Medical plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim against an event that is covered by the insurance policy. Following are two claim processes:

Expense Reimbursement:

Health insurance policies provide the insured with the benefit of getting their medical expenses reimbursed by the insurer, based on the policy terms documented. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon's fees etc. are paid back to the insured at the time of claim. The insured pays the (hospital) expenses, but gets reimbursed by the insurance company.

Cashless Treatment:

Insurance companies provide policyholders with a wide network of hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured, since the clause involves a mutual agreement between both the parties, i.e. the insurer and hospital. In contrast, availing cashless benefit requires TPA approval.

The insured can also show the insurer-issued health card at the particular hospital as a proof of medical insurance cover along with a valid government ID. Following cases considered for cashless treatment:

Planned Hospitalization:

In case of planned hospitalization, to avail health insurance benefit the policyholder needs to have TPA approval in advance along with other mandatory documents. Fill the pre-authorization form at the hospital signed by the treating doctor(s).

Emergency Hospitalization:

Show the health card issued by the insurer at the hospital along with the appropriately-filled pre-authorization form to get TPA approval for emergency hospitalization. If you fail to get TPA approval, get the expenses reimbursed later. The policyholder might have to show itemized bill, proof of medical expenses, discharge bill etc., as the proof of the treatment availed to avail claim reimbursement.