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How Does The Claim Settlement Process Differ For Cashless Medical Insurance Policies

Medical insurance offers a safety net for individuals and families – it helps to offset the financial burden that arises from unexpected health crises or long-term medical conditions. Among the various types of insurance, cashless medical insurance is gaining popularity due to its hassle-free claim process.

Understanding Cashless Medical Insurance

Cashless medical insurance works by collaborating directly with network hospitals, ensuring that the policyholder doesn’t have to bear the upfront costs of hospitalization. The insurance company directly settles the coverable medical expenses with the hospital. This smoothes out the otherwise complex process of getting treated, paying off the medical bills, and then filing a claim for reimbursement, a feature typically seen in reimbursement health policies.

Claim Settlement Process for Cashless Medical Insurance

The claim settlement process for cashless medical insurance starts when the policyholder or their family informs the insurance company about the hospitalization in a network hospital as soon as possible. The formal procedure often includes the submission of a pre-authorization form, detailing the nature of the medical condition, type of hospitalization – whether emergency or planned, and the estimated cost.

Once the insurance company approves the pre-authorization request, the treatment procedure can commence without the policyholder worrying about the billing. The insurer directly settles the billed amount (subject to the policy terms and conditions) with the hospital.

However, if the pre-authorization request gets denied, the policyholder can still go for the treatment and later file for a reimbursement claim. The claim settlement process, in this case, depends on the submission of all the original bills and documents related to the treatment.

Cashless Medical Insurance extending to Maternity Health Insurance

Many insurers offer maternity insurance as an add-on benefit to their health insurance policies. An individual can opt for this feature and enjoy the benefits of cashless treatment during both pre and post-natal stages. This could be highly beneficial considering the rising maternity costs.

At the time of the claim, the policyholder can follow the same cashless process, beginning with the pre-authorization form. By selecting a network hospital for delivery, the claim process gets smoother. Apart from hospitalization costs, maternity health insurance might also cover pre and postnatal expenses, newborn baby cover, and vaccination cover, amongst others, thereby helping families limit their financial burden.

Variation with Personal Accident Insurance

Now, let’s talk about personal accident insurance, another distinct insurance segment that provides financial protection against accidental death or permanent total disablement resulting from an accident.

Here, the settlement procedure differs significantly from cashless medical insurance. Firstly, cashless facility is not often an option available under personal accident insurance. Instead, upon the happening of an accident, the policyholder or their nominee must inform the insurance company and submit the necessary documents like the duly filled claim form, FIR or police report if applicable, and medical reports.

Upon successful verification, the insurance company then reimburses the claim amount. Unlike cashless medical insurance, no cashless facility with network hospitals is available, and neither is there a need for any pre-authorization form. In terms of policy benefits, it primarily provides lump-sum compensation on the event of accidental death or permanent total disablement.

Among the various types of insurance, cashless medical insurance is gaining popularity due to its hassle-free claim process. For a seamless experience, consider using the Bajaj Finserv app. Download Bajaj Finserv app to explore a range of medical insurance options and enjoy the convenience of cashless claims, ensuring you and your loved ones are protected without the stress of financial strain.


As a customer, understanding the nuances of various health insurance policies and their respective claim settlement processes empowers you to make informed decisions and choose a policy that best fits your needs. Cashless medical insurance plans offer hassle-free medical treatment, maternity health insurance policies provide financial coverage for maternity-related expenses, and personal accident insurance assists you in tiding over potential financial risks in the event of unfortunate accidents.


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