Call us now to secure insurance coverage for health, motor, and more. Timing: 10:00 a.m. to 07:00 p.m. every day.
Chat with us on our WhatsApp number
Find quick answers to all your insurance queries from our self-help section.
Call us for any help with renewals or claims. Timing: 09:00 a.m. to 07:00 p.m. every day.
Join India’s leading general insurance company. Timing 09:30 a.m. to 06:30 p.m. Monday-Saturday.
Switch to Reliance General Insurance. Trusted by 5 Crore+ Indians
Sent to Edit
Resend OTP in 60 Seconds
Our Health Insurance Expert will contact you to provide you further details about credit score-based discounts.
However, a common discussion at the time of a claim is whether to go for a reimbursement claim or a cashless claim settlement. Understanding the relationship between health insurance and reimbursement claims is crucial for making informed decisions.
Reliance General Insurance offers a wide range of health insurance policies to cater to the specific needs of individuals, families and groups. The best part? All these plans offer the convenience of medical reimbursement online.
In this guide, let's understand what a reimbursement claim is, how it works, and what its benefits are.
100%* Claim Settlement
Cashless
Everywhere
Premiums start at ₹243/ month
Up to 35% off on Online Purchases
A health insurance reimbursement policy requires upfront payment of medical bills and then settlement of the claim from the insurer. It is one of two options offered by insurers for effective claim settlement.
The reimbursement meaning in health insurance is simple. It states the process of filing a claim after treatment and getting the applicable reimbursement after you clear the bills.
It starts when you get treatment at a hospital and make upfront payments until the insurer reimburses you for the incurred costs.
With a reimbursement health insurance claim, you are the primary person who pays the medical bills first. Once the bills are paid, you collect and submit the bills and file a claim with your insurer to get the expenses reimbursed to your bank account.
The medical reimbursement process is fairly straightforward. Health reimbursement is a crucial financial safety net that comes into play once you have paid the medical expenses.
Here is how a reimbursement in medical billing works.
Buy Health Reimbursement Plan - First, you buy a health insurance reimbursement plan that meets your specific coverage needs and budget.
Get Medical Treatment - Next, during medical emergencies for a covered event, you go to the nearest hospital for treatment.
Make Payment - Once treatment is over, you pay all the medical bills that are due upfront with your savings.
Document and Submit Claim - After payment is made, you collect all the medical bills, receipts, invoices, etc., and file a reimbursement claim with your insurer. You must submit all the bills to the insurer for verification.
Get Reimbursement - After evaluation, the insurer will reimburse you the applicable claim settlement amount in your bank account against your bills.
One of the top medical reimbursement features is the extensive financial protection you can avail of. From pre- and post-hospitalisation expenses, daycare procedures, and inpatient treatments to AYUSH treatments, ambulance charges, and more, you can file a health reimbursement claim for everything.
Another popular health insurance reimbursement benefit is the convenience of filing a reimbursement insurance claim with any type of health insurance policy. Whether you choose an individual plan, family policy, critical illness insurance, or a group plan, you can easily file a reimbursement claim online.
Many health insurance plans that offer reimbursement claim options also offer ample scope of customisation with a range of add-ons. These add-ons help you personalise your chosen health plan with specific coverage. This ensures you have the necessary financial protection via a reimbursement claim.
You can file a reimbursement claim at any hospital in India. This freedom of choice for hospitals ensures you get the necessary medical treatment quickly during emergencies. Alternatively, it also allows you to get specialised treatments from a known doctor.
You can easily file a reimbursement health insurance claim online, reducing the time and effort required for claim settlements. This streamlined process ensures quick filing and more efficient claims settlements.
In a reimbursement claim, you first pay the bills and then submit them for reimbursement. Thus, you benefit from complete transparency, as you know what bills you paid for and what reimbursement to expect from the insurer.
Reliance General Insurance offers numerous health insurance plans with different types of coverage for specific needs. With all our plans, you can file a claim for reimbursement without any hassle.
Our online process for filing a reimbursement insurance claim takes only 2 minutes. Moreover, our 100% claim settlement ratio for FY 2023-24 ensures quick and efficient claim settlements.
We also have a dedicated in-house claim team, Rcare Health, and a TPA (third-party administrator) licensed by the Insurance Regulatory and Development Authority of India (IRDAI). These two entities ensure quick and smooth claim settlements.
Here are the types of health reimbursement plans offered by Reliance General.
Types of Health Reimbursement Plans
Ideal for
Reliance Health Plans
Individual Health Insurance
Individuals looking for comprehensive medical coverage
Reliance Health Infinity Insurance
Family Floater Health Insurance
Ideal for families looking for coverage for all under the same plan.
Reliance Health Gain Insurance
Senior Citizen Health Insurance
Ideal for individuals above the age of 65 years with pre-existing conditions and diseases.
Critical Illness Health Insurance
Ideal for individuals with life-threatening conditions.
Reliance Critical Illness Insurance
International Health Insurance
Ideal for individuals who require extensive coverage for planned treatments abroad.
Reliance Health Global Insurance
Super Top-Up Health Insurance
This plan acts as a backup to your existing health plan by increasing the scope of coverage in times of need.
Reliance Health Super Top-Up Insurance
Group Health Insurance
Ideal for employers or companies looking to secure a group of employees under the same plan.
Reliance Group Mediclaim Insurance
Accidental Health Insurance
Ideal for individuals residing or commuting to accident-prone areas frequently.
Reliance Personal Accident 360 Shield Insurance
Step 1 - Inform us regarding the medical incident within 24 hours (for emergencies) or 48 hours (for planned treatments). You can contact us in the following ways -
Give an online intimation using our website
Call us at +91-22-4890-3009
Email us at rcarehealth@relianceada.com
Download our Reliance Self-i App on your mobile phone
Step 2 - Get the required medical procedures or treatments at any hospital of your choice.
Step 3 - Once done, pay all the medical expenses and collect all the medical bills and payment receipts.
Step 4 - Now, submit your reimbursement insurance claim form and supporting documents, such as bills, payment receipts, medical reports, test reports, etc., to RCare Health or the authorised TPA for verification.
Step 5 - After verification, we will reimburse you for the applicable expenses as per your policy terms and conditions.
A duly filled and signed medical claim reimbursement form
Proof of identity
A clear copy of the health card
Original prescription from the doctor in charge
All hospital and treatment-related bills, receipts, invoices
A clear copy of the discharge summary
A cancelled cheque
Any medicine bills
A First Information Report (FIR), if an accidental injury treatment is required
Any other accident or treatment-related documents
The standard reimbursement health insurance cover, common for all our health insurance plans, consists of the following -
Pre-and post-hospitalisation expenses
Inpatient treatments
Daycare procedures
AYUSH treatments
Ambulance charges
Diagnostic tests
Domiciliary treatments
Special treatment (limited to the type of policy you buy)
Cancer treatments
Joint reconstruction or replacement
Gene therapies
Donor organ transplant
Heart valve repair or replacement
Major burn-related skin grafting procedures
Neurosurgeries
Robotic surgeries
Deep brain stimulation procedures
Balloon sinuplasty
Stem cell therapy, etc.
Please note that the following exclusions limit the effectiveness of claim settlements, even if an insurance policy covers the type of medical treatment.
You might not be able to file a reimbursement or cashless claim for a medical treatment that was not declared at the time of policy purchase.
You cannot file a claim for gender change, dental, cosmetic, or other related medical expenses.
Different types of treatments have a pre-set sum insured limit. You must read the policy document before filing a claim.
You must check the waiting period for your chosen health plan to avoid filing incorrect claims.
Read the chosen health plan’s policy exclusions carefully.
For reimbursement in health insurance, you must cross-check the age limitations. For most plans, the age limit is between 18 to 65 years for individuals. The age range of dependent children for the claim is anywhere between 91 days to 25 years.
Depending on the type of health insurance policy you purchase, there might be some limitations for the sum insured for pre-existing conditions. Moreover, some policies might not cover it, especially if you do not inform the insurer before purchase. In such cases, a reimbursement claim is not possible.
You must only file an offline or online reimbursement claim after carefully checking the policy exclusions. For example, any pre- and post-hospitalisation claims for injuries due to excessive alcohol consumption are not eligible for approval. Thus, you must check the exclusions before purchasing any plan and filing a claim.
Most health insurance policies have a set waiting period before which you can file any reimbursement claim. The waiting periods vary based on the type of policy and claim. For instance, for Reliance General Insurance, the initial waiting is 15 to 30 days, whereas for pre-existing conditions, the waiting period can be anywhere from 24 to 36 months.
A crucial aspect of health reimbursement eligibility is the submission of the correct documents for claim settlement. For example, a duly filled and signed claim form, medical reports, discharge summary and all bills for paid medical expenses must be submitted for a reimbursement claim.
Other than reimbursement in health insurance, there is also an option of cashless everywhere health insurance today.
The General Insurance Council announced this new facility in January 2024. With a combination of health insurance and cashless everywhere, you can file a cashless claim at any hospital in India.
Previously, the convenience of cashless claims was limited to only the authorised network hospitals of any insurer. However, you can now easily file a cashless claim online for any hospital.
With a cashless claim, your medical bills are directly settled between the insurer and hospital once your treatment is completed. There are various other benefits of a cashless claim -
Quick and efficient online claim filing process
Direct payment settlement by the insurer on your behalf
Completely cashless hospitalisation
Applicable for most health insurance policies
Reduces upfront expenses for the policyholder
Parameters
Cashless Health Claim
Reimbursement Health Insurance Claim
Payment Responsibility
Direct expense settlement between the insurer and the hospital.
First, the policyholder has to pay the bills, and then the policyholder is reimbursed after verification.
Choice of Hospitals
Any hospital
Claim Procedure
Quick and hassle-free, with no involvement of the policyholder.
It may vary based on the type of claim and the submission of the correct documents.
Convenience
With the online process, it is very convenient.
The online process is fairly convenient but might require additional documentation.
Availability with Health Plans
It is limited to the insurer and the type of plan you choose, as not all health insurance plans offer this option.
It is standard for all health insurance plans and insurers.
Inclusion of Medical Emergencies
Included, provided you inform the insurer within 24 hours of the event’s occurrence.
To understand whether health insurance reimbursement is taxable or not, you must understand the two aspects that are applicable to taxation.
The first is the premiums you pay towards the chosen health insurance plan. Under Section 80D of the Income Tax Act, the premiums paid are eligible for tax deductions based on your age. Let’s have a look.
For individuals below 60 years - up to ₹25,000
For family plans with spouse and children below 60 years - up to ₹25,000
For family plans with spouse, children + parents below 60 years - up to ₹50,000
For family plans with spouse, children + parents above 60 years - up to ₹75,000
The next aspect is the reimbursement you get from the insurer after filing a claim. According to Section 17(2) under the Income Tax Act, your reimbursement for health insurance is taxable only if you are an employee.
For this tax exemption, your employer must provide you with a reimbursement health insurance plan for coverage.
To claim a tax exemption for the incurred medical expenses (for self, spouse, or children, you must submit valid proof of the same. You can do so by submitting original medical records and paid bills.
The amount for reimbursement received from the employer should not exceed ₹15,000.
Here are some conditions to remember for HRA in medical billing -
You must submit all the actual medical bills to the employer.
Your medical bill should be less than or equal to ₹15,000.
If the amount is more than ₹15,000, the balance amount will be added to your salary, adding your taxable income, making the remaining reimbursement for health insurance taxable.
If you submit incorrect information on your reimbursement insurance claim form.
If you submit incomplete or inaccurate documents for a claim for reimbursement.
If you notified the insurer after a significant delay, resulting in missed deadlines for reimbursement of health insurance claims.
If you file a reimbursement claim for one of the policy exclusions that is not covered by your plan,
If you file a claim for a non-disclosed pre-existing condition.
If you file a false claim for reimbursement.
Your claim can also be rejected if the insurer feels you did not require medical treatment but received it for no valid reason.
Also Read -How to Appeal Against A Denied Health Insurance Claim?
Medical reimbursement errors like delayed submission of the claim request.
Filing a claim without understanding the different policy exclusions can lead to reimbursement claim issues.
Submitting less documents for the claim.
Adding wrong information on your form for reimbursement of medical claims.
Not paying the applicable deductibles or non-medical expenses incurred during the treatment.
Forgetting to follow up on your claim request.
Reliance General allows you to track your health claims online in a few quick steps. This can help in avoiding reimbursement errors.
Review the reimbursement claim settlement process offered by the insurer. This includes checking the types of documents required, the time available for updating the insurer, the convenience of online claim submission, etc. Go for an insurer that offers an online process for faster claim settlements.
An insurer's claim settlement ratio (CSR) is crucial to understanding whether filing a claim is a good option. The CSR showcases the insurer’s ability to offer quick and efficient claim settlements.
Reliance General Insurance has a claim settlement ratio of 100%, ensuring your reimbursement claims are settled as soon as possible.
You must review the policy inclusions and exclusions carefully to file the right claim. This is necessary as it will ensure your claims are not delayed or rejected during times of need.
When purchasing any reimbursement health plan, check the available sum insured for different policy inclusions. This will help you understand how much financial support is applicable to your claim request.
Check the waiting period that is applicable to your policy. This is necessary, as filing a reimbursement claim before the waiting period is over will result in instant claim rejection.
In reimbursement insurance, you need to pay the medical expenses upfront before getting the financial reimbursement from the insurer. Thus, you must assess your financial situation to ensure you can afford the out-of-pocket expenses.
Yes, you can file a reimbursement claim for outpatient or domiciliary treatments, diagnostic tests, and doctor fees under a health plan, even if you are not hospitalised.
Yes, Reliance General offers 24/7 customer service for all its customers. If you have any doubts or queries about a reimbursement claim, you can reach out to them.
To buy a health plan, visit our website.
Select “Health” on the main page and add the required information.
Once done, click on “View Prices” to check all the health plans available for you.
Modify the plan of your choice, pay the premium and receive your health insurance policy via email.
In a reimbursement claim, you pay the incurred expenses out of your pocket and then get the reimbursement deposited into your bank account. In a cashless claim, the insurer pays the hospital on your behalf once your treatment is completed.
The processing time for a reimbursement claim depends on various factors, such as the type of medical expenses, the availability of necessary documents, the insurer’s claim settlement ratio, and the complexity of the overall case.
The coverage for non-medical expenses for a reimbursement claim depends on the inclusion of your chosen policy. If the expenses you incur are included in your plan, you can file a claim. If not, you will need to cover the costs yourself.
You will receive the applicable reimbursement for the claim settlement directly in your bank account. This is a standard practice applicable to all insurers.
Yes, you can customise your reimbursement health insurance policy by combining as many add-ons as required by your insurer. Moreover, you can also choose a higher sum insured value, a higher deductible, or a longer policy tenure to suit your needs.
No, there is no network hospital limitation applicable to a reimbursement claim. You can go to any hospital of your choice and get the required treatment before filing a claim.
Thanks for the information. Our Customer Care will get back to you.
