Treated at a non-network hospital, or paid yourself? When to tell the insurer, the documents to send, the deadlines, and how to claim the balance from a second policy.
How to file a reimbursement health claim
In a reimbursement claim, you pay the hospital and the insurer pays you back. You need it at a non-network hospital, when cashless is not approved, and for bills before and after the hospital stay. The steps below use the timelines in Narayana Arya's wording. Most current wordings are similar, but check your own.
1. Tell the insurer in time
- Emergency: within 24 hours of admission, or before discharge, whichever is earlier.
- Planned: at least 48 hours before admission.
Some plans charge a co-pay for late notice at certain hospitals, so do not skip this step.
2. Collect the documents
- Completed claim form and the patient's photo ID.
- The doctor's prescription advising admission.
- Original bills with an itemised break-up, and payment receipts.
- Discharge summary with the full medical history.
- Test reports, with the doctor's prescription for them.
- OT notes or the surgeon's certificate, for surgery.
- Implant stickers or invoices, if any.
- MLC and FIR copies, for accidents where they exist.
- Bank details and a cancelled cheque.
- KYC of the proposer, for claims above ₹1 lakh.
Bills must be in the patient's name. Ask the hospital for itemised bills before you leave; a single total is the most common cause of delay.
3. Submit before the deadline
- Hospital stay and pre-hospital bills: within 30 days of discharge.
- Post-hospital bills: within 15 days of finishing post-hospital treatment.
A delay can be accepted if it was for reasons beyond your control, but do not rely on that.
4. How long the insurer has
Narayana Arya must settle or reject within 15 days of the last document; some older wordings say 30 days. If the insurer investigates, it must finish within 30 days and settle within 45. For a late payment, it pays interest at 2% above the bank rate.
5. Claim the balance from a second policy
If you have two policies, say a company policy and your own, the standard Multiple Policies clause lets you:
- choose which policy to claim from first;
- claim the amount disallowed by one policy from the other;
- claim the balance from the second insurer when a bill is more than one policy's sum insured.
Send the second insurer copies of the documents along with the first insurer's settlement letter, certified by the first insurer.
6. Read the settlement letter
Check each deduction against your policy: non-payable items, room rent limits, co-pays and sub-limits. If a deduction does not match the wording, ask in writing for the clause. See how to complain.
Frequently asked questions
How do I claim health insurance after discharge?
File a reimbursement claim. Send the claim form, bills, discharge summary and reports, usually within 30 days of discharge. Post-hospital bills usually go within 15 days of finishing that treatment.
How long does a reimbursement claim take?
Current wordings such as Narayana Arya require settlement within 15 days of the last document, or 45 days if investigated. Some older wordings say 30 days.
Can I claim the disallowed amount from another policy?
Yes. The standard Multiple Policies clause lets you claim amounts disallowed by one policy, or the balance above its sum insured, from your other policy.