Guides
Guides to hospital insurance claims
10 plain guides to health insurance claims for a hospital stay in India. Each one explains a single rule or process, cites its sources, such as IRDAI circulars and insurer documents, and shows the date we last checked it. Start with the one that matches your question.
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- 🏥Cashless claim process in India, step by step, with IRDAI time limitsHow a cashless hospital claim works step by step, with IRDAI's 1-hour approval and 3-hour discharge limits from the 2024 master circular.
- 🧮Co-payment and deductible in health insurance, with worked examplesWhat co-payment and deductible mean in a health policy, how IRDAI defines each, and worked rupee examples of what you pay.
- ⚖️Health insurance claim rejected or cut in India, what to do nextWhy health claims get rejected or cut, the rights IRDAI gives you, and the steps from grievance officer to Bima Bharosa to the Ombudsman.
- 🧾Non-payable items in health insurance, the IRDAI list in plain wordsWhat IRDAI's list of non-payable items covers, its four lists explained in plain words, and where to read the full annexure yourself.
- ✍️Pre-authorisation in health insurance, what it means and what you signWhat pre-authorisation means, what the hospital desk sends, what the patient signs, and how planned, emergency and enhancement requests work.
- ✂️Proportionate deduction in health insurance, the formula and a worked exampleThe proportionate deduction formula, a worked rupee example, and the bill heads IRDAI said insurers must not scale down.
- 📥Reimbursement claim process in health insurance, documents and deadlinesHow to file a reimbursement health claim in India, the documents to keep, your deadlines, and IRDAI's 15-day limit for the insurer to settle.
- 🛏️Room rent limit in health insurance, explained with numbersWhat a room rent limit is, what no room rent limit means, and how a costlier hospital room can cut the payout on your whole bill.
- 🤝TPA and insurer in health insurance, who decides your claimWhat a TPA is, what it does in a cashless or reimbursement claim, why your insurer takes the decision, and how to find your TPA.
- ⏳Waiting periods in health insurance, pre-existing and specific diseases, IRDAI 2024 limitsWhat a waiting period means, IRDAI's 36-month caps for pre-existing and specific diseases since April 2024, and the 60-month moratorium.
Check your own policy
Send your policy on WhatsApp. A person reads it and works out what your stay would cost you before you are admitted.
A person replies, not a bot. Free for you.