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What is Reimbursement Claim in Health Insurance?

Having health insurance in your investment kitty ensures that at no point is your family thrown into dire financial straits due to any medical emergency in the family.

One of the essential features of health insurance is Claim Settlement since its primary purpose is to provide financial support during a medical emergency.

There are two main types of health insurance claims: Cashless and Reimbursement. In this article, let's discuss a Reimbursement Claim in detail.

Reimbursement Claim refers to the type of claim wherein an insured must pay for the medical costs and treatment out of their pocket and later claim the bill from the insurance provider. For this kind of claim, the insured can visit any hospital for treatment and not necessarily the empanelled cashless hospital.

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Features and Benefits of a Reimbursement Claim

There are several benefits of a Reimbursement Claim in Health Insurance.

Let's have a look at the most common features and benefits of a Reimbursement Claim in Health Insurance:

How to file a Reimbursement Claim?

If you wish to opt for a hospital of your choice that might not be empanelled with your insurance provider, you can use the Reimbursement Claim facility. You can avail of the medical treatment first, settle the bills and then apply for a reimbursement claim from your insurance provider.

Here are the significant steps involved in making a reimbursement hospitalisation claim with most of the insurance providers:

Step 1: Inform your insurance provider about the treatment and the medical centre.

Step 2: Avail your treatment and settle the bills out of your pocket.

Step 3: Apply for the claim with your insurance company.

Step 4: Share all hospitalisation-related documents like health invoices, medical bills, doctor's prescriptions or any other relevant information.

Step 5: The insurance company will verify your documents. Your claim will be settled as per your policy and the scope of coverage.

At Digit, let us know in case of hospitalisation within two days of admission at 1800-258-4242 or email us at healthclaims@godigit.com, and we'll send you a link where you can upload your hospital bills and all relevant documents to process the reimbursement.

Documents Required for the Reimbursement Claim

Although the exhaustive list might differ across insurance providers, here is a list of the most common documents required for a Reimbursement Claim:

Duly filled and signed claim form
All original hospital bills, including prescriptions and pharmacy receipts
Diagnostic and Lab Reports
Medical Certificates signed by the doctor
Original Discharge Summary
FIR or Medico Legal Certificate if it's the case of an accident

Factors You Should Consider Before Opting for Reimbursement Claim

Medical Reimbursement Claim might be a good option considering the flexibility that it provides in terms of selecting the medical centre for the treatment. We can choose any desirable hospital, not just the empanelled hospital, for the treatment.

However, while opting for a reimbursement claim or selecting a non-network hospital, one must consider a few points as listed below:

1. The Validity of Your Health Insurance Plan

It is of utmost priority to note your health insurance tenure and expiry date to ensure that you are not left without coverage when you need it the most.

2. The Scope of Your Coverage

You must carefully review your health insurance policy document and note all the exclusions and inclusions. When you have clarity on the extent of coverage from your health insurance, you can better plan your treatment and the claim process.

3. The Coverage and Waiting Period for Specific Diseases

All health insurance plans do not cover certain pre-existing diseases and medical conditions. Even if some insurance companies provide coverage for these, there might be a certain waiting period before the said coverage becomes active. Some companies might also provide you with an option of covering these by purchasing the relevant Add-on. Knowing the specified waiting period and exclusions make you better prepared for your treatment.

4. Check Your Funds Availability

In a reimbursement claim, you must check your funds' availability while planning for the treatment since the initial payment is made from pocket.

5. Keep Your Documents Secure

Keep a track of all the original documents- the bills, prescriptions, receipts, and all other documents necessary to file a claim.

FAQs about Reimbursement Claims in Health Insurance

All

How long does it take for the reimbursement claim to be processed?

The insurance company might take 2-4 weeks to process your reimbursement claim.

Is a health insurance reimbursement claim taxable?

No. The reimbursement claim received from your insurance provider is not taxable since it is not an income or a profit for the insured.

What is the advantage of a Cashless claim over a than Reimbursement claim?

Overall, yes.

A Cashless Claim Process is better than the Reimbursement Claim Process under health insurance because of the convenience attached to it.

During a medical emergency, when the patient and family members are already under stress, a cashless claim takes the toll off their head by paying the expenses. However, in case of a reimbursement claim, the expenses, at that time are to be borne by the patient or family and are only reibursed later.

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Disclaimer #1: *Customer can choose options at the time of availing insurance. Premium amount may vary accordingly. Insured is required to disclose any pre-existing condition or on going treatment before policy issuance in the proposal form.

Disclaimer #2: This information is added only for informative purposes and collected from different sources across the Internet. Digit Insurance is not promoting or recommending anything here. Please verify the information before making any decisions.

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CIN: U66010PN2016PLC167410, IRDAI Reg. No. 158.

Go Digit General Insurance Limited (formerly known as Oben General Insurance Ltd.) - Registered Office Address - 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, City Survey No.1579, Shivaji Nagar, Pune-411005, Maharashtra | Corporate Office Address - Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru-560095, Karnataka | Trade logo of Go Digit General Insurance Ltd. displayed above belongs to Go Digit lnfoworks Services Private Limited and is provided and used by Go Digit General Insurance Ltd. under license.