Claim help — the part insurers don't make easy
Step-by-step what to do, who to call, and what to carry — for cashless and reimbursement claims, plus the IRDAI Ombudsman directory if the insurer says no and the grievance escalation channels.
IRDAI grievance
Bima Bharosa portal →
Official IRDAI complaint channel against any registered insurer.
Escalate further
Insurance Ombudsman →
12 zones across India. Free, statutory grievance redressal.
Regulator
IRDAI homepage →
Official source for all insurer registration & compliance data.
Document checklist by claim type
Print this. Take it to the hospital.
planned
Planned hospitalisation (cashless or reimbursement)
Before admission
- ▸Confirm the hospital is on your insurer's PPN / network list (use the hospital-locator URL on your policy or call the TPA helpline).
- ▸Intimate the insurer at least 48-72 hours before admission via the toll-free helpline or app.
- ▸Carry your health-card / e-card, a government ID and the policy schedule (PDF on phone is fine).
During admission
- ▸Show your health card at the cashless desk; they generate the pre-authorisation form.
- ▸Treating doctor fills the clinical section (diagnosis, line of treatment, expected length of stay, estimate).
- ▸TPA processes the pre-auth — typical SLA 2-4 hours for planned cases.
Documents to keep (originals)
- ✓Pre-authorisation form (provided by the hospital cashless desk)
- ✓Policy schedule (first page of your policy PDF)
- ✓Photo ID (Aadhaar / passport / driving licence)
- ✓Doctor's referral / consultation notes
- ✓Past medical records relevant to the admission
At the cashless desk — say this
“Hi, I'm here for a planned admission tomorrow under [insurer name + policy number]. Please raise the pre-authorisation with [TPA name]. The treating consultant is Dr. [name]. Here is my e-card, ID, and a copy of the policy schedule.”
emergency
Emergency hospitalisation
Before admission
- ▸Get the patient to the nearest hospital first — emergency claims are processed even at non-network hospitals (you'll just pay first and reimburse).
- ▸Call the insurer / TPA helpline within 24 hours of admission to intimate the claim.
During admission
- ▸If the hospital is in network: cashless desk raises emergency pre-auth (TPA SLA is faster, ~1-2 hours).
- ▸If non-network: keep ALL originals — bills, prescriptions, investigation reports — for reimbursement.
- ▸Get the discharge summary signed by the treating consultant.
Documents to keep (originals)
- ✓Filled claim form (insurer-specific; download from their site)
- ✓Discharge summary (must mention diagnosis, line of treatment, dates)
- ✓Final bill (itemised; UTR for any deposit/refund)
- ✓Investigation reports + radiology films
- ✓Doctor prescriptions / pharmacy bills
- ✓Photo ID + policy schedule
- ✓Cancelled cheque for NEFT settlement
At the cashless desk — say this
“This is an emergency admission under policy [number] with [insurer]. Please intimate [TPA] for emergency pre-authorisation. I will keep the original discharge summary and final bill for the reimbursement claim if cashless is denied.”
day care
Day-care procedure (cataract, dialysis, chemo, etc.)
Before admission
- ▸Confirm the procedure is on the policy's day-care annexure — anything outside the list usually needs a 24-hour admission to qualify.
- ▸Pre-authorise at least 24 hours in advance for predictable day-care (cataract, knee scopy).
During admission
- ▸Cashless desk raises day-care pre-auth; same flow as planned admission but typically same-day.
- ▸Pick up the day-care discharge summary — it must explicitly say 'day-care procedure' and the procedure code (PPN/IRDAI list).
Documents to keep (originals)
- ✓Day-care discharge summary (with procedure name + code)
- ✓Itemised bill
- ✓Pre/post operative consultation notes
- ✓Investigation reports
- ✓Photo ID + policy schedule
opd
OPD claim (only if your policy has an OPD rider)
Before admission
- ▸Confirm OPD is included in your policy — most base health plans exclude OPD unless a rider is added.
- ▸Note the OPD sub-limit (often capped per consultation and per year).
During admission
- ▸Pay at the consultation / pharmacy desk; keep every bill and prescription.
- ▸Submit reimbursement online via the insurer app OR email a scan to claims@<insurer>.in within the policy's OPD claim window.
Documents to keep (originals)
- ✓Original doctor consultation receipt with the doctor's registration number
- ✓Original prescription
- ✓Pharmacy / lab bills matching the prescription line items
- ✓Filled OPD claim form
- ✓Photo ID + policy schedule
TPA helpline directory
TPAs (Third-Party Administrators) authorise cashless at the hospital desk and process reimbursement. Your insurer's e-card tells you which TPA you're assigned to — call that one first.
MDIndia
MDIndia Health Insurance TPA Pvt. Ltd.
Helpline: 1800-209-1101
Email: customerservice@mdindia.com
Site: www.mdindiaonline.com
Largest TPA by hospital network; handles PSU + private insurer cashless across India.
Medi Assist
Medi Assist Insurance TPA Pvt. Ltd.
Helpline: 1800-425-9449
Email: contact@mediassist.in
Site: www.mediassist.in
Strong corporate-policy footprint; portal & mobile app for live pre-auth tracking.
Vidal Health
Vidal Health Insurance TPA Pvt. Ltd.
Helpline: 1800-425-7878
Email: tpa@vidalhealth.com
Site: www.vidalhealth.com
Common across SBI General, Reliance, and IFFCO Tokio empanelment.
Family Health Plan (FHPL)
Family Health Plan Insurance TPA Ltd.
Helpline: 1800-425-4033
Email: customercare@fhpl.net
Site: www.fhpl.net
Hyderabad-headquartered; widely used for state-government schemes (Aarogyasri).
Paramount Health
Paramount Health Services & Insurance TPA Pvt. Ltd.
Helpline: 1800-225-557
Email: info@paramounttpa.com
Site: www.paramounttpa.com
Mumbai-headquartered; common with United India, New India, Oriental policies.
Insurance Ombudsman — 12 zonal offices
File with the Ombudsman zone that covers the state where the policy was issued. The process is free, time-bound (3 months target), and decisions are binding on the insurer up to ₹50 lakh.
Sitting ombudsman names rotate — always confirm via the live CIO directory before posting documents.
Ahmedabad
Jurisdiction: Gujarat, Dadra & Nagar Haveli, Daman & Diu
Office of the Insurance Ombudsman, 6th Floor, Jeevan Prakash Bldg., Tilak Marg, Relief Road, Ahmedabad – 380001
Email: bimalokpal.ahmedabad@cioins.co.in
Phone: 079-25501201/02/05/06
Bengaluru
Jurisdiction: Karnataka
Office of the Insurance Ombudsman, Jeevan Soudha Bldg., 19/19, 24th Main Road, JP Nagar 1st Phase, Bengaluru – 560078
Email: bimalokpal.bengaluru@cioins.co.in
Phone: 080-26652048 / 26652049
Bhopal
Jurisdiction: Madhya Pradesh, Chhattisgarh
Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal – 462003
Email: bimalokpal.bhopal@cioins.co.in
Phone: 0755-2769201 / 2769202
Bhubaneswar
Jurisdiction: Odisha
Office of the Insurance Ombudsman, 62, Forest Park, Bhubaneswar – 751009
Email: bimalokpal.bhubaneswar@cioins.co.in
Phone: 0674-2596461 / 2596455
Chandigarh
Jurisdiction: Punjab, Haryana (except Gurugram, Faridabad, Sonepat, Bahadurgarh), Himachal Pradesh, Union Territories J&K, Ladakh & Chandigarh
Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D, Chandigarh – 160017
Email: bimalokpal.chandigarh@cioins.co.in
Phone: 0172-2706468
Chennai
Jurisdiction: Tamil Nadu, Tamil Nadu Pondicherry, Pondicherry Town and Karaikal (which are part of UT of Puducherry)
Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai – 600018
Email: bimalokpal.chennai@cioins.co.in
Phone: 044-24333668 / 24335284
Delhi
Jurisdiction: Delhi & following districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh
Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110002
Email: bimalokpal.delhi@cioins.co.in
Phone: 011-23232481 / 23213504
Guwahati
Jurisdiction: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura
Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001 (Assam)
Email: bimalokpal.guwahati@cioins.co.in
Phone: 0361-2632204 / 2602205
Hyderabad
Jurisdiction: Andhra Pradesh, Telangana, Yanam and part of UT of Puducherry
Office of the Insurance Ombudsman, 6-2-46, 1st floor, 'Moin Court', Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad – 500004
Email: bimalokpal.hyderabad@cioins.co.in
Phone: 040-23312122
Jaipur
Jurisdiction: Rajasthan
Office of the Insurance Ombudsman, Jeevan Nidhi-II Bldg., Ground Floor, Bhawani Singh Marg, Jaipur – 302005
Email: bimalokpal.jaipur@cioins.co.in
Phone: 0141-2740363
Kochi
Jurisdiction: Kerala, Lakshadweep, Mahe – a part of UT of Puducherry
Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M. G. Road, Ernakulam – 682015
Email: bimalokpal.ernakulam@cioins.co.in
Phone: 0484-2358759 / 2359338
Kolkata
Jurisdiction: West Bengal, Sikkim, Andaman & Nicobar Islands
Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 4th Floor, 4, C.R. Avenue, Kolkata – 700072
Email: bimalokpal.kolkata@cioins.co.in
Phone: 033-22124339 / 22124346
Lucknow
Jurisdiction: Districts of Uttar Pradesh + the 24 districts assigned to Lucknow zone (see CIO directory)
Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow – 226001
Email: bimalokpal.lucknow@cioins.co.in
Phone: 0522-2231330 / 2231331
Mumbai
Jurisdiction: Goa, Mumbai Metropolitan Region (excluding Navi Mumbai & Thane)
Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz (W), Mumbai – 400054
Email: bimalokpal.mumbai@cioins.co.in
Phone: 022-69038821 / 69038825
Noida
Jurisdiction: State of Uttaranchal and the following Districts of Uttar Pradesh (see CIO directory)
Office of the Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P – 201301
Email: bimalokpal.noida@cioins.co.in
Phone: 0120-2514252 / 2514253
Patna
Jurisdiction: Bihar, Jharkhand
Office of the Insurance Ombudsman, 1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna – 800006
Email: bimalokpal.patna@cioins.co.in
Phone: 0612-2680952 / 2680042
Pune
Jurisdiction: Maharashtra, Area of Navi Mumbai and Thane (excluding Mumbai Metropolitan Region)
Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411030
Email: bimalokpal.pune@cioins.co.in
Phone: 020-41312555
PolicyPlain is not your insurer
We don't process claims, file complaints on your behalf, or receive payment from any insurer / TPA / ombudsman. The directory above is curated from public IRDAI sources so you can act directly — fastest path, no middleman.