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Difference Between a Cashless and Reimbursement Claim in Health Insurance

Difference Between a Cashless and Reimbursement Claim in Health Insurance

In India, over the past few years, especially since the COVID-19 pandemic, insurance buyers have increased significantly. Today, many people prefer paying their medical expenses through health insurance policies. 

Most first-time health insurance buyers tend to make their purchase decision based on the coverage and other benefits of the policy. However, they fail to consider a critical aspect, i.e., the claim settlement mode. Generally, insurance companies settle the claim request in two ways – cashless settlement and reimbursement settlement. 

If you are not sure which mode of claim to choose, you must know the difference between the two so that you can make an informed choice. 

Cashless Claim Settlement

In cashless settlement mode, the insurance company settles the hospital expenses you may incur directly with the hospital. However, you must inform the insurer or the appointed TPA (third-party administrator) at the time of admission. 

If your health insurance policy offers cashless hospitalisation benefits, you can avoid the hassles of arranging cash during a medical emergency. You can focus on getting the best quality medical care without worrying about costs. 

Generally, most insurance companies extend cashless claim settlement benefits only when you seek treatment at specific hospitals that are part of the insurer’s network. 

One of the significant benefits of choosing cashless claim settlement is that the insurance companies, after verifying the bills and receipts, settle the bill immediately after you get discharged. 

Reimbursement claim

In reimbursement claim mode, you must initially pay the bills from your pocket, and upon discharge, you can claim reimbursement from the insurance company. 

If you choose reimbursement claim settlement mode, ensure that you keep all the treatment-related bills, receipts and other medical documents safe. You must submit them along with the claim request form for verification and claim settlement. 

With reimbursement claims, you need not have to go through the hassles of finding the nearest network hospital in your locality. Instead, you can seek treatment at any hospital of your choice. 

Generally, the reimbursement settlement takes time. It may take up to 7-10 days before you get full compensation. 

Steps to file a cashless claim request

  • First and foremost, you must inform the insurance company about your health condition when you get admitted to the hospital. 
  • You must fill the cashless claim from the hospital and get approval from the concerned hospital authority.
  • Submit the form along with the necessary documents, including bills, receipts, etc. 
  • Upon verifying the request form, the insurer will settle the bills directly with the hospital. 

Steps to file a reimbursement claim request

  • Inform the insurer or the TPA about your admission to the hospital. 
  • After treatment, when you get discharged, pay the bills. 
  • Collect all the hospital bills, receipts and discharge summary and submit it to the insurer along with the reimbursement form for verification. 
  • Once the insurer verifies your request, they will issue a cheque to reimburse the claim as per the policy terms and conditions.

Final Word

Whether you choose a cashless claim or reimbursement claim is your personal choice as both cover the expenses you may incur while you get hospitalised. But most people prefer cashless claims as it is convenient, and the settlement is done much quicker. 

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