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Health Insurance Claim Process - Cashless Claim & Reimbursement Claim in Medical Insurance

What is a health insurance claim, Types of health insurance claim process - cashless claim, reimbursement claim. Documents required.

FAQs on the health insurance claims process

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What are the 2 types of health insurance claims available?

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The two types of health insurance claims are cashless claims and reimbursement claims. A cashless claim is where the insurer settles the claim amount directly to the network hospital. In a reimbursement claim, the policyholder settles the claim amount out of his/her pockets and later the insurer settles the bill to their bank account. 

How is claim settlement done in health insurance?

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The process for settling health insurance claims is as follows:

  1. The policyholder initiates a health insurance claim. If admitted to a network hospital, a cashless claim can be initiated; otherwise, a reimbursement claim is initiated.
  2. For cashless claims, the insurer settles the claim directly with the network hospital.
  3. For reimbursement claims, the policyholder submits necessary documents like claim forms and discharge summaries to the in-house claims team or Third-Party Administrator (TPA) for verification. Once approved, the claim amount is directly settled into the insured's bank account.
  4. Claims must be filed within 30 days of hospital discharge and must be intimated at least 4 days before planned hospitalization.
  5. The insured is responsible for all expenses not covered under their health insurance policy.
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