If you have availed health insurance, you must know the claim settlement process in insurance firms. The insurer has 2 ways of claim settlement in a health insurance plan.
A) The cashless mode
B) The reimbursement mode.
The cashless claim is a facility where the insurance company directly settles your medical bills with the hospital. This facility is offered by the insurance company when you avail medical treatment at a preferred provider network (PPN). What is PPN? A PPN is a hospital that has a tie-up with the insurer also called a network hospital. Health insurance policyholders may avail the benefit of the cashless claim for both unscheduled and scheduled medical treatments.
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See Also: Health Insurance Benefits
If you are admitted at a non-network hospital, you would have to make the reimbursement claim. Reimbursement claims are considered to be the conventional way of settling medical bills. Such claims are slow. In most cases, cashless claim facilities are used.
See Also: Family Health Insurance Plan
Cashless health insurance policies cover inpatient care, pre and post-hospitalization expenses, domiciliary treatment, travelling expenses and other aspects. The premiums paid qualify for tax benefits under Section 80D of the IT Act, 1961. Claims are settled instantly.
To avail a cashless claim, the insured must be treated at a network hospital. The biggest benefit of reimbursement claims is that they enable customers to get treatment at preferred hospitals. Reimbursement claim is processed only after collecting the required documents and bills. Insurers delay payments when the documentation is improper.
What is a third-party administrator?
A third-party administrator (TPA) is an intermediary between the insured and the insurer. TPA must be licensed by the IRDA.
What is network and non-network hospitalization?
When the policyholder gets hospitalized at a network hospital, it is called network hospitalization. On the other hand, if the policyholder gets hospitalized at a non-network hospital, it is called non-network hospitalization.
See Also: Exclusions of Health Insurance Policy
Will I be able to avail the cashless facility within 30 days of policy commencement?
Most Health insurance policies are offered after an initial waiting period of 30 days. The initial waiting period differs from insurer to insurer.
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