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Difference Between Cashless and Reimbursement Claims

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The uncertain times we’re living in, the ongoing pandemic, and our lifestyle necessitates health insurance purchase. Health insurance provides financial cover for the insured and their loved ones in any hospitalization expense. To aid people with the same, numerous insurers are offering a different mix of policies, providing comprehensive coverage and a variety of advantages that can help during financial emergencies.

There are various reasons to choose a policy, from coverage to procedure and network of the insurer. Another factor that one must carefully understand while selecting a policy is how claim settlement is offered by the insured.

There are two types of claim settlement processes offered:

Cashless claims – Here, the insured can avail of the necessary treatment at the insurer’s network hospitals without any upfront payment. The same features remain applicable within the parameters of the insurance policy and up to the sum insured. Cashless features can be availed with minimum documentation and faster approvals.

Reimbursement claims – Here, the treatment can be availed as per the terms of the policy and up to the sum insured by paying the cost of the treatment by the insured. The cost of treatment within the policy parameters can be claimed in reimbursements. For reimbursement, the insured must file necessary documentation, like claims forms, hospital documentation, original consumable bills, etc. On successful verification, the insured receives the claim amount.

Major points of difference between the two types of claims:

Network of Hospitals πŸ₯

Cashless claims can only be availed at the facility on the insurers’ network. The insurance company covers all the expenses within the policy parameters when intimation is provided by the insured as per the set guidelines.

For reimbursements, the insured can avail of the treatment at any hospital if the treatment is within the scope of the insurance. On filling in all the necessary documentation and successfully verifying the same, the insurer’s claim gets approval.

Payment for Treatment Expenses πŸ’³

On availing, cashless benefits, the insured can avail of the treatment without shelling out cash for treatment expenses. All the costs incurred for the insurance company directly settle treatment until the same is within the scope of the insurance policy chosen.

For reimbursements, the insured must pay the hospital bills and then file for claims in the required format with the insurance company. Upon successful completion of the claim settlement process, the insured gets reimbursed for the claimable expenses.

Claim Process πŸ“„

For choosing the cashless option, the insured must inform the insurance company in advance and file for a claim, after which the insurance company directly settles hospital bills.

A reimbursement has to be filed post-treatment with all the bills, original and verifiable receipts for treatment.

Time ⏲️

Cashless claims are generally quicker when compared with reimbursement.

Flexibility πŸ’ͺ

To avail of cashless benefits, the insured has to opt for treatment at a hospital within the insurance company’s network. 

Reimbursement claims can be made for treatment availed at the hospital of choice by the insured, and then with verifiable proof of treatment, the same can be claimed.

When it comes to choosing a policy based on benefits and ease associated, insurance offering cashless benefits certainly has an edge. Hospitalizations are when one already has so many burdens and stress; adding financial stress can be a bit much. A cashless option enables the insured to avail of the treatment with a lot more ease.

Health Insurance policies have various features, and choosing a policy based on merits requires one to use expert help. They are helping hands that can make you understand the minute difference between the policies and fine-tune the selection process to arrive at a solution.

An organization wishing to provide health cover to its employees requires an expert service that can enable them to devise a plan to arrive at a solution best fitted to the organization. This solution should follow the parameters along with high-quality insurance. Plum Insurance provides a mediclaim policy with no hidden costs, no surprises, and no out-of-pocket expenses.

Benefits of using Plum Insurance

  • Dashboard: A dashboard from where employers can access all the required information and make the necessary modifications as and when required.
  • Chat-based support: Plum Insurance provides a claim filing facility over WhatsApp that makes usability an excellent experience.
  • Flexibility: The Plum Insurance dashboard can be used over any device, which provides employers greater flexibility.

When there is a need to understand the difference between policy terminology and the solution that will best fit, an expert like Plum can help the corporation do wonders in their health plans. Plum Insurance adds to policy features by providing additional wellness facilities from time to time. These facilities allow the employees to maintain a healthier course through optimal consultation facilities and therapist facilities.

Let’s give our team the cover they deserve.


What is a cashless claim?

The cashless claim is a health insurance feature, which enables the insured to get treatment at an insurance network hospital without any upfront payment.

How do I claim cashless benefits?

To avail of cashless benefits at a network hospital, file your claim along with a health insurance card and the required paperwork. The person handling insurance at the hospital help desk will coordinate for the pre-authorization.

How do I claim Insurance reimbursement?

After completing your treatment, you must file for reimbursement within the stipulated time and format. For reimbursements, all the medical papers and certificates related to the treatments must be furnished. On verification of the same by the insurance company, claims get approval.

Which is better for the insured cashless or reimbursement option?

The whole purpose of buying health insurance is to lessen the financial burden in times of need. As a cashless option provides more excellent relief over reimbursement, the cashless option is preferable.

What can an Insured do to make the claim process easier?

Insured can file for claims as quickly as possible to ensure a smooth claim settlement process. Even in a cashless claim, a pre-authorization can be taken as early as 15 days before the treatment procedure.

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Hi everyone! I'm a growth marketer at Plum Insurance. I specialise in crafting functional and structural articles for search engine optimisation. I joined the insurtech space in 2018 and have been writing ever since. Also, I'm fluent in intermediate Python 🐍 as well.