Whether it is a car insurance policy, travel insurance policy, or a health insurance/Mediclaim policy, policyholders are mostly concerned about claim settlement. They expect their insurance company to provide prompt assistance during an emergency. Insurance companies are also aware of such expectations related to health insurance/Mediclaim policy hence they continuously keep improving their claim process.

Is Cashless Claim Settlement Better than Reimbursement Process in Health Insurance? - Acko

Digital-first insurers are a step ahead and leveraging technology to ensure that their policyholders are satisfied with the claim settlement process. Technologies such as Artificial Intelligence, Robotic Process Automation, and Blockchain are being implemented to meet that objective. 

A basic example of a tech-driven approach to make the claim process customer-friendly is the Cashless Claim Settlement Process. Read ahead to know more about it and how it differs from the cumbersome Reimbursement Claim Settlement Process.

Important Terminologies:

Before moving ahead towards understanding different types of claim settlement processes, here’s a list of important terminologies you should be aware of to completely comprehend the explanation.

Network Hospital:

A hospital that has a tie-up with the health insurance/Mediclaim company for smooth processing of claim settlement applications is referred to as a network hospital.

Third-Party Administrators (TPA):

TPAs are separate organizations that might be roped in by the health insurance/Mediclaim company to help in managing the claim settlement process. Their work is usually related to coordination.

Cashless Claims:

A cashless claim means you (as a patient and policyholder) do not have to pay the hospital bill (apart from a nominal amount), as your insurance company will settle it with the hospital (as part of claim settlement), as it is a network hospital.

Reimbursement Claims:

A reimbursement claim means you (as a patient and policyholder) settle the hospital bill on your own and then submit the health insurance claim application to your insurance company for applicable reimbursement.

Is Cashless better than Reimbursement?

Overall, Yes. A Cashless Claim Process is better than the Reimbursement Claim Process under health insurance because of the convenience attached to it. Health insurance is related to medical emergencies, which take a toll on the patient and the family members.

Amidst all this, it is preferable not to be bothered by the need to pay for hospital expenses from your pocket, as is the case with a Reimbursement Claim model. Instead, it would take a lot of load off the patient and the family members if the insurance company deals directly with the hospital, as is the case with a Cashless Claim.

Check: Know the Time Limit for Filing a Health Insurance Claim

Note that a cashless claim works only if the hospital you visit is a part of your insurance company’s list of network hospitals. Thus, it is important to select an insurance company that has a long list of network hospitals if you wish to benefit from the cashless claims.

Although the Cashless process is better in terms of convenience, the Reimbursement model is not flawed. It’s just tedious. You will have to keep all the bill receipts and important documents in a proper folder and then apply for claim settlement, which might take some time. But it is not like the insurance company will not honour the claim (assuming all terms and conditions are met).

The choice between Cashless vs Reimbursement boils down to convenience, and Cashless Claim Settlement certainly scores over Reimbursement Claim Settlement in this regard.

Health Insurance/Mediclaim Online:

If you feel your current health insurance company has an unsatisfactory list of network hospitals, you can easily switch your insurer at the time of renewal by renewing your policy online. You can compare plans by using a health insurance/Mediclaim premium calculator. It is easy to use a health insurance/Mediclaim premium calculator as all you have to do is enter some basic details and click a few buttons. Besides, it is available free of cost.


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