A reimbursement claim allows you to recover medical expenses incurred during hospitalisation or treatment. This is applicable if you receive treatment at a non-network hospital or if your cashless claim was denied. You pay the hospital upfront and later submit the claim to the insurer for reimbursement.

Step-by-step guide to filing a reimbursement Health Insurance claim

1. Notify the insurance provider
Inform your insurance provider or Upstox (insurancesupport@rksv.in) as soon as possible after being admitted to the hospital.

2. Collect all hospital bills and documents
Ensure you collect all original medical documents and bills from the hospital. These include admission notes, prescriptions, diagnostic reports, doctor’s advice, and hospital bills.

3. Fill the claim form
Fill out the reimbursement form accurately with all required details such as your policy number, personal details, and treatment information.

4. Submit the documents to the insurance provider
Along with the filled claim form, submit all required original documents, including:

a. Discharge summary or discharge card

b. Final hospital bills and receipts

c.  Prescriptions and diagnostic reports

d.  Pharmacy bills with doctor’s prescriptions

e. Investigative reports (X-rays, scans, etc.)

f. ID proof (Aadhar, PAN, etc.)

5. Ensure you submit all documents within the insurer’s specified timeline, typically within 15-30 days of discharge.

6. Claim verification process
Once the documents are submitted, the insurer will review and verify the claim. They may request additional documents or information if necessary.

7. Claim settlement
After verification, the insurer will process your claim and approve the eligible amount based on your policy’s terms and coverage. The reimbursement amount will be credited directly to your bank account.

Important points to remember

  • Original documents: Always submit original bills, receipts, and reports to the insurer. Keep photocopies for your records.
  • Hospitalisation criteria: The treatment must meet your policy’s criteria, such as minimum hospitalisation duration (usually 24 hours) to be eligible for reimbursement.
  • Timely claim intimation: Ensure to submit the claim form and documents within 30 days from the date of discharge

Documents required for reimbursement claims

Here’s a checklist of the documents you’ll need to submit for reimbursement:

  • Duly filled and signed claim form
  • Original hospital bills, receipts, and discharge summary
  • Pharmacy bills and doctor’s prescriptions
  • Diagnostic reports (X-ray, MRI, CT scan, etc.)
  • Original investigation reports and bills
  • Consultation bills and receipts
  • Doctor’s advice for hospitalisation
  • Government-issued ID proof (Aadhar, PAN, etc.)
  • Insurance policy copy or card
  • Any other documents requested by the insurer

For any queries and assistance, reach out to the Insurance Support Team at Upstox on insurancesupport@rksv.in