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Cashless V/S Reimbursement Hospitalization In Health Insurance

Published On Jul 21, 2021 10:00 AM By InsuranceDekho

A health insurance policy is essential to provide monetary assistance to an individual in case of a medical emergency. When you buy a health insurance cover, you look forward to a plan which offers wide coverage at an affordable price. The coverage of the health insurance policy includes hospitalization charges, ambulance charges, cashless treatment, etc. It is important to be aware of the claim settlement process of the purchased policy as it will help you make an effective claim on your policy and avail maximum benefits under it. The claim settlement process of a policy can be cashless or reimbursement claim process. Based on the claim settlement ratio of the insurance company you can determine the claim processing record of the insurer and make a choice accordingly. 

There are two types of claim settlement process namely cashless claim process and reimbursement claim process. Both the procedures have their advantages over the other and should be chosen by the policyholder based on the accessibility of the services. A lot of insurance firms offer online processing of claim requests which makes the whole experience smooth and hassle-free for the policyholders. 

Cashless V/S Reimbursement Hospitalization In Health Insurance

Comparison Between Cashless Claim And Reimbursement Claim Process 

Though both the claim settlement procedures have their own significance, let us draw the comparison between the two claim procedures,  based on certain parameters that are usually considered by the policyholders: 

1. Hospital 

To avail of the cashless claim settlement treatment, the policyholder must seek treatment in one of the network hospitals of the insurer. However, for a reimbursement claim, you can seek treatment in the hospital of your choice. 

2. Claim Process 

After processing the claim request, the medical dues are cleared by the insurer directly without involving the policyholder while, for reimbursement claims, the customer has to clear the hospital bills, and later the claim amount is transferred to the policyholder’s bank account. 

3. Claim Settlement Speed 

Cashless claim settlements take less time and the amount is settled instantly by the insurer, but reimbursement claims may take some time to process the claim request as the treatment bills are reimbursed. 

4. Individual Liability 

Under cashless claims, the insurance company settles the dues with the hospital directly, but under reimbursement claims, the bill amount is paid by the individual, and based on the receipts and discharge documents, the claim is processed. 

Steps For The Claim Settlement Process 

Following are the steps that should be followed to settle the claim of your purchased health insurance policy: 

1. Cashless Claim Process 

Follow the below steps to make a cashless claim at the time of a medical emergency: 

  • Get admitted to one of the network hospitals of the insurance company and inform the insurer about your hospitalization as soon as possible. 
  • You will be asked to produce a health ID card at the hospital desk after which you can fill a pre-authorization form and submit it with all the necessary documents to the insurer. 
  • Once your documents are verified and the claim request is accepted, the insurance company will clear your medical dues with the hospital directly. 

2. Reimbursement Claim Process

Follow the given steps to make a reimbursement claim on your health insurance policy: 

  • Get yourself admitted to any hospital of your choice and inform the insurer about the same as soon as possible. 
  • After receiving the treatment, clear all the medical bills and collect all your discharge documents, receipts, invoices, prescriptions, etc. from the hospital. 
  • Submit these documents along with the claim request to the insurance company. 
  • Once your documents are verified and your claim request is accepted, the amount of the claim will be transferred by the insurer to your bank account. 

Conclusion 

Both the methods of settling the claim for your health insurance policy are reliable but it is advisable to go for the cashless claim process while receiving any treatment, as it ensures that you don’t have to pay from your pocket and the whole claim process takes less time when compared to the reimbursement claim procedure. 

Also Read: Should I Opt For Cashless Insurance?

Benefits of Buying Cashless Health Insurance


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.

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