Cashless VS Reimbursement Claims in Health Insurance
Updated On Feb 14, 2021
Health insurance is one of the best ways for dealing with a medical emergency. They can concentrate on the sick and their treatment rather than focusing on arranging for finances to fund for the treatment. There are two aspects of health insurance, namely cashless claims and reimbursement claims. Both of them are convenient and render a helping hand during tough times.
What is a Cashless Claim?
In the cashless claim, the policyholder does not have to pay the hospital bill at times of seeking in-patient treatment. The hospital bills will be settled in the network hospitals by the insurance company as part of its claims settlement clause.
What is a Reimbursement Claim?
In this type of health insurance, the policyholder has to pay the hospital bills on their own and submit the hospital bills along with the claim application to the company to get the bill amount reimbursement in their bank account.
Cashless Claims Vs Reimbursement Claims
Both these types of health insurances come in handy as financial relief, at times of sudden and unexpected hospitalizations. The differences between both these type of health insurance are as follows:
|
S No |
Attribute |
Cashless Claim |
Reimbursement Claim |
|
1. |
Nature Of Claims |
The claims on the hospital bill are settled by the insurance company. The insurer should be informed about the hospitalization in advance or within 24 hours of emergency admission. |
The hospital bills are to be settled by the insurer and they can claim a refund on the bills from the insurance company. |
|
2. |
Liability on the Policyholder |
The policyholder may have to pay for the consumables as indicated in the policy and any co-payments if it exists. |
The insured has to bear the entire medical costs when in the hospital and can claim reimbursement by sending every single bill and discharge summary to the insurance company. |
|
3. |
Network Hospitals |
Treatment should be taken only in the network hospitals as suggested by the insurance company. |
Treatment can be taken in any hospital. And this can be of help at times of medical emergencies. |
|
4. |
Claims settlement |
The claims are settled instantly when the insured is taking hospital in the treatment |
The insurance company will take time to settle the bills, which can take about 7 – 14 days. |
Which is Better?
Cashless claims are considered more convenient than reimbursement claims as they are processed quickly and the policyholder need not undergo the hassles of arranging finances to pay for the hospital bills. Also, with reimbursement claims, a lot of bills corresponding to the laboratory, pharmacy, consultation, etc. have to be submitted with the insurance company without missing any document. Reimbursement claims take time and the insurance company will reimburse the money only after a week, leaving the policyholder financially vulnerable till then.
Bottom Line
Both types of insurance claims have their own merits and demerits. Cashless claims are better financially, but treatment should be undertaken only at the network hospitals of the insurer. Reimbursement claims are advantageous at times of medical emergencies but leave the individual financially vulnerable. Thus, the choice of insurance vests with the individual policy seeker.
Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.
