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HexaHealth's health insurance guidance tool makes the cashless hospitalization process simple. Inform the hospital insurance desk at least 4 to 6 hours before a planned procedure, or immediately for emergencies. The hospital submits a pre-authorization request to your insurer or TPA. Keep your insurance card, photo ID, and policy number ready.

• Inform the hospital insurance desk 4 to 6 hours before planned admission.
• Hospital sends pre-authorization form to your insurer or TPA.
• Insurer approves within 2 to 6 hours for planned admissions, immediately for emergencies.
• You receive treatment and the insurer settles the bill directly with the hospital.
• HexaHealth coordinators manage the entire pre-auth process on your behalf.

In a cashless claim, your insurer settles the hospital bill directly and you pay only your co-pay at discharge. In a reimbursement claim, you pay the full bill first and then submit documents to get refunded. Cashless treatment is faster and reduces financial stress but is only available at network hospitals.

For treatment at a non-network hospital, follow this step-by-step process:

1. Pay all hospital bills out of pocket at discharge.
2. Collect all original documents including bills, discharge summary, prescriptions, and reports.
3. Fill and sign the reimbursement claim form from your insurer.
4. Submit within 15 to 30 days of discharge to your insurer or TPA.
5. Insurer reviews and credits your bank account within 21 to 30 working days.
6. HexaHealth provides document preparation and reimbursement claim support.

Claim rejection is stressful but most rejections can be successfully appealed. Here is your insurance claim rejection help guide:

• Request the exact rejection reason in writing from your insurer within 24 hours.
• Common causes include waiting period not completed, non-disclosed pre-existing conditions, non-network hospital, or missing documents.
• File a formal grievance with your insurer's Grievance Officer within 30 days of rejection.
• If unresolved within 30 days, escalate to the IRDAI Bima Bharosa portal.
• Further escalation is available via the Insurance Ombudsman in your region, which is a free service.
• HexaHealth can review your rejection letter and help prepare your appeal.

• Non-disclosure of pre-existing conditions at the time of policy purchase.
• Claim filed during the initial 30-day waiting period or disease-specific waiting period.
• Treatment at a non-network hospital without prior insurer approval.
• Missing or incomplete documents in the claim submission.
• Room rent chosen exceeds the policy sub-limit, triggering a proportionate deduction on the entire bill.
• Policy lapsed due to non-renewal before hospitalization.
• Treatment for a condition explicitly excluded in the policy schedule.

Coverage varies by insurer and plan. Upload your policy to our Health Insurance Policy Assistant for a personalised summary. Standard coverage typically includes:

• In-patient hospitalization for a minimum of 24 hours.
• Day-care procedures requiring less than 24-hour admission such as cataract, chemotherapy, and dialysis.
• Pre and post-hospitalization expenses, typically 30 days before and 60 days after discharge.
• Ambulance charges.
• ICU and room rent, subject to sub-limits if any.
• Organ donor expenses.
• AYUSH treatments including Ayurveda, Yoga, Unani, Siddha, and Homeopathy if included in your plan.
• OPD cover only if you have purchased the add-on rider.

A waiting period is a window during which your insurer will not pay claims for certain conditions. Any claim filed before the applicable waiting period ends will be rejected.

• Initial waiting period: 30 days for all new claims, with accidents exempt.
• Specific disease waiting period: 1 to 2 years for conditions like hernia, cataracts, and joint replacements.
• Pre-existing disease waiting period: 2 to 4 years depending on your insurer.
• Maternity waiting period: 2 to 4 years for maternity and newborn cover.

• Day-care procedures requiring less than 24-hour admission are covered in most standard plans, including chemotherapy, cataract surgery, dialysis, and lithotripsy.
• OPD cover for consultations, pharmacy, and diagnostics without admission is only available with an OPD add-on rider.
• OPD riders significantly increase the premium but reduce out-of-pocket spend for frequent doctor visits.
• Check your specific policy schedule for the full approved day-care procedure list.

Yes. IRDAI regulations now strongly protect patients with pre-existing conditions.

• Insurers cannot outright reject your application due to a pre-existing condition.
• They may impose a waiting period of 2 to 4 years, a loading charge on the premium, or a co-payment clause.
• Always disclose all conditions honestly at the time of application.
• Non-disclosure is the single leading cause of claim rejection in India.
• After the waiting period ends, your pre-existing condition is covered like any other illness.

A pre-existing disease is any condition, ailment, or injury for which you had symptoms, diagnosis, or treatment in the 48 months before purchasing the policy. Common examples include:

• Diabetes (Type 1 and Type 2)
• Hypertension or high blood pressure
• Asthma and respiratory conditions
• Thyroid disorders
• Heart disease and cardiac conditions
• Kidney disease or chronic renal conditions
• Any prior surgery or ongoing treatment at the time of policy purchase
• Mental health conditions under IRDAI's 2023 mandates

• Visit your insurer's website or app and use the Network Hospital or Find a Hospital search tool.
• Filter by city, specialty, or pin code to find nearby empanelled hospitals.
• Ask the hospital admissions desk directly since they process pre-authorization requests daily.
• HexaHealth has cashless facilitation at 1,000+ partner hospitals across 50+ cities in India.

Sum insured is the maximum your insurer pays in a policy year across all claims.

• Minimum Rs 5 to 10 lakh for a family floater plan in 2026 given rising medical inflation.
• Rs 15 to 25 lakh for residents of metro cities or for senior citizens.
• Consider a super top-up plan to extend coverage cost-effectively beyond your base sum insured.
• Always opt for plans with restoration benefit so sum insured is reinstated after a claim.

Yes. Our Health Insurance Policy Assistant can still provide guidance without your document:

• Share your insurer name, policy number, and plan type and the bot provides general answers on claims, coverage, and waiting periods.
• For personalised advice specific to your coverage limits and exclusions, uploading the policy PDF gives far more accurate answers.
• Retrieve your policy PDF from your insurer's app, email inbox, or customer portal.
• HexaHealth can also retrieve your policy details if you have used our platform previously.

There is no single best insurer. The right plan depends on your age, health conditions, city, and coverage needs. Here is a comparison of HexaHealth's top insurance partners:

This is common, especially for longer stays or complications during surgery. Here is what happens:

1. The hospital submits an enhancement request to the insurer for the additional amount.
2. Insurer reviews and approves or partially approves the enhanced amount.
3. Any amount not approved by the insurer becomes your out-of-pocket expense.

Common reasons for shortfall include room upgrades beyond the cap, non-covered consumables, and co-payment clauses. HexaHealth reviews enhancement requests and disputes incorrect rejections. Always keep itemised bills since non-medical consumables such as gloves and syringes are commonly disputed.

HexaHealth handles the entire pre-authorization process on your behalf. You do not need to deal with the insurer or TPA directly. Here is what our dedicated insurance coordinator does:

• Assigned to you from the moment of admission confirmation.
• Fills and submits the pre-authorization form to your insurer or TPA.
• Follows up for timely approval, typically within 2 to 4 hours for planned surgeries.
• Handles enhancement requests if the bill increases during your hospital stay.
• Manages post-discharge settlement and flags incorrect deductions.
• Available across 1,000+ partner hospitals in 50+ cities across India.

Yes. HexaHealth's insurance coordinator service is provided at no additional charge to patients treated at HexaHealth partner hospitals. You get dedicated insurance claim help, pre-authorization filing, post-discharge bill reconciliation, and reimbursement support as part of your treatment journey. Call +91 92056 78109 or fill the contact form on the website to get started.