Cashless claims deliver better experience than reimbursement claims, finds report on health insurance

Cashless health insurance claims are delivering a significantly better customer experience than reimbursement claims in India, according to Policybazaar's latest Health Claims Experience (HCX™) Index report. The study found that cashless claims scored 86.7 out of 100, considerably higher than the 73.7 score recorded by reimbursement claims, underscoring a sharp difference in customer satisfaction between the two modes of claim settlement.

The report marks the launch of India's first Health Claims Experience (HCX™) Index, a benchmark aimed at evaluating how customers experience the claims process. While claim settlement ratios remain the most commonly tracked indicator of insurer performance, Policybazaar said they do not fully capture the quality of the customer journey. The HCX™ Index seeks to bridge this gap by measuring both operational efficiency and customer sentiment across the claims process.

The findings are based on a nationwide survey of 2,228 individuals across metropolitan centres as well as Tier-2 and Tier-3 cities. Respondents had undergone hospitalisation either for themselves or their loved ones and had filed health insurance claims between August 2024 and September 2025. The sample also included non-customers who had availed health insurance claims through various channels.

MUST READ: 83% health cashless requests approved within 30 minutes: Digit Insurance

According to the study, India's health insurance industry received an overall HCX™ score of 82.8 out of 100, placing the country's claims experience in the "moderate" category. However, beneath the overall score lies a substantial gap between the experiences of policyholders using cashless and reimbursement claims.

Seven out of ten respondents underwent cashless treatment, indicating that a majority of consumers are already opting for this mode of claim settlement. Customers attributed their positive experience to easier paperwork, quicker approvals and access to a wide network of hospitals. These factors have helped strengthen confidence in cashless claims and made them increasingly popular among policyholders.

MUST READ: Will Ayushman Bharat bring a new wave of healthcare demand to West Bengal?

By contrast, reimbursement claims continue to pose challenges for many consumers. Under this process, policyholders are required to bear medical expenses upfront and subsequently submit bills and supporting documents to insurers for reimbursement. The process often involves extensive paperwork and longer turnaround times, factors that may contribute to lower satisfaction levels.

Commenting on the findings, Sarbvir Singh, Joint Group CEO of Policybazaar, said health insurance ultimately proves its value at the time of a claim. He noted that while claim settlement ratios provide useful information, they do not completely reflect what customers experience during the claims journey. According to him, the HCX™ Index aims to bring greater transparency and customer-centricity by creating a common benchmark for evaluating claims experience.

MUST READ: Indemnity or benefit plan: How can I ensure my child’s health insurance plan covers emergencies, surgeries, and unexpected medical conditions?

The report also acknowledged the role played by regulatory initiatives undertaken by the Insurance Regulatory and Development Authority of India (IRDAI) in improving customer outcomes and accelerating the adoption of more consumer-friendly claims processes. As the industry evolves, the next challenge lies not merely in settling claims, but in ensuring that customers clearly understand claim decisions and have confidence in the process.

To improve the claims experience further, the report recommended greater transparency in communication, claim-specific explanations for rejections, stronger verification at the time of policy purchase, real-time claim tracking, deeper integration between hospitals and insurers and reduced paperwork. Such measures, it said, could make health insurance claims faster, simpler and more dependable for consumers.

MUST READ: Why many patients leave hospitals financially drained: The rising cost of healthcare explained