A 5-Step Guide to the Claims Process
From the first call to final settlement, your Advisor helps you understand what the insurer needs, gather documents and follow up, so you can focus on your family. Claim decisions are made by the insurer.
Inform & Get Started
Call or message your Advisor, and inform your insurer or TPA as your policy requires. Keep the policy number and ID ready.
Cashless Request
At a network hospital, the hospital sends a cashless request to the insurer or TPA. IRDAI's 2024 guidelines expect a decision on the request within one hour.
Stay in Touch During Treatment
Your Advisor can help you keep track of interim bills against your sum insured and room rent limits, so there are fewer surprises at discharge.
Bill & Document Review
Your Advisor helps you read the final bill and the insurer's queries, so you understand which items are payable and which are not.
Discharge & Reimbursement
For cashless claims the insurer settles eligible amounts with the hospital. For reimbursement, your Advisor helps you organise bills and reports to submit within the time in your policy.
Support when you need it.
We help you understand the process, prepare the right documents and follow up with the insurer.
When a family member is in hospital, you need clarity.
Hospitalisation is stressful enough without having to decode room rent limits, co-payments and TPA queries on your own. Your Distroo Advisor helps you understand what the policy says, what documents are needed and what the next step is. The insurer makes the claim decision, and we do not promise any outcome.
Key Advantages
- Cashless Guidance at Network Hospitals
- Bill Review Against Policy Terms
- Escalation Guidance
Intimation, cashless request or reimbursement, documents, insurer assessment, and settlement or resolution of queries.
In Hospital Right Now?
Admit the patient first. Then inform your insurer or TPA and call your Advisor. The hospital's insurance desk can send the cashless request.
File a Reimbursement Claim
Paid the hospital yourself? We help you organise bills and reports for a reimbursement claim and follow up with the insurer.
Documents Required for Claims
Select the claim type to see commonly required documents. Your insurer's checklist is the final word.
Health Card & Policy Number
Your insurer or TPA health card, or the policy number and member ID.
Government Photo ID
Aadhaar card, driving licence or other photo ID of the patient.
Doctor Consultation Note & Prescription
The doctor's note advising admission or the planned procedure.
Pre-Admission Diagnostic Reports
Lab, imaging or pathology reports supporting the diagnosis.
Signed Pre-Authorization Form
The cashless pre-authorisation form completed at the hospital's insurance desk.
Original Hospital Discharge Summary
A discharge summary with the diagnosis and the treatment given.
Original Itemised Bills & Receipts
Hospital bill with pharmacy, room rent and procedure charges, with payment receipts.
Investigation & Procedure Records
Case papers, operation notes and test reports, as the insurer asks.
Cancelled Cheque Leaf
Bank proof with the account holder's name printed, for direct reimbursement.
Pre & Post Hospitalization Bills
Consultation, test and pharmacy bills for the pre- and post-hospitalisation period stated in your policy.
Keep the original bills safe until your claim is settled.
What to do when a claim arises.
The first four steps:
Call your Advisor early
Let us know so that we can guide you and help with documents.
Carry your health card
Show it at the network hospital's insurance desk to start the cashless request.
Check the room category
Confirm that the room matches your policy limit to avoid proportionate deductions.
Read the discharge bill
Review the bill before you sign. Ask about any item you do not understand.
Claims Help Across Every Protection Line
Guidance for Health, Life, Motor and SME policies from partner insurers.
Health Insurance Claims
Cashless requests, planned day-care procedures, reimbursement documents and pre- and post-hospitalisation bills.
- Cashless process explained
- Bill and clause review
- Room rent limit explained
Life & Critical Illness Claims
Guidance for nominees on death claim documents, and for critical illness claims on diagnosis proof, waiting and survival periods.
- Document checklist for nominees
- Follow-up with the insurer
- Escalation guidance if needed
Motor & Commercial SME Claims
Help with accident intimation, surveyor visits, repair estimates, and documents for business property or stock losses.
- Cashless garage process explained
- Survey and estimate follow-up
- Commercial stock and asset claim documents
Facing a claim right now?
Call your Advisor. We will explain the steps, help you gather documents and follow up with the insurer. For emergencies, also inform your insurer using the number on your policy document.
Frequently Asked Questions on Claims Assistance
Answers to common questions about cashless admissions, bills and claim queries.