Cashless Vs. Reimbursement Health Insurance Plans: Which is Right for You in India?

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Overview

A Health Insurance plan, also known as a Medical Insurance plan, is designed to provide financial coverage to the entire family against unexpected medical expenses for illnesses or injuries. From basic hospitalisation costs to consultation fees, the  Health Insurance plans cover everything with extra benefits. But when it comes to filing a Health Insurance claim, it’s always confusing when choosing between two types of claiming process – Cashless Claim or Reimbursement Claim. While these claiming options provide coverage against medical costs, there are some key differences between them. So, to better understand these two types of Health Insurance plans, let’s delve into these in detail.  

What is a Cashless Claim in Health Insurance Plans?

A cashless claim is a type of claim in  Health Insurance plans that allows an insured person to receive medical treatment without paying the entire hospital bill. This facility can be availed in network hospitals only. The insurance company will provide a list of network hospitals where you can avail of cashless claims. 

After being admitted, the policyholder needs to share the Health Insurance card with the hospital. Based on the medical expenses, a cashless claim request will have to be raised to the insurance company. Then, the insurer will settle it directly with the network hospital, as per the terms and conditions of the policy. Thus a cashless health Insurance plan ensures that you do not need to worry about unexpected high medical costs in case of emergencies. 

What is a Reimbursement Claim in Health Insurance Plans?

A reimbursement claim is a type of claiming process in Health Insurance plans that allows you to pay the medical costs from your own pocket and then seek reimbursement from your insurance company. 

To avail of this, you can prefer to take medical treatment in any hospital of your choice and make the payment for hospital bills from your own pocket. After the treatment, you can submit your medical bills and other essential documents to your insurer. Then, the insurance company will verify the details and refund the expenses, as per the policy terms and conditions.

Unlike the cashless claim, reimbursement claim provides flexibility in choosing the hospital of your choice. However, please note that as per the policy deductibles and copayments, you may have to bear a portion of the medical cost yourself.  

Difference Between Cashless Claim and Reimbursement Claim

Difference Between Cashless Claim and Reimbursement Claim

Cashless Claim

• You can choose a hospital from the list of network hospitals provided by your insurance company.
• You need to share your Health Insurance card or your policy details with the hospital.
• You do not need to pay the whole hospital bill; the insurance company settles the medical expenses directly with the network hospital.
• In case of planned hospitalisation, you need to get claim approval before 72 hours. But, for medical emergencies, you should seek approval within 24 hours.
• This claiming process is faster and hassle-free as the health insurer settles your medical costs directly with the hospital. 
• It’s easier to file a claim as the insurance company directly manages the process with the hospital.

Reimbursement Claim

• You can choose any hospital of your choice
• Post-treatment, you need to submit all the original hospital bills and other important documents to the insurer to verify the details.
• You need to pay the medical expenses to the hospital from your own pocket after the treatment and get them reimbursed from the insurer later. 
• You need to get the treatment approved from your insurer. You can still get the necessary treatment in time without waiting for the approvals. 
• This claiming process is slower and time-consuming as you have to bear the medical costs and then seek reimbursement at a later stage.
• It’s complex as you need to handle the claim process yourself. 

Final Words

Cashless claims and reimbursement claims are two types of claiming methods of Health Insurance plans that an insurance company uses to cover medical costs. However, choosing a cashless claim or reimbursement claim depends on an individual’s choice or requirements. But when filing the claim, you must consider different factors, such as your financial situation, the type of policy, and the type of hospital. Hence, it’s crucial to understand the key differences between both claiming options thoroughly, ensuring you have the right Health Insurance plan as per your needs. 

Note - This article is written by Brand Desk.