Things to Know about Reimbursement Claims in Mediclaim

  • Author :
  • TATA AIG Team
  • Published on :
  • 11/04/2023

Unexpected medical emergencies can be hard to deal with for patients and their families. In this situation, having the right health insurance plan is essential. A medical insurance plan provides you with the financial help required for a medical emergency. You do not have to dip into your savings to pay the hospital bill. While you buy a health insurance plan, it is essential to understand the benefits of the health insurance plan and the claim settlement process of the insurer.

There are two types of claims - cashless and reimbursement claims. Under cashless claims, the hospital bill is directly settled by the insurer, and you do not have to pay at the hospital, depending on your health insurance plan. However, this is only applicable for treatment availed at a network hospital of the insurance provider. That does not mean claims from non-network hospitals aren’t settled. In the case of treatment at a non-network hospital, reimbursement claims can be filed.

Under a mediclaim reimbursement procedure, you have to pay the bill at the hospital and then provide the bills to the insurer. The insurer will then reimburse the costs, depending on the medical insurance plan that you have. To get the hospital bill reimbursed, you need to fill in the mediclaim reimbursement form and provide all the hospital bills along with any other required documents. Also, you can check the mediclaim reimbursement income tax rules to know more.

If you are wondering about the mediclaim reimbursement process, below are all the essential details that you need.

5 Mediclaim Reimbursement Rules that You Must Know

A reimbursement claim process has to be initiated if you do not go to any of the insurer's network hospitals at the time of a medical emergency. If you go to one of the network hospitals, you can opt for cashless claim settlement.

Thus, there are some basic mediclaim reimbursement rules that you need to keep in mind so that you do not face any issues at the time of claim settlement. The list of things that you need to know has been compiled for you. Below is the list of 5 medical claim reimbursement rules you must know to make the process easier.

  • Understanding the mediclaim reimbursement process

Reimbursement refers to the compensation that is paid for the money that has already been spent. When it comes to medical reimbursement meaning, it means you have to pay the bills at the hospital, and the money will be reimbursed to you by the insurer at a later date.

You have to submit all the necessary documents to get the bills reimbursed. Thus, this is one of the essential things that you need to know about the mediclaim reimbursement procedure.

  • You have to take the initiative

Unlike the cashless claim process in which the insurer settles the hospital bills directly with the hospital, under a reimbursement plan, you have to initiate the claim settlement process to reimburse all the bills.

You have to fill out the mediclaim reimbursement form and provide all the required hospital bills and documents. Also, you can follow up with the insurer if you have doubts about the reimbursement process.

Thus, here the initiative to get your money from the insurer is yours, and you need to keep all the medical bills as they have to be submitted as proof.

  • Arranging the required documents

As per the mediclaim reimbursement rules, you must have all the documents, such as hospital bills and other related paperwork, before you initiate the claim settlement process.

To get your bills reimbursed, you must keep all the documents handy and submit even the smallest proof of payment that you have. You also might have to communicate with a third-party administrator while you submit the required documents. This varies as per the policies of the insurer that you choose while you buy health insurance.

Keep photocopies of all the documents with you as the insurer might ask you to submit the original copies of all the bills and other documents.

  • Intense scrutiny

Any bills or documents you submit will be scrutinised carefully by the insurance company or the third-party administrator. This is very important for them as the claim is not a cashless one, and they are in no way directly related to the hospital.

So, they intensely check all the documents to ensure that the claim raised is genuine. Check all the bills you plan to submit to the TPA or insurance company. Ensure that all the information mentioned on the bills is accurate and truthful.

In case there is a discrepancy in the documents, the claim will get rejected.

  • Time-consuming procedure

The medical claim reimbursement process takes much more time than the cashless claim settlement process because of the verification process, as mentioned above.

Thus, you must cooperate and be patient while you interact with the TPA or the insurance company. They might also come to you with some specific queries you need to resolve.

Thus, be prepared that the process will take time, submit all the documentation accurately, and be cordial with the TPA or insurer.

Documents Required for Mediclaim Reimbursement Process

There are some essential documents that you need to initiate the mediclaim reimbursement process. Here is the list for your benefit.

  • A duly filled and signed mediclaim reimbursement form
  • A copy of your insurance policy or your policy card
  • A medical certificate that your doctor duly signs
  • All your pathological reports like X-ray
  • Original receipts and hospital bills
  • Discharge card from the hospital
  • Any pharmacy bills
  • Investigation reports(if available)
  • A copy of FIR/MLC(if there is an accident claim)
  • Credit claim settlement or NEFT details
  • KYC form duly filled if the claim amount exceeds 1 lakh

Thus, these are some essential documents that you need to have when you initiate the medical claim reimbursement process. Keep all your original documents safe so that there are no hassles when initiating the claim process.


While buying a medical insurance plan, choose the insurer wisely. A hassle-free claim process is one of the topmost requirements when buying a health insurance plan. While you buy a medical insurance plan, research the insurer, read the settlement process, ask any questions that you have, and then finally purchase the policy. Also, understand all the mediclaim reimbursement rules and cashless claim rules before you buy the plan.

With Tata AIG, you can buy health insurance online in a few simple steps. Additionally, our claims process is smooth, quick and hassle-free.

We also have a vast network of 7000+ cashless hospitals nationwide to choose from for seamless cashless claim settlement. With a claim settlement ratio of 94.21% for 2020-21, we ensure that you can focus on what is important - the health of your loved ones, while we take care of ensuring you get the best treatment possible.

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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