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Bharti AXA General Insurance is now part of ICICI Lombard General Insurance.

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What is Cashless Claim Settlement?

Get to know what Cashless Claim Settlement is, how it works and its benefits, including no out-of-pocket expenses, quick and easy process, and convenience in case of emergencies.

  • 27 Jan 2023
  • 3 min read
  • 1909 views

When you claim insurance—be it health or motor insurance—in the face of an emergency, your choice of claim settlement method plays a key role in determining how you feel about your policy. You invest in insurance for the assurance of financial support in your time of need. Cashless claim settlement takes the relief a notch higher by letting you focus on the crisis at hand rather than worrying about arranging for funds at the moment. Confused? Don’t be. Here’s all you need to know.

What is cashless claim settlement?

As a policyholder, there are two ways you can make a claim—cashless claim settlement and reimbursement claim settlement.

• Cashless claim settlement

Remember, you can avail of this benefit only at a network hospital or garage for health and motor insurance, respectively. Based on your policy terms, with cashless treatment, you can seek treatment at a network hospital or get your vehicle repaired at a network garage without paying anything out of your pocket. All you need is your insurance card and policy details. Your bills will be settled by the insurer with the hospital or garage directly.

• Reimbursement claim settlement

Reimbursement claim settlement is primarily used in cases where the insured either cannot access or wish to seek service at a network hospital or garage. Most insurance policies allow you to utilize the services of a network hospital or garage of your choice. However, in such situations, you must pay the bills upfront and later claim reimbursement from the insurer. To claim reimbursement, you will have to submit the original documents, bills, reports etc. along with the duly filled-up claim request form. Once your documents are verified, the reimbursed amount is transferred to your bank account by the insurer.

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How does cashless claim settlement work?

Given below is the cashless claim settlement process for health insurance:

  • In case of a medical emergency, get admitted to a network hospital.
  • Every network hospital has an insurance desk. You can get all the information regarding claim settlement here.
  • Ask for a pre-authorization at the insurance desk. Or, get a declaration from the Third Party Administrator (TPA). Get a printout of the same.
  • Submit the necessary form along with the pre-authorization letter or the TPA declaration.
  • You will get an email confirming coverage and the maximum sanctioned amount.
  • Once the treatment is completed, if the bill incurred is within the limits of the sanctioned amount, you will not have to pay a rupee. If the bill exceeds the limit, you will have to pay the extra amount.

Before choosing the cashless claim settlement method, look for your options for network hospitals and garages. When buying a policy, make sure your insurance company has a wide network of these facilities.

Furthermore, check the health insurance claim settlement ratio of the company as well. Every year the IRDA publishes the claim settlement ratio of all insurance companies registered under it. Always choose an insurance company such as ICICI Lombard that has a long record of consistent financial credibility. You can check the ICICI Lombard Claim Settlement Ratio either on its official website or the list of IRDA Claim Settlement Ratio 2022 report.

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