Health insurance has become important part of financial planning. We try to monitor and manage our finances as closely as possible, but an unexpected medical emergency can throw you out of your path. At such times, a health insurance cover is your only resort to ensure timely and quality treatment.

Using a health insurance cover, you can ensure your present lifestyle can be sustained even after an emergency hospitalisation. The wide range of policies can be purchased to suit different health requirements. Here, one can get coverage for life-threatening diseases using a critical illness cover, at the same time, including any pre-existing ailments. Moreover, these premiums have tax benefits under the Income Tax Act, 1961 as an icing on the cake.

There are primarily two ways a claim can be filed under your health insurance plan – cashless or reimbursement method.

Cashless Method

As the name suggests, the insured can avail the facility of cashless hospitalisation. The only caveat is the treatment needs to be availed from a medical facility among the network hospitals. The insurer shall provide a card, either in physical form or electronic form that proves the policyholder is covered under the insurance policy. This card needs to be presented at the time of hospitalisation or availing any treatment, and the insurance company will settle payments on your behalf.

The process for filing a claim differs in case of an emergency or planned hospitalisation. Let us look at the different methods –

In case of Planned Treatment

In the case of planned hospitalisation, the process is straightforward. A prior intimation needs to be provided to the insurer to avail cashless treatment. The number of days before such intimation varies according to the terms and conditions of your policy. This intimation can be either sent via post, e-mail or fax. Any further information regarding the coverage of diseases under cashless cover along with any sub-limits can be found in the policy document. Also, you can contact your dedicated customer support number for additional information regarding the claim process.

On completion of the above procedure, your insurer will intimate the hospital where you wish to avail the treatment. The only requirement by the insured at this time is to carry the card insured by the insurance company.

In case of Emergency Hospitalisation

In times of emergency, the insured can approach any of the empanelled hospitals. This information is available on the policy documents or can be obtained by calling the insurance company’s helpline number. When you produce your identification card at the medical facility, the hospital will complete the cashless claim procedure by submitting a form to the insurance company. Next, the insurer issues an authorisation letter to the hospital where you are availing the treatment, and your hospital bills shall be taken care of. In case of rejection of the claim, it shall be intimated by the insurance company mentioning the grounds of rejection.

A cashless facility comes handy at various times, eliminating the need to arrange funds from your hard-earned savings. It is available across all major insurance companies, be it an individual health cover or family floater plan or even health insurance for senior citizens.

Reimbursement Method

A traditional way of insurance is the reimbursement method. As insurance operates on the concept of indemnity, the insurer pays the policyholder after checking the validity of the claim. Also, when you wish to avail treatment outside the list of network hospitals, the insurance company shall reimburse your expenses. Requisite documents like the medical bills and other costs involved in the treatment need to be provided to the insurer at the time of the claim. The scope of your policy is assessed to determine the validity of the claim, and subsequently, the amount is reimbursed. In case of critical illness insurance, the entire amount reimbursed is in the beginning or when the disease or ailment is identified. It is done so as the patient can avail the necessary treatment while supporting for any ancillary medical expenses.

The benefits or either cashless or reimbursement are more or less similar though one must opt for the choice of health insurance depending on their requirements. After all, health is the only sustainable wealth.