Claim guide

Every paper a health insurance claim needs

A missing paper is the most common reason a claim gets stuck in India. Here is the full list, and the two that go missing most often.

The main list

Almost every claim needs these:

• Claim form, Part A and Part B. Part A is yours to sign. Part B needs the hospital's sign and stamp.
• Itemised final bill. Every charge listed line by line, not one total.
• Discharge summary, signed by the doctor.
• Payment receipts. The bill says what you owe. The receipt proves you paid. Both are needed.
• Pharmacy bills with the medicine names and prices.
• Lab and test reports.
• KYC papers for the patient and the policy holder.
• Insurance or TPA card.
• Bank details for the money to come back to you.

The two people forget

Pharmacy bills

Medicines get bought over many days, by different family members. So the bills get lost. Ask the hospital pharmacy for copies before you leave. It is much easier at the counter than on the phone three weeks later.

Payment receipts

People send the bill and think that is enough. It is not. Send the receipts too, including the advance you paid at admission.

Extra papers, only for some claims

• Accident or injury: FIR or MLC copy.
• Implant, stent or lens: the invoice and the barcode sticker.
• Surgery: OT notes.
• Maternity: scan reports and the doctor's notes.
• Biopsy: the histopathology report.
• Death claim: death summary and death certificate.

Two things to check yourself

Do the dates match? Compare the admission and discharge dates on the claim form, the bill and the discharge summary. Two different dates for one stay causes a question almost every time.

Is every page there? A summary that says "page 1 of 3" with pages 2 and 3 missing counts as incomplete.