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Health insurance Reimbursement claim

“A reimbursement claim in health insurance ensures that financial support follows medical care—pay first, claim later, and let your policy take care of the rest..”

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What is a Reimbursement Claim

A reimbursement claim in health insurance is a process where the policyholder pays for medical expenses out of pocket and later claims from us. Unlike a cashless claim, the Policyholder/Insured must initially bear the costs and then submit the necessary documents to get reimbursed.

How it works:

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    Treatment at any Hospital – The Policyholder/Insured can get treatment at any hospital, whether in Galaxy Health Insurance network or not.

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    Pay Medical Bills – The Policyholder/Insured must settle the hospital bills, including doctor’s fees, medicines, and other charges.

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    Collect Documents – Gather essential documents such as hospital bills, discharge summary, prescriptions, and diagnostic reports.

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    Submit the Claim – Send the required documents to Galaxy Health Insurance within 15 days from the date of discharge.

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    Claim Review – Galaxy Health Insurance verifies the documents, checks policy coverage, and assesses claim eligibility.

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    Approval & Reimbursement – If approved, Galaxy Health Insurance transfers the eligible amount to the Policyholder/Insured bank account.

Reimbursement Claim Process

1

Intimation

Claim intimation via toll free no. or Email to be given within 24hrs of hospitalization or before discharge

2

Initiating

Policyholder/Insured taken treatment and paid the hospitalization bill

3

Submission

Submission of the original claim documents to nearest Galaxy Health Office within 15 days of discharge

4

Scan/Upload

Scanning and uploading of the claim documents

5

Claim Processing

Claim processing as per policy terms and conditions

6

Decision

Approval / Query / Rejection

Reimbursement Claim Process in Health Insurance

Steps Process

1

The Policyholder/Insured member can receive treatment at a network or non-network hospital

2

The Policyholder/ Insured shall notify Galaxy Health Insurance Customer Care team about the hospitalisation details via call or email

3

The Policyholder/Insured shall pay upfront for the expenses incurred during the hospitalisation

4

Policyholder/Insured shall submit documents in original pertaining to the hospitalisation along with the duly signed claim form to the nearest Galaxy Health Insurance office or agent

5

Galaxy Health Insurance shall provide an acknowledgement to the Policyholder/Insured upon receipt of the claim documents

6

Galaxy Health Insurance Claims team shall evaluate the claim based on the policy terms and conditions

7

If the claim is admissible, Galaxy Health Insurance will process the claim and the reimbursement of hospitalisation expenses. The approved claim amount will be credited to the Proposer's account

8

If the claim is not admissible, the reason(s) for rejection of the claim will be communicated to the Policyholder/Insured

9

If any additional information or records are needed, Policyholder/Insured may submit these documents to the nearest Galaxy Health Insurance office or agent

10

The Policyholder/Insured shall be informed of the claim status at every stage through SMS / email

Documents to be submitted for Reimbursement

The reimbursement claim is to be supported with the following documents in original and submitted within 15 days from the date of discharge

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Duly filled in claim form with treating doctor’s signature

Pre/Post Hospitalisation investigations and treatment papers

All investigations reports including Radiological films (Xray, CT scan, MRI and USG) and Biopsy reports pertaining to the hospitalisation

Discharge Summary from the hospital

Cash receipts from hospital, chemists

Cash receipts and reports for tests done

Receipts from doctors, surgeons, anaesthetist

Certificate from the attending doctor regarding the diagnosis

KYC (Identity proof and Address proof) of the proposer, as per Anti Money Laundering Guidelines

Copy of PAN Card

CKYC No. of the proposer (if available)

NEFT documents viz., Customer name, Bank Account No., Name of the Bank, IFSC code

Legal heir/succession certificate, wherever applicable

Ensure all documents are properly organized and submitted within the insurer's specified timeframe to avoid delays or rejection

Disclaimer

The content provided on this website is for informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any insurance products. Health insurance policies and plans are subject to underwriting and approval by Galaxy Health Insurance. The terms, conditions, exclusions, and benefits of each policy may vary based on disclosure by the prospect and plan selected.

For more details on terms and conditions please read the sales brochure carefully.