cashless health insurance policy it is exactly that - cashless. The policy
holder makes no payment and the insurance company settles the bill. In a
reimbursement plan the policy holder pays the bills and the insurer pays him
when he files a claim.
With a cashless health policy the choice of hospitals is
limited, as you have to be admitted to a hospital which comes under the
insurer's network. When you choose a hospital within the network the bill will
be settled directly. When a policy holder chooses a hospital outside the
network he will first clear bills and claim later.
reimbursement policy will allow you the choice of hospital and after you pay
upfront the claims will be reimbursed.
cashless policy is a real boon when a person is low on cash reserves, you can
manage without emergency cash, as when you use a network hospital, the
insurance company makes all the payments.
reimbursement plan you will need to pay first even if your funds are limited,
and later file a claim and wait for the reimbursement.
In a cashless plan the policy holder will
make use of the best hospital, with expensive rooms, since he need not pay. But
the insurer can charge higher premiums from the policy holder. This is not the
case with reimbursement plans as he will choose affordable care, since he will
be making all payments, before he can claim from the insurer.
reimbursement plan, the policy holder has to retain all the bills, test reports
and doctors bills. The claim will have to be first made and will be settled
after a month. With a cashless card the insured can receive immediate treatment
with it. The third party administrator (TPA) mediates to ensure a smooth claim
settlement. Emergency cases are cleared within 6 hours and others within 4
days. The TPA can be informed earlier for pre-planned medical procedures.
Hannah Punitha (IRDA
Licence Number: 2710062)
Yohannan, March 2013