Definition
Reimbursement Claim
A reimbursement claim is when the policyholder pays the hospital first and later submits documents to the insurer to recover eligible expenses.
Reimbursement applies when treatment is at a non-network hospital, when cashless was not arranged, or for pre- and post-hospitalisation costs. The policyholder gathers the discharge summary, itemised bills, prescriptions and reports and files a claim within the insurer's deadline.
The insurer scrutinises the documents and pays the admissible amount after applying deductibles, sub-limits and exclusions. Reimbursement requires the patient to fund the cost upfront, so it is less convenient than cashless, but it is essential where the chosen hospital is outside the network.
Related terms
- Network HospitalA network hospital is a healthcare provider that has a tie-up with the insurer or TPA to offer cashless treatment to policyholders.
- Cashless ClaimA cashless claim is a settlement method where the insurer or TPA pays the network hospital directly, sparing the policyholder from upfront payment of covered costs.
- Claim IntimationClaim intimation is the act of formally notifying the insurer that a claim event, such as hospitalisation or death, has occurred, within the stipulated time.
Plain-English explainer from The Dispatch Investors Encyclopedia. General information, not financial advice.