What is Cashless vs Reimbursement in health insurance?
Cashless and reimbursement are the two ways a health claim is settled. In a cashless claim the insurer pays the network hospital directly, so you leave paying only deductions and non-payable items. In reimbursement you pay the hospital yourself first and then claim the money back from the insurer by submitting the bills, discharge summary and documents.
In plain English
Cashless means the insurer pays the hospital directly (at network hospitals only). Reimbursement means you pay first, then send in the bills to get your money back.
A quick example
On a ₹3,00,000 bill at a network hospital, cashless means the insurer pays the hospital directly and you cover only, say, ₹20,000 of non-payable items. At a non-network hospital you'd pay the full ₹3,00,000 yourself and claim roughly ₹2,80,000 back afterwards.
What IRDAI says
IRDAI's 2024 Master Circular on Health Insurance requires insurers to grant final cashless authorisation at discharge within 3 hours of the request, and is driving the industry toward cashless settlement at all hospitals.
Related terms
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Cashless normally works only at your insurer's network hospitals. IRDAI's 2024 'Cashless Everywhere' push aims to extend it to non-network hospitals too, subject to the insurer's approval.
After you submit all bills and documents, insurers typically settle reimbursement claims within a few weeks; the 2024 Master Circular requires faster, time-bound processing.
A cashless denial doesn't mean the claim is rejected. You can pay the hospital and file a reimbursement claim later using the same documents.
Reviewed by
Atul SharmaAVP, Founder’s Office at CoverSure · 7+ years in insurance (ex-Tata, Ditto, Cholamandalam)
