Medical treatments and interventions, whether it is planned or emergency, requires a considerable spending. They can take a toll on people’s savings and hinder their financial stability. The cost of healthcare in India has been on the rise due to various factors including medical inflation.
To tackle hefty medical bills and minimize the out-of-pocket spending Health Insurance becomes essential. Understanding its significance, nowadays, an increasing number of people opt for Health Insurance. Yet there are many people who still hesitate to invest in Health Insurance. The reason for this hesitation can be attributed to various misconceptions revolving around claim settlement by Health Insurance companies, among others. Hence it is essential to know about how claim process works, what are the different types of claims, etc. as this will help minimize last minute hassles.
There are two types of claims in Health Insurance – Cashless Claims and Reimbursement Claims. Knowing how each one of that works will come in handy at times of need.
Cashless Claim
It is a type of Health Insurance claim in which the Insurance company will directly settle with the hospital. Thus policyholders do not have to spend for medical bills from out-of-pocket. The cashless claim can be availed for both planned hospitalisation as well as emergency hospitalisation. But it is crucial to remember that such claim can be availed only if the treatment is taken in a Network Hospital. This is where many people face troubles during claim settlement.
Every Health Insurance company has tie-ups with a group of hospitals known as Network Hospitals. These hospitals will usually be listed on the official website of the respective Health Insurance companies. People can also get such information from the intermediaries and Health Insurance agents.
For planned hospitalisation, the policyholder can inform the insurer about the hospital admission typically from forty-eight to seventy-two hours in advance. However, no prior information needs to be given to the insurer in case of emergency hospitalisation. But it must be communicated to the insurer within 24 hours of the hospital admission.
Cashless claim facility is indeed one of the biggest benefits in Health Insurance. While purchasing a Health Insurance policy, it is wise to choose the insurer who has a wide network of hospitals as people do not have to have a hard time in finding the company’s network hospitals to avail cashless treatment. In that regard, Star Health and Allied Insurance Co Ltd., has an extended network of over 14,000+ Network Hospitals spread across the country ensuring quality health care to people. It is important to know that cashless hospitalisation is available for Group Health Insurance policy as well.
Reimbursement Claim
There may be times when people have to undergo treatments in non-network hospitals either due to some situations or lack of awareness. These are the hospitals with which the Health Insurance companies do not have tie-ups, and people cannot avail cashless treatment facilities in those hospitals. However, still they are eligible to make claims in the form of reimbursements. The policyholder initially has to pay the hospital bills and request for reimbursement by submitting necessary documents including the proof of hospital bills as required by the insurer.
To sum up, the knowledge about Health Insurance claims is crucial to avoid claim rejections and other claim-related troubles. Cashless claims can come in handy when getting admitted to network hospitals, whereas, in case of hospital admission in non-network hospitals, the policyholders can get coverage in the form of reimbursements. To avoid any last-minute hassle and rejection of cashless claims, it is better to check the network hospitals in and around your locality.
