Reimbursement in Insurance

Reimbursement refers to the process of getting compensated for out-of-pocket expenses you’ve already paid. In insurance, this means you cover your medical expenses first, then submit a claim to get reimbursed by your insurer.

Reimbursement in insurance is a claim method where you pay the hospital or clinic upfront and later request a refund from your insurance provider. Unlike the cashless system that covers costs directly at partner hospitals, reimbursement requires you to collect and submit all medical transaction documents.

This guide covers what reimbursement means in insurance, how it differs from the cashless method, the required documents, and how long reimbursement claims usually take to be processed. Let’s break it down step by step.

What Is Reimbursement in Insurance?

Reimbursement refers to the process of getting compensated for out-of-pocket expenses you’ve already paid. In insurance, this means you cover your medical expenses first, then submit a claim to get reimbursed by your insurer.

This method is typically used when receiving treatment at non-partner hospitals. While it offers flexibility in choosing healthcare providers, it requires proper documentation—such as original receipts and a medical summary—to get approval.

In everyday language, reimbursement is often referred to as "rembes," which informally means requesting a refund for legitimate and documented expenses.

Cashless vs. Reimbursement: What's the Difference?

In health insurance, two main claim methods are used: cashless and reimbursement. Each has pros and cons, depending on your situation and preferences.

1. Payment Method

  • Cashless: The insurer directly covers costs at partner hospitals.
  • Reimbursement: You pay the costs first, then submit a claim for reimbursement.

2. Claim Process

  • Cashless: Simply show your insurance card—no need to handle paperwork.
  • Reimbursement: Submit full documentation, including receipts and prescriptions.

3. Hospital Network

  • Cashless: Limited to partner hospitals.
  • Reimbursement: Valid at any hospital, including non-partner providers.

4. Speed of Processing

  • Cashless: No waiting period—coverage is instant.
  • Reimbursement: Takes time to process and transfer funds.

5. Premium Costs

  • Cashless: Usually comes with higher premiums for convenience.
  • Reimbursement: More affordable, but requires extra effort.

Requirements for Reimbursement Claims

To file a reimbursement claim, you must prepare all required documents. Incomplete documentation can lead to claim rejection.

Typical required documents include:

  • Completed and signed claim form

  • Copy of ID (KTP, passport, etc.)

  • Medical certificate or hospital discharge summary

  • Original payment receipts and itemized bill

  • Copy of prescriptions and lab/radiology results

  • Police report (if claim is related to an accident)

  • Medical release form (if requested by the insurer)

Ensure all documents are neatly compiled and submitted within the deadline stated in your policy. Incomplete submissions may delay or cancel your claim.

How to File a Reimbursement Claim

Submitting a reimbursement claim is straightforward if you follow the proper steps:

  1. Gather required documents: Make sure you have receipts, prescriptions, claim forms, and any other required paperwork.
  2. Fill out the claim form: Complete all fields accurately to avoid delays.
  3. Submit the documents: Send the documents either physically or digitally, depending on your insurer’s procedure. Some insurers offer online submissions.
  4. Wait for verification: The insurer will review your claim and verify the documents.
  5. Receive reimbursement: Once approved, the funds will be transferred to your bank account based on your policy terms.

If you're insured with Roojai—such as for car insurance, Hospital Cash Plan, or personal accident insurance—you can refer to the Roojai claim guide for detailed steps.

How Long Does Reimbursement Take?

Reimbursement processing times vary by insurer and depend on document completeness.

Generally, it takes about 7 to 14 business days after the complete documents are received. In some cases—such as missing documents or need for clarification—it may take 30 to 60 business days.

Factors that affect reimbursement processing:

  • Completeness and clarity of your documents

  • Number of claims being processed

  • Internal policies and procedures of the insurer

To avoid delays, always keep proof of document submission and monitor your claim status through customer service or your insurer’s online portal.

Protect Yourself with the Right Insurance

Understanding how reimbursement works helps you maximize your insurance benefits and avoid claim rejection due to missing paperwork.

Roojai offers flexible health insurance plans that support both reimbursement and cashless claims. The claims process is easy, hassle-free, and can be done online.

Start finding the best protection for your health needs with Roojai Health Insurance today!