission. In case of an emergency hospitalisation, you must notify us within 24 hours of admission.

How can I check the status of my health insurance reimbursement claim online?

IndusInd General Insurance makes it easy to track your health insurance reimbursement claim online. Simply visit the health claim status page. Enter your policy number or claim number to view real-time updates on your claim status. This convenient process ensures transparency and keeps you informed throughout your claim journey. For any additional assistance, you may contact IndusInd’s customer support team.

Can I file a reimbursement claim if my treatment does not require hospital admission?

Yes, you can file a reimbursement claim for outpatient or domiciliary treatments, diagnostic tests, and doctor fees under a health plan, even if you are not hospitalised.

Can I claim for non-medical bills?

The coverage for non-medical expenses for a reimbursement claim depends on the inclusion of your chosen policy. If the expenses you incur are included in your plan, you can file a claim. If not, you will need to cover the costs yourself.

Can I customise my reimbursement health insurance policy?

Yes, you can customise your reimbursement health insurance policy by choosing add-on covers, such as consumables cover, maternity cover, OPD cover, hospital cash cover and more. You can also choose a higher sum insured value, a higher deductible or a longer policy tenure to suit your needs.