Cashless Claim Process vs Reimbursement Claim Process

Become an Advisor and earn commissions

Buying health insurance has become an essential thing after the outbreak of coronavirus. As we know that the rate of inflation in India is very high i.e. 7.01%. Therefore, it is important to have a health insurance plan to deal with the rising cost of medical treatment and hospital bills.

But, to know how to use health insurance effectively, you must have an understanding of the claim process prevalent under health insurance. There are two types of claim processes under health insurance i.e. cashless claim process and Reimbursement claim process.

Cashless Claim Process vs Reimbursement Claim Process

The below table shows the detailed difference between the cashless claim process and the reimbursement claim process.

Parameter	Cashless Claim	Reimbursement Claim
Claims	The health insurance settles the hospital bill directly with the hospital. But, you need to inform the hospital about the hospitalization in advance.	The policyholder pays the bill amount at the time of discharge and then, the insurance company reimburses the amount.
Individual liability	The policyholder does not need to pay any amount to the hospital at the time of discharge. The insurance company will directly settle the bills with the hospital.	The policyholder needs to pay the total bill amount initially and have to file a reimbursement claim with the insurance company for claims settlement.
Treatment	Cashless hospitalization can be availed only in network hospitals recommended by the health insurance company.	Policyholders are not bound to seek treatment in network hospitals. In case of reimbursement hospitalization, they can get treatment in any hospital.
Speed of claims settlement	In cashless hospitalization, you don’t need to file a claim as the health insurance company directly settles the bill amount with the hospital.	Reimbursement claim is a time-consuming process as in this process, you need to file a claim with the insurance company for settlement of the claims.

Cashless claim settlement is best when comparing the two types of health insurance claim processes as it relieves the policyholder from the financial burden. They don’t need to hesitate or worry about paying for their medical treatment even in case of an emergency.

But, during the reimbursement process, it is important to have the cash to pay the bill amount at the time of discharge. In case of emergency, you can be admitted to any nearby hospital to get the treatment and file a reimbursement claim later.

Health Insurance Claim Process

There are two types of claim processes under health insurance i.e. reimbursement claim or cashless claim. To file a health insurance claim, policyholders need to complete the following steps:

Cashless Claim Process

Below mentioned are the general process to avail of the cashless claim under a health insurance plan:

Intimate the insurance help desk in the hospital about the hospitalization.
Show the health card of the insured at the help desk for identification.
Submit the pre-authorization form to the insurer.
The insurance company will verify the submitted documents and process the claim as per the term and conditions of the health policy.
Once all the formalities are done, the insurance company will settle the claim as per the term and conditions of the policy.

There are two types of cashless claim processes: Planned hospitalization claim process, and Unplanned hospitalization claim process.

Planned Hospitalization

In planned hospitalization, the policyholder is aware of the hospitalization before the treatment. The steps to file a claim under Planned Hospitalization are given below:

Intimate the insurance company before 3 to 5 days of hospitalization.
The insurance company will provide a confirmation letter to the hospital.
Submit the health card and the confirmation letter on the day of admission of the insured.
The insurance company will directly settle the bill with the hospital.

Unplanned Hospitalization

This is also known as emergency hospitalization. This type of hospitalization happens suddenly and unexpectedly. Generally, this type of hospitalization occurs when the policyholder met with an accident or an illness that requires immediate treatment.

Inform the insurance company within 24hrs of hospitalization.
Submit the health insurance claim form along with the other required documents.
The insurance company will send an authorization letter to the hospital.
The insurance company will directly settle the bill with the hospital.

Reimbursement Claim Process

Policyholders have to pay the bill amount after getting the treatment if the insurer does not provide a cashless claim option or if the hospital is not on the list of their network hospitals. The health insurance company will reimburse you for the medical bill later.

Inform the health insurance company within 15 days
Fill in and submit the health insurance claim form along with the original discharge summary and other medical bills.
Submit other relevant documents such as ID proof, address proof, and a canceled cheque.
The insurer will verify all the documents.
The insurer will then start the reimbursement process.
The insurance company will complete the claim within 21 days from the date the documents reached the health insurance company.