List of Documents Required for Health Insurance & Its Importance

Health insurance is the only way to cope with medical inflation, which hovers between 12% and 14%, much higher than retail inflation. It helps you access quality healthcare without worrying about medical expenses.

However, purchasing a health insurance policy might seem complicated if you are new to it. It gets easier with all the necessary documents required for health insurance in place. Without the right documents, the process of buying health insurance may get delayed.

What Are the Documents Required for Health Insurance?

Confused about what documents are required for buying health insurance? You need to submit age proof, identity proof, address proof and a few more.

Find out the complete list of documents required for health insurance purchase below: 

Age Proof

It is one of the crucial documents you must submit while purchasing a health insurance plan. In the case of a floater plan, you have to submit the documents of the whole family. The age-proof documents required for any health insurance are:

1. Birth Certificate
2. 10th or 12th Mark sheets  (If available)
3. Affidavit sworn before a magistrate stating the date of birth​
4. Domicile Certificate
5. Aadhaar Card
6. Driving License (If available)

Why is Age Proof Essential?

Your age is one of the factors insurers consider when assessing your health insurance premium. Since the likelihood of requiring medical treatment generally increases with age, premiums may also be higher for older applicants. An age-proof document helps the insurer verify your date of birth and calculate the premium based on your correct age.

Identity Proof

The policyholder’s identity proof is required for insurers to maintain records. For a group plan, you need to submit address proof of all the insured members. The documents required for address proof are:

1. Aadhaar Card
2. PAN Card
3. Voter ID
4. Government Employee ID
5. NREGA Job Card

Why is Identity Proof Essential?

These documents are required to complete the Know Your Customer (KYC) process. Insurers use it to verify your identity and ensure that the policy is issued to the correct person. This helps strengthen safeguards against identity theft, financial fraud and other forms of misuse.

Address Proof

The address you provide is also used for sending policy-related documents, notices and other important communications. Depending on the insurer, you may submit any of the following as address proof:

1. Passport (If available)
2. Utility Bills (not older than 3 months)
3. Registered Rent/Lease Agreement
4. Property Tax Receipt
5. Voter ID Card
6. Aadhaar Card

Why is Address Proof Essential?

Besides the communication purpose, the location of the policyholder heavily impacts healthcare zoning. For instance, the premium cost of Tier-1 metro cities such as Delhi or Mumbai is higher in comparison to Tier-3 cities such as Udaipur and Jhansi.

Passport Size Photograph

All insured individuals under the chosen health insurance policy must submit a passport-size photograph for easy approval. The detailed conditions of the photo are discussed below:

1. Recent, clear, colour photograph
2. Without a hat or sunglasses
3. Photograph taken against a plain (white or light) background

Why is a Passport-Size Photograph Essential?

It is essential for visual KYC and identity verification. Though identity proofs consist of a photograph, a recent physical or digital one acts as a visual anchor to verify that the person applying matches the documents provided.

Income Proof

This is requested in certain cases to understand your financial profile and assess whether the coverage you are seeking is appropriate. Commonly accepted income-related documents include:

1. Form 16
2. Recent salary slips
3. Bank statements
4. Income Tax Returns (ITR)

Why is an Income Proof Essential?

Insurers use this information to assess the suitability of the coverage requested and establish the policyholder’s insurable interest.

Keep your health insurance journey simple with Bajaj General, with hassle-free documentation and quick policy approval. Contact us now for more details!

Which Documents Are Required for Health Insurance Claim Settlement by Reimbursement?

For a reimbursement claim, you need to submit documents that help the insurer verify your treatment and expenses, such as the discharge summary, medical certificates, diagnostics and more.

Here is a detailed look at the documents you may need:

Filled and Signed Claim Form

You need to collect a two-part document of the claim form, one filled by you and another by the hospital. It is the legal and formal request to initiate contract terms. Without the signature of the policyholder, the Third-Party Administrator (TPA) or direct insurer cannot process the audit legally.

Hospital Discharge Summary

The admission and discharge date and time, chief medical complaints, clinical findings, treatment administered and more that a policyholder must provide. It lets the insurer know what actually happened. The insurer also uses these details to check whether it is covered under your policy.

Itemised Bills and Payment Receipts

Submit the entire bill breakdown, including line-by-line costs of ICU charges, nursing and surgical fees (if required) and the paid stamp receipt. The insurer will not pay based on a lump-sum estimate; they will audit every single rupee spent to filter out non-payable items such as hygiene kits, food for attendees and more.

Investigation Reports

Policyholders must submit pathology results, blood test reports, X-rays, MRI/CT scans, or any applicable reports to the insurer as documents required for medical insurance. This establishes that the policyholder truly required medical treatment. For instance, a policyholder admitted to the cardiology department must have an ECG or Angiography report.

Bank Details or Cancelled Cheque

The policyholder must submit a cancelled cheque or the bank details to the insurer, ensuring the name, account number, and IFSC code are included. It is required for National Electronic Funds Transfer (NEFT), ensuring the money is safely routed back to the exact policyholder.

Documents Required for Cashless Facilities

Cashless claims are generally less complex as the insurer coordinates with the network hospital for claim processing. However, you still need to provide certain documents during admission and discharge to avail the cashless facility.

During Admission

1. Health insurance card or the E-card
2. Pre-authorisation request form provided by the insurance desk of network hospitals
3. Government-Issued photo ID of policyholder

During Discharge

1. Discharge summary
2. All pharmacy bills and doctor prescriptions
3. Signed cashless claim form

Final Thought

Having the documents required for health insurance ready can make both the policy purchase and claim process smoother. Thus, keep your identity, address, age and income proof organised so as to avoid unnecessary delays when you need to submit them.

Note that cashless claims can be simpler than reimbursement claims, as the insurer coordinates with the network hospital for claim processing.

In case you are looking for a smoother health insurance experience, explore Bajaj General Insurance plans and get support through our extensive 18,400+ network of hospitals. Download the app now!

Frequently Questions Asked

Are diagnostic test reports mandatory for claims?

Yes. A diagnostic test report is mandatory to understand the seriousness of the illness.

When is an FIR required for a health insurance claim?

If the hospital admission is due to an accident, an FIR is required to claim insurance.

What happens if a required document is missing during a claim?

It delays the claim and may result in rejection due to the absence of proof.

*Standard T&C apply. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.