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Reimbursement Health Insurance

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Reimbursement Health Insurance

Reimbursement Health Insurance

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Claim settlement is one of the critical factors in a health insurance policy because a medical insurance policy is all about providing a financial backup during medical emergencies. There are mainly two types of claims in health insurance: cashless and reimbursement. In this article, let’s throw light on the key features and benefits of Reimbursement Health Insurance.

What is Reimbursement in Health Insurance?

The word reimbursement refers to the action of repayment to a person who has spent or lost money. In health insurance, it is a type of claim settlement wherein you have to pay the medical/hospitalisation bills for the availed medical treatment. Later, you can get it reimbursed from your insurer, in this case ACKO.

Key Features and Benefits of Reimbursement Health Insurance

Reimbursement Health Insurance is nothing but a health insurance plan with a reimbursement claim facility. One of the critical features of such a claim settlement option is the flexibility of availing of medical treatment at your desired hospital. The hospital need not be empanelled with ACKO to avail the benefits of the medical insurance. Here are the benefits of such a health insurance claim settlement.

Need not worry about locating a network hospital during medical emergencies.

Can avail treatment from any hospital (non-network hospital).

Need not go through any health insurance-related procedures while availing of medical treatment.

Can apply for a claim once the medical treatment is availed and the bills are settled.

What is Covered in a Reimbursement Health Insurance?

The coverage offered by a health insurance policy remains the same irrespective of the claim settlement method. Here are the coverage benefits of a Reimbursement Health Insurance.

Covers hospitalisation expenses

It covers pre- and post-hospitalisation expenses

Covers cost incurred due to daycare treatment

It covers critical illnesses such as stroke, cancer, paralysis, etc.

Covers domiciliary hospitalisation expenses

OPD treatment (Depends on the terms and conditions of the policy)

Covers the cost of transportation of the insured patient via ambulance in a medical emergency

Reimbursement Health Insurance Claim Settlement

You can use the reimbursement claim settlement facility if you wish to opt for a hospital of your choice. You can avail of the medical treatment and settle the hospital bills first before applying for a claim.

For raising a claim, you need to furnish all the required documents such as original hospital bills, pharmacy bills, doctor certificates, etc.

After verifying the documents, ACKO will settle the claim provided the claim meets all the terms and conditions and is under the scope of coverage of the health insurance policy. Post the approval of the claim, ACKO will make the payment to the insured.

Reimbursement Hospitalisation Claim Process

Here are the steps involved in making a reimbursement hospitalisation claim.

Inform ACKO about the medical treatment and the details of the hospital.

Avail of medical treatment at your desired hospital.

Settle the hospitalisation bills.

Apply for the claim online or by writing to us.

Share all hospitalisation-related documents.

Upon verification of the documents and scope of coverage, ACKO will make the payment to the insured after excluding the deductibles.

Frequently Asked Questions

Here are some of the most commonly asked questions related to reimbursement claim settlement.

Is a cashless claim better than a reimbursement claim in a health insurance policy?

A cashless claim has its own set of advantages. One of the talking points of the reimbursement claim is that you have the flexibility to avail treatment in a hospital of your choice. That means, in a medical emergency, you need not waste your time in locating a network hospital. So, it all depends on which is the convenient option for you.

How much time does it take to settle my health insurance reimbursement claim?

ACKO may settle your claim within 7 days of the receipt of the claim-related documents. However, the timeframe may differ depending on the complexity of the claim.

Is a health insurance reimbursement claim taxable?

No, the reimbursement received from your health insurance provider (ACKO) is not taxable because it does not account for profit or income for the insured.

Is there any timeframe to apply for a reimbursement claim at ACKO?

Yes, you need to raise the claim within 30 days of the hospitalisation. However, we recommend that you apply for a claim as soon as possible. It allows ACKO to settle the claim quickly.

How Does a Reimbursement Health Insurance Work?

The Reimbursement Health Insurance is nothing but a health insurance policy that provides reimbursement claim settlement. So, the policy's overall coverage benefits and facilities will remain the same as for cashless treatment. The only difference is that you can avail of medical treatment at the hospital of your choice, and you have to clear the hospital bills on your own before applying for a claim. The rest of the terms and conditions of the policy will remain the same.

Documents Required for Reimbursement Claim

Here is the list of required documents to apply for a reimbursement claim.

Duly filled and signed claim form

Medical certificates signed by the doctor

Original discharge summary

All original hospital bills

Original prescriptions and pharmacy receipts

Diagnostic reports/lab reports

FIR or Medico-Legal Certificate (in case of an accident)

Factors You Should Consider Before Opting for Reimbursement Claim

Medical reimbursement claim is a convenient option as you need not stick to the insurer’s (ACKO) network hospitals for medical treatment. But there are a few things that you should remember before opting for such a claim. Here are the points you should consider before deciding to opt for a non-network hospital for medical treatment.

You ought to have sufficient funds to avail of medical treatment if you are planning for reimbursement hospitalisation.

You have to keep track of all the original bills and documents, which is a tedious process.

Have to submit all the original documents during the claim process.

The time taken to settle the claim may be more due to the tedious process of validating the documents.

Cashless claim in health insurance

Cashless claim or cashless hospitalisation is a hassle-free claim facility provided by ACKO wherein the insured can avail treatment at a hospital without making any payment. But the insured or any covered member must avail of the medical treatment in a network hospital. The medical expenses will be paid by ACKO directly to the hospital after verifying the coverage limits of the health policy and applicable deductibles.

Network and non-network hospitals

A network hospital refers to a hospital that is partnered with ACKO to offer a cashless treatment facility. You can view the list of ACKO network hospitals by logging in to your account via the website or mobile app. Non-network hospitals are those hospitals that have not partnered with ACKO. You can opt for a non-network hospital if you are planning for reimbursement hospitalisation. Such hospitalisation requires you to clear the hospital bills before you apply for a claim.

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CIN: U66000KA2016PLC138288

IRDAI Registration No: 157

Category: Non-Life Insurance

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