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Your insurance claim checklist

Use this during your hospital visit. Check off each step as you complete it.

What type of claim are you filing?

Numbers you will need

Your TPA helpline
Check policy card
Insurer helpline
Check policy card
Hospital insurance desk
Ask at reception
IRDAI grievance
155255
Keep your policy number, TPA ID, and UHID (hospital ID) written down at all times.

Document tracker

Tap each document as you receive it. Collect originals — photocopies are not accepted for reimbursement claims.

Policy card / e-card
Photo ID (Aadhaar / PAN)
Doctor's prescription
Lab / test reports
Admission advice note
Pre-auth approval letter
Discharge summary
Final hospital bill (itemised)
Payment receipts
Pharmacy bills (stamped)
Investigation reports
Follow-up consultation bills
1. Before and at admission
Before leaving home
Locate your insurance policy card or e-card
Also note: policy number, TPA name, sum insured, and policy period.
Critical
Carry a valid photo ID (Aadhaar, PAN, Passport)
Must match the name on the policy. Carry ID for both patient and policyholder if different.
Check if the hospital is in your insurer's network
Call TPA helpline (on your policy card) or check insurer's website. This determines cashless versus reimbursement.
Ask TPA
Ask at the hospital insurance desk

"Is this hospital empanelled with [your insurer name]?"

"Where is the TPA / insurance desk?"

"What documents do you need from me right now?"

At the hospital
Get the doctor's admission advice note
This is the single most important document. Without it, no claim — cashless or reimbursement — can be initiated.
DocumentCritical
Visit the hospital's insurance / TPA desk
Submit your policy card, ID, and admission advice. They will guide you on whether cashless is available.
Inform your TPA or insurer about hospitalisation
Planned admission: 48–72 hours before. Emergency: within 24 hours of admission.
Time-sensitive
Confirm your claim path: cashless or reimbursement
The hospital insurance desk will confirm. Update your selection at the top of this checklist.
Note your UHID (hospital ID) and bed/room number
You will need this for every form and follow-up query.
2. During hospitalisation
Cashless path
Pre-authorisation process
Confirm the hospital has filed the pre-authorisation
The hospital admin files this, not you. But confirm it has been submitted — delays here delay everything.
Ask hospital desk
Check if TPA raised any queries (deficiency)
TPA may ask for additional medical reports or clarification. The hospital handles this but follow up proactively.
Get a copy of the pre-auth approval letter
Shows the sanctioned amount. Check: does it cover the estimated treatment cost? Is there a co-pay?
Document
Watch for enhancement

If the sanctioned amount is less than the estimated bill, the hospital must file an enhancement request. Ask the insurance desk: "Has the enhancement been filed?"

Reimbursement path
Payment and records
Get receipts for every payment you make
Deposit, interim bills, pharmacy — every rupee must be documented. Ask for stamped original receipts.
DocumentCritical
Keep all pharmacy and medical supply bills
Should be stamped by hospital pharmacy and match entries in your treatment chart.
During treatment (both paths)
Note treating doctor's name, department, and registration number
You will need this for the claim form. Ask the nursing station if unsure.
Keep a daily log of treatments and medications
Photograph the daily treatment chart on the patient's bed. Helps if charges are disputed later.
Collect copies of all investigation reports
X-ray, MRI, blood work. Ask the lab or nursing station. Keep photocopies for your records.
Document
3. At discharge
Do not leave the hospital without collecting every document listed below.

It is extremely difficult to get documents from hospitals after discharge.

Mandatory documents
Collect the discharge summary
Signed by the treating doctor. Must include: diagnosis, treatment given, medications prescribed, follow-up instructions.
DocumentCritical
Get the final itemised hospital bill
Not just the total — an itemised bill showing room charges, doctor fees, investigations, pharmacy, consumables.
DocumentCritical
Verify any deductions or co-pay amounts
For cashless: hospital will tell you the balance to pay. Ask for a written breakup of non-covered items, co-pay, sub-limit excess.
Collect all original investigation reports
Lab reports, imaging, histopathology — ask each department individually. They may not volunteer these.
Document
Collect all original payment receipts
Including advance deposits, interim payments, and final settlement. Stamped originals only.
Document
Photograph every document before leaving
Clear photos of every original. This is your backup if anything gets lost in the claim process.
Ask before you leave

"Is there any balance I need to pay?"

"Can I get the itemised breakup of deductions?"

"Have all insurance formalities been completed from the hospital side?"

4. After discharge
Reimbursement deadline.

You must submit your claim with all original documents to your TPA or insurer within 15–30 days of discharge. Check your policy for the exact deadline.

Claim submission (reimbursement)
Fill the reimbursement claim form
Download from your insurer's or TPA's website. Fill every field — incomplete forms get rejected.
Document
Submit all original documents to TPA or insurer
Send via registered post or courier (keep tracking number). Some TPAs accept walk-in submissions.
Time-sensitiveCritical
Post-hospitalisation (both paths)
Keep all follow-up consultation bills
Follow-up visits within 60–90 days post-discharge (check your policy) are covered. Keep prescriptions and bills.
Document
Keep all post-discharge pharmacy bills
Medicines prescribed in the discharge summary are claimable. Keep bills and the corresponding prescription.
Respond to any TPA queries promptly
If TPA sends a deficiency letter, respond within the stated deadline. Missing this can result in claim rejection.
Time-sensitive
Track your claim status
Call TPA helpline weekly. Note claim reference number, status, and any pending actions.
If your claim is rejected or short-settled

"Can I get the rejection or deduction reasons in writing?"

"What is the grievance redressal process?"

Escalation path: TPA → Insurer → IRDAI (155255) → Insurance Ombudsman