# Cashless vs Reimbursement Health Insurance Claims > Cashless vs reimbursement health claims: how each works, IRDAI's 1-hour and 3-hour cashless rules, and Cashless Everywhere at non-network hospitals. - **Published**: 2026-10-18 - **Modified**: 2026-10-18 - **Category**: health-insurance - **URL**: https://www.tldr.money/articles/health-insurance/cashless-vs-reimbursement --- Most people only learn how their insurer pays out on the day they are admitted. This guide, part of our [health insurance in India](/health-insurance) hub, explains **cashless vs reimbursement** claims, the timelines IRDAI sets for each, and how Cashless Everywhere changes the old network-hospital rule. For the paperwork, step by step, see our [health insurance claim process guide](/articles/health-insurance/health-insurance-claim-process). ## Cashless vs reimbursement at a glance | | Cashless | Reimbursement | |---|---|---| | Who pays the hospital | The insurer, directly | You, then the insurer repays you | | Where | Network hospitals, and non-network ones under Cashless Everywhere if accepted | Any eligible hospital | | Approval | Pre-authorisation before or during admission | After discharge, on documents | | IRDAI timeline | Decision within 1 hour; discharge authorisation within 3 hours | Settlement within 15 days of submission | | Cash you need | Only for non-covered items, co-pay and deductions | The whole bill, up front | ## How a cashless claim works 1. **At admission**, the hospital's insurance desk sends a pre-authorisation request to your insurer or TPA, with your policy details and the doctor's notes. For a planned admission, start this in advance. 2. **The insurer decides within one hour.** IRDAI's 2024 health master circular requires a decision on a cashless request "immediately but not more than one hour" after receiving it. Insurers must also offer pre-authorisation through a digital mode. 3. **During the stay**, the hospital may ask for an enhancement if costs rise above the approved amount. 4. **At discharge**, the insurer must give final authorisation within **three hours** of the hospital's request. IRDAI says the policyholder should never be made to wait to be discharged, and if a delay beyond three hours causes extra hospital charges, the insurer pays them from its shareholders' funds. 5. **You pay only the difference**: non-payable items, co-pay, deductible and any room rent or sub-limit deductions. IRDAI has also told insurers to aim for 100% cashless settlement and to keep reimbursement claims to a bare minimum, used only in exceptional circumstances. ## How a reimbursement claim works 1. **Inform the insurer** as soon as practical. IRDAI rules say no claim can be rejected for delayed intimation, but early notice avoids disputes. 2. **Pay the hospital** and collect the discharge summary, itemised bills, prescriptions, reports and payment receipts. 3. **Submit the claim form** with documents. IRDAI's master circular says the insurer or TPA should collect the documents it needs from the hospital, and no claim can be rejected or closed for want of documents. 4. **Settlement within 15 days** of submission. If the insurer is late, it owes you interest at the bank rate plus 2%, paid without you asking. ## Cashless Everywhere: cashless outside the network Until January 2024, cashless generally meant a network hospital. On 25 January 2024 the General Insurance Council, the industry body for general and health insurers, launched **Cashless Everywhere**, under which policyholders can seek cashless treatment at hospitals that are not in their insurer's network. The conditions, as reported at launch: - **Planned admission:** inform the insurer at least **48 hours before** admission. - **Emergency admission:** inform the insurer **within 48 hours** of admission. - **The claim must be admissible** under your policy terms and the insurer's operating guidelines. - **The hospital must agree** to provide cashless treatment on the insurer's terms. Some reports at launch said the facility was meant for hospitals with 15 or more beds registered under the Clinical Establishments Act. In practice, cashless is still smoother at network hospitals, where rates and processes are pre-agreed. Use Cashless Everywhere when the hospital you need is outside the network, and inform the insurer early. ## Worked example: what you pay at discharge You have a Rs 10 lakh policy with no co-pay and a room rent cap you stayed within. The final bill is Rs 3,20,000, including Rs 12,000 of non-payable items (registration, toiletries and similar). - **Cashless:** the insurer approves Rs 3,08,000 and pays the hospital. You pay **Rs 12,000** at discharge. - **Reimbursement:** you pay the hospital Rs 3,20,000, submit the claim, and the insurer repays Rs 3,08,000 within 15 days. You are out of pocket by the same Rs 12,000, but you have to fund Rs 3,20,000 for a few weeks. The final cost is the same. The difference is cash flow and stress. If your policy had a [room rent cap](/articles/health-insurance/room-rent-capping-proportionate-deduction) or [co-pay](/articles/health-insurance/co-pay-vs-deductible), those deductions would apply in both routes. ## When reimbursement is the only option - The hospital refuses cashless, or does not meet the insurer's criteria. - You could not inform the insurer within the Cashless Everywhere timelines. - Pre- and post-hospitalisation expenses, such as tests and medicines before admission and after discharge, are usually claimed by reimbursement even when the stay itself was cashless. - The insurer denied cashless pending more information. A denial of cashless is not a rejection of the claim. You can still claim reimbursement. ## Tips for a smooth cashless claim - **Check the network** before you need it. Each insurer page on our site has a network hospitals page, for example [Care Health's](/health-insurance/care-health/network-hospitals). - **Carry your health card or policy number** and ID. - **Know your room eligibility** and ask for a room within it. - **Keep copies** of everything the hospital sends to the insurer. - **If cashless is denied or partly approved**, ask for the reason in writing. Our guide on [why health claims get rejected](/articles/health-insurance/health-insurance-claim-rejection-reasons) covers how to escalate. Insurer claim records differ. Our [claim settlement ratio comparison](/articles/health-insurance/top-claim-settlement-ratio-companies) and the [all health insurance companies](/health-insurance/insurers) page are good places to start. ## Sources - IRDAI, Master Circular on Health Insurance Business (IRDAI/HLT/CIR/PRO/84/5/2024), 29 May 2024, Chapter I paras 15-17: https://irdai.gov.in/en/document-detail?documentId=4942918 - IRDAI, Master Circular on Protection of Policyholders' Interests (IRDAI/PP&GR/CIR/MISC/117/9/2024), 5 Sep 2024, Part B (claims and settlement timelines): https://irdai.gov.in/en/document-detail?documentId=5625747 - The Hindu, "Cashless facility for policyholders at all hospitals: General Insurance Council", Jan 2024: https://www.thehindu.com/business/cashless-facility-for-policyholders-at-all-hospitals-general-insurance-council/article67773757.ece - The Indian Express, "Insurers to opt for 'cashless' treatment in hospitals everywhere from today", Jan 2024: https://indianexpress.com/article/insurance/insurers-to-opt-for-cashless-treatment-in-hospitals-everywhere-from-today-9126396/ --- - [More health-insurance articles](https://www.tldr.money/articles/category/health-insurance) - [All articles](https://www.tldr.money/articles)