Cashless vs. reimbursement claims

Cashless claims

At a network hospital, the hospital coordinates with the insurer or its claims administrator. Once the request is approved, eligible expenses are settled directly, and you pay only what the policy doesn’t cover, such as non-payable items or co-payment.

Reimbursement claims

You pay the hospital yourself and then submit bills and documents to the insurer. After assessment, eligible amounts are reimbursed as per the policy. This is the route for non-network hospitals — and a fallback if cashless approval isn’t given.

Planned vs. emergency

For planned treatment, insurers usually expect advance intimation. For emergencies, inform the insurer as soon as practical after admission. Check the time limits in your policy.

Documents to keep ready

• Policy copy or health card and photo ID
• Doctor’s prescription and admission note
• All hospital bills, receipts and pharmacy invoices
• Diagnostic and investigation reports
• Discharge summary

Who decides a claim?

Claims are assessed and decided by the insurer according to the policy terms. We can help you understand the process and gather documents, but we cannot guarantee any claim outcome.