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Cashless & Reimbursement Hospital Claim, on health insurance,

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Here is all you need to know

Today, most Health Insurance policies do offer cashless hospitalization facility. In case of hospitalization, if you get admitted to Hospital you will be eligible for cashless hospitalization, subject to the other terms and conditions mentioned in your policy being fulfilled.

Cashless hospitalization is a facility provided by most health insurance policies and enables an insured customer to obtain admission and undergo the required treatment without a direct payment.

First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf.

There are two facilities, the cashless mode and the reimbursement mode

 

• Cashless mode

With this facility, the insured is not required to pay for the treatment except for the non-medical items. This is a direct mode of claims settlement where the insurance company settles the payment directly with the hospital depending on the insurance policy terms and conditions.

In order to take advantage of the cashless claims benefit, a customer needs to follow below mentioned procedure:

1. In case the hospital admission is planned, a customer needs to take a pre-authorization from the insurer, which includes sharing treatment and its corresponding expense details with the insurance company through the hospital.

2. Once you connect with your insurance company, they will inform you about the documents that may be required. Post sharing these documents and medical details with the insurer, it evaluates the treatment details as per policy terms and conditions and informs the concerned hospital and insured.

3. The customer needs to produce following documents at the Ruhunu hospital in addition to the documents that are specified by the insurer:

a)Pre-Authorization Letter or

b) ID card issued by the insurance company

4. Once the treatment is done and the customer has availed the cashless facility, the original bills and treatment evidence should be left with the hospital. The hospital shares these bills with your insurance company and accordingly payment is processed by the insurer to the hospital.

5. The customer can request for cashless hospitalization by producing the insurance card provided by the insurers.

6. Once the customer makes this request, hospital connects with the insurance company by filing the pre-authorized request form and consequently the insurer issues an authorization letter to the hospital and also shares details pertaining to the policy coverage of the customer.

7. Once the treatment is over, the insurer will then settle the payment of admissible claims.

 

• Reimbursement mode

Another process that one can option for settling a health insurance claim is the reimbursement mode. This situation mostly arises when a patient choosesthe hospital as per his choice and convenience and the hospital is not empanelled with the insurer. In such scenarios, a policy holder has to make the payment for all the medical bills that are related to the said treatment and later on files the claim for reimbursement.

The reimbursement procedure is usually as follows:

1. The insurance company evaluates the documents and maps it against the policy coverage.

2. The customer is required to provide necessary documents along with the original medical bills to the insurer at the time of claim filing. These documents typically include a claim form, bank details, ID Cards, hospital discharge summary, investigation and diagnosis reports and bills, original hospital and pharmacy bills along with paid receipts and prescriptions. Additionally, in case of an accidental hospitalization.

3. Post the evaluation, the insurance company makes the payment to the beneficiary as per policy term

 

 

Insurance Companies We Work With

Local Companies

  • AIA Insurance Lanka PLC
  • Allianz Life Insurance Lanka Ltd
  • Amana Takaful Insurance
  • Arpico Insurance
  • Ceylinco Insurance
  • Co-operative Insurance Company Ltd
  • Employees' Trust Fund Board
  • Janashakthi Insurance Co. Ltd
  • MBSL Insurance Co. Ltd
  • Medilink Lanka
  • People's Insurance - Health Care
  • Sri Lanka Insurance
  • Union Assurance Limited PLC
  • Fair fist insurance
  • Soft logic life insurance.
  • National insurance trust fund(Agrahara)

and more...

Foreign Companies

  • Asia Rescue & Medical Services (Pvt) Ltd
  • Ceylon Foreign Insurance Assist
  • East West Rescue
  • Lanka Assist
  • South Asia Gateway Terminals
  • SOS International

and more...