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Cashless Claims

The high medical costs and exponential medical inflation in India underline the importance of Cashless health insurance policies. In the event of a medical emergency, one may need more time to arrange the finances to cover the medical expenses. However, under a Cashless claim, the insurance provider and the hospital will work together to settle your medical bills as per your insurance coverage.

What is a Cashless Claim in Health Insurance?

A cashless claim in health insurance is a type of claim you file under your policy when you are hospitalised for need of medical attention. In a cashless claim, your Insurance company/ TPA and the hospital will coordinate and settle the bill based on your policy coverage.

Moreover, a cashless claim can only be filed if you choose to receive treatment at an associated network hospital.

What are the benefits of Cashless Claims?

  • Filing a cashless claim can be a convenient process wherein your insurance provider and the network hospital will settle your medical bills as per your policy coverage.
    • When you purchase a health insurance policy and want to file a cashless claim, your policy enables you to access any of the network hospitals as listed under the insurance policy and avail of cashless treatment.

    • your insurance provider and the hospital will not require any extensive documentation from your end. You need to inform your Insurer authorized TPA for any cashless assistance.

    • A health insurance policy ensures that in the event of a planned or emergency medical treatment, you need not incur the cost of treatment when accessing quality healthcare.

    • If you do not have immediate access to cash, your cashless policy pays for your treatment at any of the network hospitals listed under your health insurance policy.

    • You and your family can have peace of mind during your treatment since the insurer and the hospital will take care of the cashless claim settlement process.

    • You can save the time and effort required to gather funds for your treatment if you have a cashless policy. You need to inform your insurer, and the cashless claim will be filed.

How to Initiate a Cashless Claim with Tata AIA?

  • 01.

    Look for the nearest network hospitals and inform your authorized TPA about your hospitalisation. If it is a planned admission, notify them 2 days in advance and, in case of emergencies, within 24 hours of being admitted to the hospital.

  • 02.

    Show the network hospital your valid ID proof and the TPA E-health card at the hospital Insurance/TPA help desk for further process.

  • 03.

    Hospital will provide the Cashless claim form for initiation of cashless claims. You can also download the claim form from TPA website.

  • 04.

    Hospital will share the duly filled cashless authorization form and send the request to the authorized TPA for authorisation.

  • 05.

    After the pre-authorisation is approved from Insurance Company /TPA, ensure that the hospitalisation takes place within 15 days of receiving approval from the helpdesk.

Documents Required for Cashless Claim

Below is the indicative list

  • Duly Filled and Signed Cashless Claim form

  • Discharge Summary

  • Medical Records (Optional Documents may be asked on need basis: Indoor case papers, OT notes etc.)

  • Hospital Main Bill

  • Hospital Main Bill with breakup

  • Pharmacy Bills with Prescriptions (except hospital supply)

  • Consultation & Investigation Papers

  • Digital Images/CDs of the Investigation Procedures (if required)

  • KYC (Photo ID Card) Bank Details with Cancelled Cheque

There are some more documents that will be needed only in specific cases, such as:

  • In case of an accident or involvement of police- MLC/FIR Report

  • In case of death or disability- Post Mortem Report, Death Certificate or Disability Certificate Invoice/Sticker (If applicable)

  • Attending Physician Certificate (If applicable)


  • What are the Common Reasons for Health Insurance Claim Rejection?

     These are some of the main claim rejection reasons that you should be aware of while filing a cashless claim:

    Claims During the Waiting Period

    There may be a waiting period for certain risks and diseases covered under the policy. During this waiting period, if you are affected by any such condition or disease, you cannot file a successful cashless claim till the period is over.

    Claims on Exclusions

    Your insurance policy will have a list of exclusions or risks, diseases and illnesses not covered under the plan. Hence, you cannot file a cashless claim to get treatment for any of the excluded diseases.

    Withholding Information

    If you have a pre-existing medical condition or a medical history, be sure to inform your insurance provider. Withholding this information can be risky for you as your insurance plan may not cover some illnesses and conditions.

    Giving False Information

    Mentioning wrong information regarding your or your family’s medical history, age, or income details for lower premium benefits can also get your cashless claim rejected. Your insurer can also choose to terminate your coverage.

    Lapsed Policy

    A lapsed, expired, or invalid policy is a major cause of health insurance claim rejection. If your policy coverage is inactive your claim can be rejected.

How to Avoid Health Insurance Claims Rejection?

These are some important tips through which you can avoid a health insurance claim rejection:

  • If you are suffering from a pre-existing illness or condition, be sure to mention this to your insurance provider before purchasing the policy. That way, if you need to be hospitalised or treated due to your condition, the insurer can ensure you receive adequate coverage.

  • Inform your insurer if you are being admitted to the hospital for a planned or emergency treatment. The cashless claim procedure starts soon after your insurer has been informed, which helps them settle your cashless claim as required without any hassles or delays.

  • Get your treatment or hospitalisation only at a network hospital. Only the cashless hospitals under your insurance provider can offer cashless claim benefits. If you are treated at any other hospital, you will not be able to file a cashless claim for the same.

  • Your policy document has all the details of the health insurance claim and policy coverages, Waiting period, General Exclusions. As soon as you get this document and before you file a claim, read all the terms and conditions carefully to avoid rejection of claims.

  • Ensure all documents are in place while filing the claim. Although Tata AIA does not require extensive documentation for a cashless claim, a list of essential and correct documents must be submitted so that your claim can be settled on time and without any issues.

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Frequently Asked Questions

What is Cashless Health Insurance?

Cashless insurance is a type of health insurance that does not require you to pay any cash for your medical bills. Instead, your insurance provider and third-party administrator will coordinate with the network hospital to settle the medical bills.

Cashless health insurance is unlike reimbursement health insurance, wherein you first pay the hospital bills after your treatment and then get the amount reimbursed by your insurance provider. Cashless health insurance plans can be convenient for people with health conditions who need medical treatment regularly. It can also be useful during sudden medical emergencies where one may not have the time and resources to arrange for and pay a huge medical bill in one go.

Are cashless treatments available at any hospital?

No, It is only available at our network hospitals only.

When is a cashless health insurance policy necessary?

A cashless health plan is necessary if you want to avoid paying the hospital and treatment bills from your own pocket. Most people may not have immediate access to the money required to pay for their medical costs in a single instalment. If you get cashless treatment at a network hospital as listed under your policy, your insurance provider will settle the bills with the hospital as per the policy coverage limit.

Does cashless health insurance offer any tax benefits?

Yes, your cashless health insurance offers tax deductions on the policy premiums paid under Section 80D of the Income Tax Act. You can claim these benefits each year when filing your tax returns.

My cashless claim got rejected. What could be the possible reasons for the same?

The following reasons can get your cashless claim rejected if:

  • You have not availed of treatment at a network hospital.

  • The treatment/procedure is not covered under your policy like general exclusions, waiting period, Pre Existing or Non-disclosure of material information

  • You submit incorrect or inadequate documentation.

Does cashless health insurance have any exclusions?

Yes, when availing of cashless health insurance, always read the list of exclusions under the policy. This list contains all the diseases, illnesses and conditions that are not covered under your insurance policy. Hence, when you file a cashless claim for a disease/condition listed under the exclusions, your claim can be rejected.

It is also essential to know that you can only file a cashless claim when you avail of treatment/hospitalisation/medical attention at a network hospital with which your insurance provider has a tie-up.



  • Insurance cover is available under the product.

  • The products are underwritten by Tata AIA Life Insurance Company Ltd.

  • The plans are not a guaranteed issuance plan, and it will be subject to Company’s underwriting and acceptance.

  • For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding a sale.

  • Every effort is made to ensure that all information contained in this document is accurate at the date of publication, however, the Tata AIA Life shall not have any liability for any damages of any kind (including but not limited to errors and omissions) whatsoever relating to this material. 

  • L&C/Advt/2023/Jun/1892


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