Health Insurance Reimbursement Claims: Documents, Process & Timeline
Treated at a hospital not on your insurer's network? Or paid your bills and want the money back? This guide walks you through every step of the reimbursement claim process under your group health insurance policy - from collecting documents to receiving the NEFT transfer in your bank account.
What Is a Reimbursement Claim?
A reimbursement claim is a post-hospitalisation settlement where the insured employee pays the medical bills out of pocket first and then applies to the insurer for repayment. Once the TPA (Third Party Administrator) reviews and approves the submitted documents, the insurer transfers the eligible amount directly to the employee's bank account.
Unlike cashless claims which are limited to network hospitals, reimbursement can be used at any hospital in India - including non-network facilities, government hospitals, and clinics. It is also the standard route for pre and post-hospitalisation expenses such as diagnostics, follow-up consultations, and pharmacy bills.
When Should You File a Reimbursement Claim?
Reimbursement is not just for non-network hospitals. There are four situations where it is the right - or only - option available to you.
Treatment at a Non-Network Hospital
If you chose a specialist clinic, government hospital, or private facility not in your insurer's empanelled list, cashless is unavailable. Pay the bills and claim reimbursement. Check the full list of network hospitals on the insurer's website or via SecureNow before choosing a facility for planned treatment.
Emergency Admission at Nearest Available Hospital
In a life-threatening emergency, you cannot always wait to verify network status. If the nearest hospital is non-network, get the treatment done and file a reimbursement claim. IRDAI guidelines allow reimbursement for genuine emergency admissions at non-network facilities - document everything carefully.
Pre and Post-Hospitalisation Expenses
Expenses incurred before admission (diagnostics, specialist consultations) and after discharge (medicines, follow-ups, physiotherapy) are almost always settled through reimbursement. Your policy typically covers 30–60 days pre-admission and 60–90 days post-discharge. Read more in our guide on pre and post-hospitalisation cover.
Shortfall from a Partial Cashless Approval
If your cashless claim was partially approved and you paid the outstanding amount at discharge, you can file a supplementary reimbursement claim for the balance. Submit the itemised hospital bill and the partial cashless approval letter together with your reimbursement claim package.
Reimbursement Claim Process: Step by Step
A reimbursement claim involves more active participation from the employee compared to a cashless claim. Follow each step carefully to avoid delays or rejection.
Step 1: Intimate the Insurer or TPA
Even for reimbursement claims, you must notify your insurer or TPA about the hospitalisation. For emergencies, do this within 24 hours of admission. For planned cases, inform before discharge. Some policies require pre-admission intimation even when cashless is not being used. Failing to intimate on time can jeopardise your entire claim.
Step 2: Pay Hospital Bills and Collect All Originals
Pay the full hospital bill at discharge and collect every original document - itemised bills, receipts, prescriptions, diagnostic reports, discharge summary, and indoor case papers. Request an official stamp on each bill from the hospital accounts department. Originals are mandatory; photocopies alone will result in claim rejection.
Step 3: Obtain and Complete the Claim Form
Download the reimbursement claim form from your insurer's website or collect it from SecureNow. Fill in all sections accurately - insured's name, policy number, hospitalisation dates, diagnosis code, treating doctor's name, and hospital registration number. Ensure the attending doctor signs the form where required.
Step 4: Compile and Submit the Claim Package
Arrange all documents in order: claim form, hospital bills, discharge summary, prescriptions, reports, and bank details. Submit the package to your employer's HR team or directly to the TPA within the deadline (typically 30 days from discharge). Many insurers in 2026 now accept digital uploads through their claims portal, speeding up the process considerably.
Step 5: Respond to TPA Queries Promptly
After submission, the TPA may raise queries requesting additional documents such as indoor case papers, doctor's certificate, or a clarification on the diagnosis. Respond within the time frame specified in the query letter - usually 7–15 days. Delayed responses can result in claim repudiation even if all other conditions are met.
Step 6: Receive NEFT Transfer
Once the TPA approves the claim and forwards it to the insurer, the approved amount is credited directly to your registered bank account via NEFT. Standard processing is 15–30 working days from the date of complete document receipt. You will receive an SMS and email confirmation when the transfer is initiated.
Complete Document Checklist for Reimbursement Claims
Reimbursement claims require thorough documentation. Use this checklist before submitting your claim package to ensure nothing is missed. Our claims support team can help you compile and verify documents.
Always submit originals. Photocopies are accepted only if attested by the hospital or a gazetted officer. Keep photocopies of everything for your own records before submission.
Reimbursement Claim Timelines
Timing is critical in reimbursement claims. Missing a deadline - even by a single day - can lead to rejection. Here is the full timeline from discharge to payment.
Deadlines vary by insurer and policy type. Always verify the exact submission window from your policy document or by contacting SecureNow.
Why Reimbursement Claims Get Rejected - and How to Prevent It
A large share of reimbursement rejections are preventable. Knowing the common reasons helps you build a cleaner, stronger claim package from the start.
What Is Not Reimbursable Under Standard GMC Policies?
Including non-payable items in your claim is one of the most common reasons for partial rejection. Remove these from your claim before submission.
The IRDAI non-payable items list is updated periodically. Your policy schedule provides the definitive list of exclusions applicable to your GMC plan.
Key Takeaway
Reimbursement gives you the freedom to seek treatment anywhere - but it demands thorough documentation and timely submission. The two most common failure points are missing original documents and late submission. Collect everything before leaving the hospital, submit within 30 days, and respond to TPA queries without delay. If your claim is partially settled or rejected, you have the right to raise a formal grievance. Track your claim progress anytime via our claim status page. For pre-planned hospitalisation at a network hospital, consider using the cashless route instead.
Frequently Asked Questions
Answers to the most common questions about health insurance reimbursement claims in India.
A reimbursement claim is a post-hospitalisation settlement where the insured employee pays the medical bills out of pocket and then applies to the insurer for repayment. Unlike cashless claims, reimbursement can be used at any hospital - including non-network facilities. The insurer reviews submitted documents and transfers the approved amount directly to the employee's bank account.
Most group health insurance policies require reimbursement claims to be submitted within 30 days of hospital discharge. Some insurers allow up to 60 days. Late submissions may be rejected or require a written justification. Always submit as early as possible to avoid complications.
Required documents include: filled and signed claim form, original hospital bills and receipts, discharge summary, all prescriptions and pharmacy bills, diagnostic test reports, doctor's consultation notes, cancelled cheque or bank passbook for NEFT transfer, and photo ID proof of the claimant.
Once all documents are submitted and verified, most insurers process reimbursement claims within 15–30 working days. Insurers with digital claim portals often settle within 7–15 days. If the TPA raises queries or requests additional documents, the timeline resets from the date documents are received.
Common reasons include: submission after the deadline, missing original documents, treatment for excluded conditions, incomplete claim forms, non-payable items included in the bill, claim amount exceeding sum insured or sub-limits, and undisclosed pre-existing conditions.
Yes, if your group health insurance policy includes OPD coverage, you can claim reimbursement for outpatient consultations, diagnostics, and pharmacy expenses. Some corporate policies offer a cashless OPD benefit instead. Contact SecureNow to confirm what OPD expenses are reimbursable under your specific GMC plan.
Yes. If your cashless claim was partially approved and you paid the balance at discharge, you can file a supplementary reimbursement claim for that portion. Submit the discharge summary, itemised hospital bill, and the partial cashless approval letter. The insurer will review whether the deducted amount qualifies.
If your claim is rejected, the insurer must provide a written rejection reason. Review it carefully - many rejections stem from missing documents, not policy exclusions. You can file a formal grievance with the insurer within 30 days of receiving the rejection letter. If unresolved, escalate to the Insurance Ombudsman or IRDAI's Bima Bharosa portal.
Need Help Filing a Reimbursement Claim?
From document checklists to TPA follow-ups and rejection disputes - SecureNow's dedicated claims team handles it all on your behalf. Reach out today and get your reimbursement processed without delays.