- Different types of Cashless Mediclaim Policies
- Cashless Claims for Different types of Hospitalizations
- Checklist of Buying Cashless Mediclaim Policy
Cashless Health Insurance
As the name implies, cashless health insurance allows policyholders to receive cashless medical care in the insurer's network hospitals. In the event of an emergency, insurance holders may be grateful for their decision to invest in cashless medical insurance because it spares them from having to arrange funds for hospitalizations.
What if there is an emergency & you have incurred a huge amount of Medical Bills? At that point of time, you might need to rush to arrange for cash for the medical treatments. Medical Emergencies come announced and can put a severe financial burden on the necessary treatments.
In such cases, Cashless Mediclaim Policy proves to be quite beneficial. It is a great way to protect yourself from skyrocketing medical expenses in the case of an illness or accident, without having to pay any out-of-pocket expenses.
To provide a Cashless facility, Insurance Companies have partnered with several hospitals across the country which are termed as 'Network Hospitals'. Under this particular feature, if you're availing of treatment at Network Hospitals, the Insurance Company directly settles the bills without you worrying about the exorbitant expenses.
In case of a medical emergency, 'Cashless Mediclaim' turns out to be a blessing, as it provides comprehensive coverage, financial support & peace of mind.
What is Cashless Health Insurance?
A cashless health insurance policy is an essential investment because it protects you and your family from all minor and major health problems, whether planned or unplanned. Medical care is costly and can deplete your life savings in the event of a severe critical illness. Even a minor procedure may cost several thousand rupees.
Medical emergencies can strike without warning, so people must be prepared. As the name implies, cashless health insurance is a health insurance plan that allows insured people to receive cashless treatments at select network hospitals through medical practitioners. To receive cashless treatment, the insurance holder must contact their insurance provider within 24 hours of being admitted to the hospital, after which the insurance provider settles the medical expenses directly with the hospital, allowing the insurance holder to focus on their health.
Individuals must research and select the best cashless mediclaim policy for themselves based on the sum insured provided, features and benefits, cashless network hospitals, claim settlement statistics of the insurance provider, and customer support.
How Does Cashless Health Insurance Work?
Cashless Health Insurance benefits the policyholder by eliminating the requirement for cash payments at hospitals during medical care. The plan is activated at the insured person's request and pays hospital fees for treatments received by the insurance holder. Cashless health insurance plans operate at network hospitals designated by insurance providers and are responsible for claim settlement without involving the individual in question. As soon as an individual is admitted to the hospital, they may concentrate on receiving the best medical care possible without having to worry about settling debts with hospitals because the insurance providers or TPAs linked with the insurance providers will handle this procedure. Most cashless medical insurance policies now cover OPD charges that do not need a person to be hospitalized for 24 hours.
It is necessary to check the list of network hospitals associated with the health insurance plan you opt for as it will be easier to avail of the cashless medical insurance in times of an emergency. Once the patient is admitted to the network hospital you need to notify the insurance provider. The insurance provider will then take the process of fulfilling all the formalities and may only contact you if any documents related to the hospitalization are required. The cashless health insurance commences once the information of your insurance has been verified.
Types of Cashless Health Insurance Policy in India
You can financially protect yourself & your family by investing in different types of cashless medical insurance available in India
- Individual Cashless Health Insurance Policy
- Family Floater Cashless Health Insurance Policy
- Senior Citizen Cashless Health Insurance Policy
Individual Cashless Health Insurance Policy
An individual is offered a certain amount of medical coverage for a specific period of time under an Individual Cashless Medical Insurance. The coverage provided can be used to cover hospitalization costs whenever the Insured person gets treatment at the company-affiliated Network Hospital.
Family Floater Cashless Health Insurance Policy
All the family members are covered in a single policy with one fixed sum insured under Family Floater Cashless Mediclaim Policy. This policy usually covers self, spouse, and dependent children.
Senior Citizen Cashless Health Insurance Policy
These types of policies are carefully crafted to take care of Senior citizen's hospitalization expenses at the time of need. It covers Hospitalisation expenses, Ambulance charges, treatment expenses against Pre-Existing Diseases, as specified by the policy document.
Importance of Investing in a Cashless Medical Insurance
In case of any emergency situation when you do not have the required cash on hand and need to rush to a hospital, cashless medical insurance is your reliable partner. Cashless Health Insurance is designed to cater to individuals without letting them worry about funds to avail the best medical care.
Benefits of Cashless Facilities
- A cashless facility empowers insured individuals to avail of medical treatments in their choice of network hospitals without having to make any cash payments as it is handled by the insurance provider
- When an individual is admitted to a network hospital for planned/unplanned hospitalization he/she can be guaranteed the best medical care and facilities as the insurance providers are stringent with their quality checks before impaneling the hospital as a network hospital
- Since the insurance provider and the hospital are directly in contact insured individual need not worry about paying the hospital bills
- You can avail of tax benefits under section 80D for your cashless health insurance policy
- Cashless Health insurance covers specialized treatments as well such as dialysis, surgical expenses, chemotherapy, and more
Features of Cashless Health Insurance
There are a plethora of benefits of cashless health insurance that allow insurance holders to seek medical treatments without any financial stress.
1
Coverage of Pre- Hospitalisation (before hospitalisation) and Post Hospitalization (after hospitalisation) Expenses
2
Availability of 'No Claim Bonus'
3
Availability of 'Hospital Daily Cash'
4
Coverage for Emergency expenses i.e. Ambulance Expenses, etc
5
Coverage of Domiciliary Treatment
6
No amount to be paid at the Network Hospital
7
Lifelong renewability feature available under cashless medical insurance
8
A vast network of cashless network hospitals is available 24/7 that can be availed by insurance holders
9
Access to 24/7 customer support
10
Discounts at network pharmacies
11
Tax Benefits under Section 80D
How to avail Cashless Mediclaim Policy (Planned /Emergency)?
When you opt for a Cashless Mediclaim Policy, you don't have to worry about arranging for funds in the case of a medical emergency.
You can choose the nearest Network Hospital of your Insurance Provider and avail of the benefits of the Cashless Mediclaim facility to avoid financial pressure.
There is an Insurance desk in every Network Hospital to help policyholders or their families in initiating Cashless Claims.
Cashless Mediclaim Services can be availed in both the cases-Planned & Emergency Hospitalisation:
Cashless Claims for Planned Hospitalization
In case of planned hospitalization, you have enough time to select the most appropriate hospital from the list of your Insurer's Network Hospitals. The procedure for receiving Cashless Treatment in the case of planned hospitalization is as follows:
- Select Network HospitalChoose a Network Hospital from the list of the total number of Network Hospitals on your Insurance Company's official website or you can connect with your Insurer's customer care for the same.
- Fill Pre-Authorization Cashless Request FormOnce you choose a hospital for your treatment, contact the hospital's Insurance Desk and fill a Pre-Authorization Cashless Request Form, which can be downloaded from the official website or a hard copy can be obtained at the Network Hospital's insurance desk.
- Verification of InformationSubmit the Pre-Authorization Cashless Request Form within the time period set by your Insurance Company. The hospital authorities will verify and sign the details on the request form.
- Approval or Rejection of RequestThe insurance desk or TPA will either approve or reject the placed request, depending upon the documents and Terms & Conditions of the policy.
- Amount ApprovalThe hospital will receive a sanction letter from the Insurer, stating the amount approved.
- Claim PaymentOnce the final documents are produced by the hospitals, the Insurance Company will pay the claim directly to the hospital.
Cashless Claims for Emergency Hospitalization
After being admitted to the nearest network hospital in case of a medical emergency that requires immediate medical attention, you need to follow the below-mentioned steps for filing a claim.
- Show your Policy DocumentsShow your policy document/card to the hospital at the Network Hospital that you're admitted to. The document must include information such as the policy number, policy type, Insurance Company's name, etc.
- Fill Pre-Authorisation Request FormWithin 24 hours of hospitalization, contact the hospital's Insurance Desk and fill up the Pre-Authorization Request Form.
- Verification of DocumentsThe Insurance Company or TPA will review your pre-authorization request and other submitted documents.
- Approval or Rejection of RequestTPA will either approve or deny your cashless claim request when the paperwork is validated. If your claim is approved, you will be able to receive Cashless Treatment.
- Settlement of ClaimOnce the final documents submitted by the hospitals are verified, the Insurance Company will directly settle the amount with the Network Hospital.
Reasons for Rejection of Cashless Claims
Cashless Insurance Claims can also be rejected for various reasons. However, with a little caution, some of these can be avoided.
Let's look at some of the reasons why Cashless Claims can get rejected.
- Unawareness of Claim ProcessClaim rejection might occur when people are unaware of the right claim process. For example, failing to submit a claim within the specified time frame may result in rejection. Cashless claims can be rejected if incorrect information is provided, or proper documents are not submitted. Knowing how to file a claim correctly or getting help from the Health Insurance Company's Customer Service team can reduce the chances of claim rejections.
- Pre-existing ConditionsSome Pre-Existing Diseases (PED) are not covered under the Cashless Claim Policy for a certain period of time i.e. Waiting Period, which may vary from 2 to 4 years. During this Waiting Period, if you file any claim for PED, expenses incurred for the treatment would not be covered under Cashless Mediclaim policies.
- Non-Disclosure of InformationOne of the most common reasons for claim rejections is hiding information when buying a Cashless Mediclaim Policy. For example, not revealing the information about a Pre-Existing health condition while purchasing a Cashless Mediclaim Policy could result in a Claim rejection.
- ExclusionsHealth Insurance Policies come with a set of certain exclusions, i.e. treatments/ illnesses which are not covered under the policy. For example, treatment related to Sexual Transmitted Diseases like HIV/AIDS is not covered under Cashless Mediclaim Policies. Raising a Claim for any treatment/ ailment leads to rejection.
- Policy periodCashless Mediclaim Policy is a type of Insurance contract that lasts for a set period of time known as the policy period. When a policy expires, the coverage provided by the policy becomes invalid. Any claim raised after the policy period and before the renewal date leads to rejection.
Points to Remember before Buying Cashless Mediclaim Policy
Choosing the best Cashless Health Insurance Policy can be difficult due the plethora of health plans available in the market. Mentioned below are a few points points to remember for your benefit
When purchasing cashless medical insurance it is necessary to keep a few pointers in mind
- Network HospitalsBenefits of Cashless Claim can be availed only at Network Hospitals. Therefore, you must check Network Hospitals associated with your Insurer in your vicinity for convenience.
- Record of DocumentsYou must keep photocopies of all the relevant documents like Claim Form, Medical Bills, Discharge Summary, Diagnostic Reports, etc.
- Terms & ConditionsAlways read the Terms & Conditions carefully, as certain conditions can make you ineligible to avail of the benefits of Cashless Hospitalization.
- Claim Settlement RatioClaim Settlement Ratio of the Insurer is one of the important things to consider while buying a Cashless Mediclaim Policy. Insurance companies with higher Claim Settlement Ratio ensure a quick and hassle-free Claim Settlement.
- 24/7 Customer Support A good customer service team is required to answer all of your questions about your cashless health insurance policy. Insurance customers must choose an insurance company that provides excellent customer service.
- Features Insurance policyholders must carefully examine the features offered by their cashless health insurance policy. It is critical to read policy wordings, terms and conditions, and other important documents to determine whether the policy meets all of its healthcare requirements and needs.
- Sum Insured Insurance holders can choose from a variety of sum-insured options available through the various cashless health insurance plans offered by multiple insurance providers. You must choose the sum insured that is appropriate for your and your family's medical needs.
What is not paid in Cashless Health Insurance
Generally, the following things are not covered under Cashless Mediclaim Policy:
Attendant Fees
Service Charges
Hygiene Products of the Patient
Medical Consumables
Documentation Charges
Cashless Mediclaim Policy protects your finances in case of a Medical Emergency. Cashless facility enables you to get quality medical care at the right time without worrying about finances.
At PolicyX.com, you can buy a Cashless Mediclaim Policy by evaluating different policies side by side based on various parameters and choose the best one for yourself.
Health Insurer Network Hospitals
Cashless Mediclaim Policy:FAQs
1. Can the insurance holder avail the cashless facility at any hospital?
Insurance holders can avail of treatments only at the network hospitals listed with their insurance providers.
2. How can I find out the nearest cashless hospital for treatment?
When purchasing the policy insurance holders must go through the list of cashless hospitals in their vicinity to understand where can they avail of treatments when the need arises. You can also contact the customer care of the health insurance providers in order to know the list of network hospitals or you can visit www.policyx.com to find the list of network hospitals by your insurance provider
3. Does cashless health insurance cover OPD?
Yes, many cashless health insurance plans now cover OPD as well which does not require 24 hours of hospitalization at the network hospital.
4. Are tax benefits available when investing in a cashless health insurance policy?
Yes, you are eligible for tax exemptions under Section 80D of the Income Tax Act.
5. Do I need to inform the health insurance provider when availing cashless facility?
Yes, in case of a planned hospitalization, an individual must inform the health insurance provider 48 hours prior to the hospitalization. In case of an emergency hospitalization you can inform the health insurance provider immediately at the time of hospitalization and they will take care of the hospital bills.
6. What are the factors that affect the Cashless Mediclaim policy& 039;s premium?
Age Pre-Existing Medical Diseases Habits such as alcohol or smoking Profession Family Health History Marital Status
7. Can I have more than one Cashless Mediclaim Policy?
Yes, you can have more than one Cashless Mediclaim Policy.
8. What is a Network Hospital?
Network Hospitals are specific hospitals which partner with Insurers for providing Cashless Claim facility to the policyholders.
9. Which one is better: Cashless or Reimbursement?
Cashless Claim facility has its advantages over the Reimbursement Model as the policyholder does not have to pay any amount to the hospital. He/ she can get quality medical treatment without any financial burden. However, in certain cases, when the policyholder has to be admitted in a Non- Network Hospital due to an emergency, Reimbursement Claim comes into picture.
10. Does the Insured person have to pay extra to avail of the Cashless facility?
No, you do not have to pay extra for availing the benefits of Cashless Claim. You just have to get admitted at a Network Hospital to avail the benefits.
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Written By: Simran Saxena
An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Travelling and writing are her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and seamlessly solves the reader’s query.
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