Cashless Claim vs Reimbursement
  • Understanding Claim Settlement Methods
  • Which One is Better for You?
  • Key Differences Between the Two
Cashless Claim vs Reimbursement
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Claim Settlement Options in Health Insurance

Everyone, especially Indians loves to get free items as much as possible. Guess what, this applies to your health insurance too! With the cashless claim facility offered by health insurance providers, you do not have to pay any cost to the hospital for your availed medical services.

How is this possible?- Understanding Cashless Claim Settlement

Let us first understand how health insurance works, briefly. When you buy the policy, you need to pay some amount in the form of premiums. So whenever there is any medical emergency, you do not have to worry about the cash for bill payment. You can apply for cashless claim settlement to pay the bill. In this method, the company will pay your bill to the hospital directly. '

But that does not only claim settlement options available by the insurance companies.

Another claim settlement option available is called reimbursement.

Now, let's learn about that in more detail.

What is Reimbursement?

Let us understand this term with a scenario.

Jayansh went to a non-network hospital for his kidney treatment. While paying the bill, he submitted the amount and then sent the documents to his health insurance providers and got the money back.

So, the insurance providers do not allow cashless settlement in all the medical procedures. They pay you back in the form of reimbursement.

Key Differences Between Cashless and Reimbursement Claim Settlement

Here is the representation of the basic idea between cashless claim settlement and reimbursement claim settlement.

Basis Cashless Claim Settlement Reimbursement Claim Settlement
Definition You can receive medical treatment without paying upfront. You have to pay the bills upfront and later seek reimbursement from the insurance company.
Process of Payment The insurer will directly pay the bill to the hospital. You need to pay the bill first and then apply for the reimbursement.
Approval Process You might need a pre-authorisation from the insurer. You need a pre-approval before the treatment.
Financial Impact You do not need to make any immediate out-of-pocket expenses. You need to bear upfront costs until you get the reimbursement.
Hospital Selection You can only choose the network hospitals specified by your insurance provider. You can choose any hospital.
Requirement of Documentation Minimal documents are required during the time of treatment. A detailed requirement of the documents with bill and verification documents.
Processing Time The cashless claim process is generally faster. It will take around 2-4 hours to process. Reimbursement is generally slow due to the verification and documentation process.
Convenient Offers convenient process and medical services. Requires a hustle for the approval and document submission.

Which One is Better?

Determining the best claim settlement process depends on various factors, such as:

  • Understand which one is more convenient.
  • Choose your hospital and check whether it is covered by your policy provider.
  • Understand your financial status and choose accordingly.
  • Understand the evaluate the approval process.
  • You need to understand how much time the claim process takes.

Bottom Line

When it comes to health insurance choices, we ask a lot of questions to ourselves and our health insurance providers. Although, as per the General Insurance Council, "Cashless Everywhere" has been implemented in recent times. This means you can avail of cashless claim settlement anywhere for emergency hospitalisation. Most importantly, irrespective of cashless or reimbursement claim settlement, you should go for the best hospital services to get proper treatment and recover fast. Though cashless claim settlement always triumphs over reimbursement, ultimately choose the one that suits your needs the best.

In case of any query, you can reach out to us.

Cashless Claim vs Reimbursement: FAQ's

1. What are the 2 types of health insurance claims available?

The two types of claim settlements available are cashless claim settlement and reimbursement claim settlement.

2. Can I claim both cashless and reimbursement?

Yes, it is possible to claim both cashless and reimbursement options, depending on the situation and circumstances.

3. What is the "Cashless Everywhere"?

According to the recent reports by the General Insurance Council (GIC), now you can avail of cashless claim settlement anywhere for emergency hospitalisation, even if the hospital is not under the network of your insurance service provider.

4. Which claim settlement process is more convenient?

Cashless claim settlement offers a more convenient process.

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Simran Saxena

Written By: Simran Saxena

An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.