Not happy with your current health insurer? You don’t have to start from scratch. I
When you are admitted to a hospital, the last thing you want is confusion about how your insurance will pay. India’s health insurance system offers two settlement routes: cashless and reimbursement. Knowing the difference and when each applies can make a genuine difference at a stressful time.
How Cashless Claims Work
You are admitted to a hospital in your insurer’s network. You show your health card or policy details, the hospital verifies your coverage with the insurer, and the insurer pays the hospital directly for eligible expenses. You pay only what the policy does not cover: deductibles, non-covered items, amounts above sub-limits, or room rent excess.
Most leading insurers have networks of 5,000 to 15,000+ hospitals across India. For planned hospitalisations, confirm your hospital is in the network before admission. The insurer or their TPA must be notified at least 48 hours before a planned admission.
How Reimbursement Claims Work
If you are treated at a non-network hospital by choice or in an emergency , you pay the full bill yourself and claim reimbursement later. You submit original bills, discharge summary, diagnostic reports, prescription records, and the completed claim form. The insurer reviews and settles the eligible amount, typically within 15 to 30 days.
Reimbursement gives you the flexibility to go to any hospital, but you need the funds upfront and must preserve all original documents carefully.
When to Use Each
For planned admissions ,surgeries and scheduled procedures always try to use a network hospital for cashless. It is simpler and avoids a large cash outflow. For genuine emergencies, get admitted wherever is best for your health first, and worry about the paperwork later. Most policies require emergency cashless notification within 24 hours of admission.
Why Reimbursement Claims Get Delayed
RDAI’s portability rules allow you to switch to a different insurer at renewal time without losing the waiting period credit you’ve already built up. Here’s how it works.
What Portability Actually Means
Missing original bills, no discharge summary, documents not matching the insured’s name, or incomplete claim forms are the most common causes of delays. Keep a complete file of all documents from admission through discharge. Do not let discharge papers and bills get scattered across WhatsApp messages , gather them physically before leaving the hospital.
Want a health policy with a reliable cashless network in your city? Draco Insurance can help you find the right plan. Visit dracoinsurance.in or call +91 7064106417.
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