# Health Insurance Claim Process: Cashless vs Reimbursement

> How health insurance claims work in India, the difference between cashless and reimbursement, the documents you need, and why claims get rejected.
- **Published**: 2026-08-16
- **Modified**: 2026-10-18
- **Category**: health-insurance
- **URL**: https://www.tldr.money/articles/health-insurance/health-insurance-claim-process

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Use this alongside the full [health insurance in India](/health-insurance) guide. If you are still shortlisting, the [best health insurance plans](/articles/health-insurance/best-health-insurance-plans-india) and the [buying checklist](/articles/health-insurance/health-insurance-checklist) cover what to check before a claim ever happens.

## The two ways a claim is settled

Health insurance in India pays out in one of two ways. **Cashless** means the insurer settles the approved bill directly with a network hospital, so you pay only what is not covered. **Reimbursement** means you pay the hospital yourself, then file for the insurer to pay you back. The cover is the same; only the cash flow and paperwork differ. For a side-by-side comparison, including cashless at hospitals outside the network, see [cashless vs reimbursement](/articles/health-insurance/cashless-vs-reimbursement).

## Cashless claims

Cashless is smoother because the hospital's insurance desk coordinates with the insurer.

1. Choose a network hospital. Confirm it is on your insurer's cashless list before admission.
2. Show your health card or policy details at the insurance desk.
3. The hospital sends a pre-authorisation request to the insurer.
4. The insurer approves an amount. IRDAI's May 2024 health master circular requires a decision within one hour of the request, and final discharge approval within three hours.
5. At discharge, you pay only the non-covered items, and the insurer settles the rest.

For planned procedures, request pre-authorisation 2 to 3 days in advance. For emergencies, hospitals usually accept you first and file within 24 hours.

## Reimbursement claims

Use reimbursement when you are treated at a non-network hospital that does not offer cashless, or cashless was declined.

1. Pay the hospital and collect every original document.
2. Submit the claim form, discharge summary, bills, prescriptions, and reports within the insurer's window.
3. The insurer reviews and pays the approved amount to your bank account. IRDAI requires claims other than cashless to be settled within 15 days of submission, with interest at bank rate plus 2% if the insurer is late.

Keep copies of everything. Missing or inconsistent documents are the most common reason a reimbursement is delayed.

## Documents you will need

- Filled and signed claim form
- Discharge summary
- Itemised hospital bills and payment receipts
- Doctor prescriptions and diagnostic reports
- Policy or health card details and ID proof
- Bank details for reimbursement

## Why claims get reduced or rejected

- **Room-rent cap breach.** Choosing a room above your eligible category can trigger proportionate deductions on linked charges such as doctor and nursing fees. See [room rent and proportionate deduction](/articles/health-insurance/room-rent-capping-proportionate-deduction).
- **Waiting periods.** Pre-existing diseases and specific illnesses have waiting periods; claims inside them are declined.
- **Non-disclosure.** Undisclosed medical history is one of the most common causes of rejection in the first five years of cover.
- **Exclusions and sub-limits.** Consumables, cosmetic treatment, and capped procedures may be partly or fully excluded.

If your claim is rejected or cut, our guide to [claim rejection reasons and how to appeal](/articles/health-insurance/health-insurance-claim-rejection-reasons) covers the rules insurers must follow and how to escalate.

## Before you need to claim

Confirm your preferred hospitals are cashless, understand your room eligibility, and keep your policy and disclosures accurate. Compare insurers on the [all health insurance companies](/health-insurance/insurers) page, and align premium payments with your [tax planning](/tax-planning) to use the Section 80D deduction.

When comparing insurers, look beyond the headline ratio to how much of each claim is actually paid; see [claim settlement ratio vs amount settled](/articles/health-insurance/top-claim-settlement-ratio-companies).
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