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Cashless vs. Reimbursement Hospitalization in Health Insurance

Avoid last-minute hustle of arranging large funds for getting treated at hospitals by opting for a cashless claim facility from your health insurer. You can even apply for reimbursement claims by understanding the claim process.

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Last Updated - September 6, 2023
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Health Insurance has become a vital part of everyone’s life post the hit of the pandemic as it has led to unimaginable medical expenses. While ​medical technology has improved so has the treatment cost. That’s why having adequate health insurance coverage is the need of the hour. Due to a significant rise in lifestyle-related illnesses, health insurance is now seeing a boom in the market. However, the majority of the population still remains unaware of the benefits of availing of a health insurance policy. Before purchasing a mediclaim policy, it is advisable to compare health insurance policies so that you can get the optimum benefits. so that you can get the optimum benefits. 

Avoid the last-minute hustle of arranging large funds for getting treated at hospitals by opting for a cashless claim facility from your health insurer. You can even apply for reimbursement claims by understanding the claim process. 

One usually makes a health insurance claim when they end up visiting a hospital due to any accidents or illness. And when you make claims for such incidents, you can either opt for a cashless claim or a reimbursement claim. Basically, you can get your treatment done and later get your hospital bills reimbursed from your health insurer. Or, you can get approval beforehand or at the time of admission to the hospital from the health insurance company. 

What is a Cashless Claim in Health Insurance?

A cashless claim is a type of health insurance claim where you can get treated at any network hospital as listed by the insurer without paying out of your own pocket at the time of hospitalization. The medical bills are sent directly from the hospital and settled by the insurer.
So, you can head to one of your insurer’s network hospitals and show them your health e-card and ID proof. Just remember that you need to get your claim approved by your health insurer within a particular time period. 

Important things to know about the cashless facility:

The cashless facility can be availed only if you seek treatment from any of the network hospitals of the insurer.
The hospital explains to the insurer the detailed condition and the treatment given to the patient.
Even though it’s cashless, it is safe to maintain copies of the hospital bills and medical expenses for records.
Carefully read the terms specified by the health insurer for availing of the cashless facility.
If your treatment amount exceeds the sum assured, then the remaining balance has to be paid by you. The health insurance company won’t be liable to pay the full amount of the medical bill in such a scenario.

What is a Reimbursement Claim in Health Insurance?

The second type of health insurance claim is a reimbursement claim. In this type of claim, you can visit any hospital, not just those under your health insurer’s cashless network list. Over here, you get your treatment done at the hospital, and the expenses are paid out of your pocket. Post payment you can then apply for a reimbursement for the expenses with your health insurer. At the time of making a reimbursement claim, you’ll need to submit all your hospital bills, prescriptions, and medical documents. 

How does reimbursement work?

So if you choose for reimbursement claim, there are a few documents that need to be submitted to the insurer. It has to be submitted duly in time to get reimbursement. List of documents to be submitted for Reimbursement claims;

  • Duly completed claim form
  • Pre Admission investigations and treatment papers
  • Reasons why your health insurance claim might get rejected
  • When a claim is made for Permanent exclusions as mentioned in a health insurance plan
  • If medical facts were not disclosed at the time of purchasing the policy and then going ahead the claims were made for that purpose.
  • If you fail to submit the documents required for the claim

Apart from these, there are various reasons why your health insurance claims can get rejected – Know more

Conclusion:

Overall, it would be appropriate to say that the cashless claim process is better than the reimbursement claims, as it is far way convenient. Also, one should check for network hospitals on the panel of the insurer as you won’t have to pay the hospital expenses from one’s pocket.
You can protect your family with term insurance plans. Visit MyInsuranceClub to do term insurance comparisons between multiple insurers. Our certified experts will be there to guide you through making the best choice.

. Visit MyInsuranceClub to do term insurance comparisons between multiple insurers. Our certified experts will be there to guide you through making the best choice.

. Visit MyInsuranceClub to do term insurance comparisons between multiple insurers. Our certified experts will be there to guide you through making the best choice.

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Author

Sachin Telawane is a Content Manager and writes on various aspects of the Insurance industry. His enlightening insights on the insurance industry has guided the readers to make informed decisions in the course of purchasing insurance plans.