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NISM Certifications · NISM-Series-X-B: Investment Adviser (Level 2) · Non-Life Insurance Products

Ms. Rao, a 35-year-old software professional in Bengaluru, wants to ensure that a hospitalisation claim is settled without her paying upfront at the hospital. Which feature of her health policy provides this?

Cashless facility at network hospitals is the feature. The insurer or its third-party administrator pays the hospital directly for covered expenses, so the policyholder need not pay upfront. In contrast, reimbursement requires paying first and claiming afterwards, and co-payment actually makes the insured bear part of the cost.

  1. AReimbursement claim facility
  2. BCashless facility at network hospitalsCorrect
  3. CNo claim bonus
  4. DCo-payment clause

Explanation

Cashless facility lets the insurer or its TPA settle the bill directly with a network hospital, so the insured does not pay upfront. Reimbursement requires the insured to pay first and claim later. No claim bonus raises cover, and co-payment makes the insured share the cost.

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