Difference Between a Cashless and Reimbursement Claim in Health Insurance

Cashless vs. Reimbursement Claims in Health Insurance

In Life, Health acts like a roller-coaster that takes us through ups and downs where one may not know when they would face an unexpected situation. To tackle such unexpected situations, health insurance would be good life support. Today, many insurance companies have come forward to introduce various policies that would suit the up-to-date financial struggles of people. It’s our responsibility to choose the right plan that would serve us in sudden medical emergencies.

Cashless Facility

During hospitalization Cashless Facility means the insurer (Health insurance Co.) pays directly to the Network hospital for treatment of the Insured (Policy Holder) as per the Policy Conditions.

How does a cashless claim work?

During an Emergency / Planned hospitalization at empaneled Networked Hospitals, treatment cost is paid to hospital directly by the insurance company.

• Star health insurance has a qualified in-house claim settlement team without any third party involvement.
• Approach the insurance desk at a network hospital.
• Intimation can be given either through contacting us at 1800 425 2255 / 1800 102 4477 or e-mail us at support@starhealth.in
• Obtain a Claim number
  a) Planned Hospitalization can be intimated between 7 to 10 days in advance.
  b) Intimation for Emergency Hospitalization within 24 hrs of hospitalization
• The insurance desk at the hospital will send the required documents for cashless request online to Star via Hospital Portal.
• You will get notified about the approval and the insurer will settle the bill with the hospital.
• In case if it gets rejected, you may need to pay the bill by yourself.

Reimbursement Claim

A reimbursement claim means settle the hospital bill from out-of-pocket and then apply for reimbursement from the insurance company.

How does reimbursement work?

Documents to be submitted for Reimbursement claims;

• Duly completed claim form
• Pre Admission investigations and treatment papers
• Discharge Summary & Final Bill from the hospital
• Cash receipts from hospital, chemists etc
• Cash receipts and reports for tests done
• Receipts from doctors, surgeons, anesthetist
• Certificate from the attending doctor regarding the diagnosis
• Copy of PAN card, Cancelled cheque or NEFT Details
  On getting discharged, submit all the above mentioned documents to your insurance company within stipulated period. On approval, a direct amount will be credited into your account.

 Reasons why your claim could be rejected

• A claim for Time Bound / Permanent exclusions in a health insurance plan
• If Material Facts, are Non-disclosed / Mis – Represented / Fraudulent claims
• Claims from Excluded Provider (only Payable  during a Life threatening situation / accident up to the stage of stabilization )
• If you fail to submit the documents required for the claim

Comparison between Cashless and Reimbursement claim

 Which is better: Cashless or Reimbursement?

In-patient hospitalizations in India turn out to be expensive, regardless of even the minor surgery or treatment.  Ensure to have a good understanding of your health insurance plan during the time of purchase. Be prepared to face health issues in this fast-pacing environment. Hence, it is always good to take precautions that would serve the purpose of Medical exigencies.

As per expert opinion having health insurance is a must, the two modes of payment towards hospitalizations expenses are well accepted. It is clearly understood that either Cashless or Reimbursement would be the best ways to handle medical emergency.