People buy insurance as a promise. Insurance companies take insurance premium and promise to support the policyholder financially during challenging times. This support is subject to the terms and conditions of the chosen plan.

Types of Health Insurance Claims: Cashless Vs Reimbursement - Acko

A policyholder gets ‘value for money’ paid as premium at the time of claim settlement, which is a crucial aspect of the insurance cycle. This ‘value’ is not just in terms of the money received as claims, but also in the way it is received. The service aspect of it is also extremely important. Especially, when it comes to health insurance/Mediclaim policy. Here, the policyholder is a patient (or has a family member who is a patient) and this immediately amplifies the emotions involved in the claim settlement process.

The policyholder not only expects to receive the promised financial support but also hopes for a smooth claim settlement process supported by top customer service. This is where the policyholder’s choice of raising a claim is of utmost importance. There are two types of claims one can raise against a health insurance/Mediclaim policy; Cashless and Reimbursement. Read ahead to know the meaning, advantages, and disadvantages of these two claim settlement processes.

Reimbursement Mediclaim/Health Insurance Claim Settlement:

Meaning:

The word reimbursement essentially means repayment or payment at a later stage. With respect to Mediclaim/health insurance claim settlement, reimbursement means you have to pay the hospital bills on your own and then get them reimbursed from your insurance company.

Advantages:

The advantage of this type of claim settlement process is that you do not have to act immediately. If the patient is hospitalized in an emergency, the policyholder might not have enough time to check out hospitals affiliated with the insurance company, which is a necessity for Cashless Claims.

Disadvantages:

This is a tedious process. You will have to keep a track of all the bills and other relevant documents, file them, and submit them to the insurance company to validate your claim. Because of the elaborate process of validating the claim, the time taken to settle claims is also more. You will have to keep following up with the hospital and the insurance company to get the reimbursement.

Cashless Mediclaim/Health Insurance Claim Settlement:

Meaning:

Cashless is a process wherein a claim is majorly settled between the health insurance company and the hospital. This happens because there is a tie-up with the health insurance company and the hospital (also known as network hospital).

Advantages:

Unlike the Reimbursement process, you do not have to pay the hospital bills upfront. This can save a lot of effort. No one wants to be in a situation where there is a health scare as well as a financial drain to attend to the medical emergency. The Cashless Claims process removes the burden of arranging money immediately in times of medical crisis.

Moreover, the process is also fast-tracked as the insurance company doesn’t have to spend too much time validating the claim and executing the claim settlement process because it already has a set process with its network hospital for such issues.

Disadvantages:

If your preferred hospital is not a part of the insurance company’s network, then you won’t be able to raise a Cashless Claim request. You will have to go for a Reimbursement Claim. That is why it is suggested to choose an insurer who has a tie-up with top hospitals in and around your locality.

Being Proactive:

Overall, the Cashless process scores over the Reimbursement process when it comes to the convenience of settling a claim. A little bit of research from your side before selecting an insurance company can go a long way in deciding whether your claim settlement process will be smooth or not. Choose a health insurance company that is credible.

You also have the option of comparing policies online before buying them. You can make use of a Health Insurance/Mediclaim premium calculator to check if a policy lives up to your expectations in terms of the premium charged. A Health Insurance/Mediclaim premium calculator is easy to use, you just have to key-in basic information and it will let you know the premium charged for the desired coverage within seconds.

Have a word with your insurance company’s customer care executive if you are still confused about the Cashless vs Reimbursement claim. Remember to clear your doubts, and make an informed choice when it comes to health insurance.


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