Difference Between a Cashless and Reimbursement Claim in Health Insurance
Cashless vs reimbursement claim in health insurance refers to two different ways of managing eligible hospitalisation expenses. Under a cashless claim, the insurer settles eligible medical bills directly with a network hospital, subject to policy terms and approval. With a reimbursement claim, the policyholder pays the hospital bills first and submits the required documents to the insurer for eligible expenses.
Understanding cashless vs reimbursement claims in health insurance can help policyholders compare how each option works. Cashless treatment can reduce the need to arrange a large amount of money upfront when care is received at an eligible network hospital. Reimbursement offers flexibility when treatment takes place at a non-network hospital, provided the hospitalisation and expenses meet the policy conditions.
The difference between cashless and reimbursement claims depends on the hospital, policy terms, approval requirements and documentation. Knowing these differences in advance can help individuals understand the procedures involved and prepare for potential medical expenses.
This guide explains cashless vs reimbursement claims in health insurance, including their key differences, required documents, processes and factors to consider when choosing between the two options.
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
| Cashless | Reimbursement |
| Cashless health insurance is where the insurance company settles your medical / treatment bills with the hospital directly | A reimbursement is a process where you settle the medical bill out-of-pocket and get it reimbursed from the insurance company. |
| Cashless facility is only available in networked hospitals. | Can avail reimbursement of Treatment expenses in any hospital across India. |
| Stress Free from arranging the Medical / treatment expenses | Pay medical / treatment bills first and later reimburse |
| Hassle-free | In Remote Places networking of hospitals will be a challenge, Saving Health and Life will be a Priority. |
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.
FAQs
In a reimbursement claim, you pay the hospital bills first and then submit the required documents to get reimbursed by the insurer. This usually applies when treatment is taken at a non‑network hospital.
Some products adjust cumulative bonus after claims. You can check how this applies to your policy by raising a request in the STAR Health App.
No, each claim is evaluated independently.
The main difference between cashless and reimbursement claims is who pays the hospital directly. In a cashless claim, your insurer settles bills directly with network hospitals within a few hours. Primarily available at network hospitals; exceptions may apply in emergencies and if applied for cashless anywhere, as the insurer facilitates and the provider agrees. In reimbursement claims, it takes up to 7-30 days. They can also be used for network hospitals if cashless isn’t used. You pay the hospital upfront and later file for a refund, which is especially useful for non-network hospitals.
Yes, cashless and reimbursement claims differ significantly in hospital eligibility. Cashless claims require treatment at network hospitals for direct settlement. On the other hand, reimbursement claims give flexibility for treatment at any registered hospital, but you need to pay upfront and claim the expenses later with your insurance provider.
Yes, generally, documentation is different for cashless and reimbursement claims. Cashless requires pre-authorisation forms and minimal administrative formalities upfront, focusing on fast approvals. Conversely, reimbursement requires extensive documentation, including all original bills, reports, and discharge summaries submitted post-treatment to claim a refund.
Cashless claim process is faster as compared to reimbursement process. Former claims are approved within a few hours to 1 day, while reimbursement takes up to 7 -30 days to be processed. This is why a cashless claim is generally good due to its convenience, seamless processing and financial relief.
Yes, a cashless claim can be converted into a reimbursement claim. If a cashless facility is denied or not used, you can settle the hospital bills upfront and submit the original documents for reimbursement. This involves final bills, discharge summary, and claim form submission for claim refund.
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The information provided on this page is for general informational purposes only. Availability and terms of health insurance plans may vary based on geographic location and other factors. Consult a licensed insurance agent or professional for specific advice. T&C Apply. For further detailed information or inquiries, feel free to reach out via email at marketing.d2c@starhealth.in
