Health Insurance Claim Documents Checklist
Incomplete paperwork is a common reason for claim delays and short-payments. Use this interactive checklist to verify every single hospital paper, implant sticker, and doctor note before submission.
1. Policy & KYC Documents3/3 Done
Current active policy schedule mentioning Member ID and Sum Insured.
Clear copy verifying patient identity and date of birth.
Mandatory under IRDAI KYC guidelines for all claim payouts above ₹1,00,000.
2. Hospital & Medical Records1/4 Done
Must bear treating doctor’s physical signature, hospital seal, admission date/time, discharge date/time, diagnosis, and treatment given.
Complete day-wise temperature chart, vitals, physician visit logs, and nursing notes.
The doctor’s initial prescription slip stating the first onset date of current symptoms and advising admission.
Required for any surgical admission: pre-op diagnosis, anesthesia record, surgical procedure, and post-op notes.
3. Bills, Pharmacy & Implants1/4 Done
Must have line-by-line itemization: room rent per day, nursing charges, ICU, OT charges, doctor fees, and investigation costs.
All advance payment receipts, intermediate payment receipts, and final settlement payment receipt.
Individual bills for medicines bought inside or outside the hospital. Must correspond with doctor’s prescription entries.
For cataract lens, stents, pacemaker, hernia mesh, or knee/hip implants. The original outer packaging sticker with Barcode/Serial Number.
4. Diagnostic & Investigation Reports0/3 Done
Signed radiologist reports along with physical films/CDs that justified the hospital admission.
Complete blood counts, cardiac enzymes, cultures, kidney/liver profiles with numerical laboratory ranges.
Required whenever tissue/tumor/appendix/gallbladder was excised and submitted for pathological analysis.
5. Bank Details for NEFT Payout0/2 Done
Cheque from the Policyholder’s account with printed name, account number, and IFSC code for direct claim credit.
Signed NEFT mandate form. If cheque does not have pre-printed name, attach first page of bank passbook / statement attested by bank.
Computer-generated discharge summaries without physical ink signatures and hospital seal are rejected immediately as "unverified records".
Any medicine billed without a corresponding entry in the doctor’s treatment sheet will be disallowable as an unprescribed expense.
If the surgical sticker for intraocular lens (cataract) or heart stent is missing, TPAs reduce the entire implant cost to zero.
Ensure resident doctors don't casually write "history of hypertension since 5 years" if the patient was only diagnosed 6 months ago. TPA will invoke PED.
Have you received a 'Query / Deficient Documents' letter from your TPA?
Upload the query letter along with your hospital bills. Our AI letter auditor checks what is genuinely missing and drafts the formal reply letter with legal citations so your claim gets approved.