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Cashless Health Insurance

Best Cashless Medical Insurance for Family in India

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7.5% Discount
10% Discount

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Above Premium includes 18% GST

I

94%

Claim Settlement Ratio (OND 2018)

II

8100 +

Network Hospitals across 500 cities

III

400 Lacs+

Lives covered

Cashless health insurance is beneficial to a family or a patient who is in a dire emergency and is unable to arrange for money at the last minute. In such acute circumstances, a cashless medical insurance facility serves as a boon to the patient’s worries.

Table of Content:

What is Cashless Health Insurance?

Cashless health insurance is amongst the most important features that a health insurance policy must cover. This facility ensures that one can bypass the reimbursement formalities at any of the network hospitals by handling the cost of the treatment. With cashless health insurance, you do not need to worry about cash arrangements. You can go for the best treatment without thinking of a cash crunch.

When the health insurance company directly settles your medical bills with the hospital, it is called a cashless claim settlement. This is very useful when one may not have cash on hand, and there is a medical emergency. There are two main categories that health insurance policies come under. They are reimbursement and cashless claims.

Importance of Cashless Health Insurance

We are living in times of digitalization where every transaction can be done easily with the help of cashless payments. From buying groceries to paying for medical bills, going cashless has many benefits that include saving time and efforts while ensuring security.

In an unforeseen event such as a medical emergency, a family goes through a lot of stress and arranging finances to pay for the medical treatment is an added stress factor, since that would cause a delay in getting timely treatment.

Thanks to the facility of cashless health insurance, one can skip the hassles of paying medical bills during hospitalization as the insurer directly settles the expenses with the hospital. The cashless feature has changed the way people pay for their medical treatment and offers a lot of convenience in terms of saving time, money and efforts. Cashless hospitalization is one of the biggest advantages that health insurance policies provide as it keeps families free from any financial worry and minimizes the burden of making payments from their pockets during any medical situation.

Cashless vs Reimbursement Claims in Health Insurance

Medical insurance plans are recognized for their cost-saving benefits that the policyholders are entitled to. The choices available to a policyholder when making a claim on a health plan includes a cashless claim and a reimbursement claim for the expenses incurred during medical treatment.

Every policyholder must be aware of the process of making a claim on the health policy to ensure he or she gets the due benefits given by the insurer. It is also important to understand the claim settlement process of health insurance policy which can either be cashless or reimbursement mode, as discussed below:

Cashless Claim:

Under this feature, the policyholder is not required to make any payment from his/her pocket during a medical emergency. In the event of hospitalization or related medical expenses, the insurer directly settles the bills with the hospital. However, to avail of this facility, the policyholder must get treatment at any of the insurer's network hospitals only.

Reimbursement Claim:

In the event of hospitalization, the policyholder is firstly required to bear the medical expenses from his/her pocket. He or she must then approach the insurer with the medical bills for getting a reimbursement on the payment made. This feature is especially helpful when the person avails treatment at any non-network hospital.

How Does Cashless Health Insurance Work?

Cashless health insurance is a feature of health policies that can be availed by the policyholder when he or she gets medical treatment at a network hospital listed by the insurer. Network hospitals are healthcare facilities that have a tie-up with the insurer to provide cashless treatment. All the necessary coordination between the insurance company and the hospital will be handled by a third-party administrator (TPA) or a representative of the company. The TPA is responsible for settling the cash as well as cashless health insurance claims. This representative has the authority to accept or deny the patient's claims for cashless medical insurance. That is, only after proper verification, the hospital gets the approval for treating the patient.

Since insurance companies ensure that the network hospitals maintain their standards through stringent quality checks and yearly contract renewals, they offer some of the best cashless health insurance.

How to Avail Cashless Health Insurance?

To make a claim on cashless health insurance, the policyholder must follow the steps given below:

  • Verify if the hospital is a partnered or network hospital with the insurer
  • Submit pre-authorization form a few days before the hospitalization
  • Contact your insurer and provide all the supporting documents like identity proof, hospital and pharmacy bills, discharge summary, investigation reports, and doctor's consultation
  • Based on the insurance cover, the company representative will accept or reject the claim.

In case of emergency hospitalization, the policyholders should inform the insurer within 24 hours of admission. On the other hand, they must inform the insurer 48 hours prior to admission in case of planned hospitalization.

>> Also Read: Health Insurance for Parents

Why Should I Buy Cashless Health Insurance?

5 reasons to buy a cashless health insurance policy are:

  • Immediate Treatment
  • Tax Benefit
  • Treatment in Network Hospitals
  • Cover Pre and Post Hospitalization Expenses
  • Peace of Mind

Immediate Treatment: With cashless health insurance, you can immediately get admitted to any of the network hospitals in case of a medical emergency. You are not required to wait, and full fill cash deposit formalities. You have to inform to help desk in the hospital and to your insurer about your hospitalization. Later, after submitting all the required documents, your insurance company pays hospital bills directly.

Tax Benefits: Under Mediclaim 80D, the premiums paid for health insurance for self, dependent parents, children, and spouses are exempted from tax. Thus, you can have saved a good amount of money and enjoy the tax benefit. It also reduces your taxable income, which reflects less tax liability.

Treatment in Network Hospitals: During any medical exigency, you do not need to get confused about the hospitals. Under cashless health insurance, you can admit in the network hospitals nearby to your residence. These hospitals provide good healthcare services and treatment and also have trained medical professionals. You can rely on their medical treatment and get your bills paid by the insurer.

Cover Pre and Post Hospitalization Expenses: This cover includes your pre and post-hospitalization expenses that include diagnosis, treatment, and medicine expenses, along with doctor's fees. It also covers treatment costs such as dialysis, chemotherapy, daycare treatments, and surgeries as well. With this cover, your savings will not be drained in treatments, and you can keep it for your future.

Peace of Mind: Cashless health insurance gives you peace of mind. You can stand strong in any medical emergency. You do not need to borrow extra money for you or your family member's treatment. From hospitalization to daily cash allowance, ambulance cover, second opinion all you get under this cover.

FAQs on Cashless Health Insurance

What if Cashless Claim is Rejected?

Policyholders must be aware of the claim settlement process and must adhere to the same when making a claim. This will enable them to get the benefits of cashless health insurance and save them from additional cost burden during any medical emergency. However, there could be situations when their claim may get rejected. It is extremely important to understand the scenarios when the claim can get rejected.

As health plans are supposed to cover medical expenses, it could be disappointing when a claim gets rejected and you end up paying for the medical bills. Some reasons for claim rejection are:

  • When the policyholder avails treatment at the non-network hospital where cashless treatment is not possible and the claim could be rejected
  • If the pre-authorization request is not shared on time
  • In case the hospital or treating doctor does not provide sufficient details to the insurer
  • If the health policy is not valid and has lapsed
  • If treatment cover for the particular medical condition is not covered under the health policy
  • If there is a waiting period for covering treatment for a particular medical condition

When the cashless treatment is denied at a hospital, then the policyholder must approach the insurer to know if the expenses could be reimbursed.

What Could be the Possible Reasons for Denying my Request for a Cashless Settlement?

A policyholder's claim for cashless settlement can be denied due to various reasons that include:

  • If treatment is availed at a non-network hospital
  • If the pre-authorization request is not shared on time
  • If sufficient details are not given to the insurer by the hospital
  • If the health policy is not valid
  • If the medical condition is not covered under the health policy or if there is a waiting period

Can I Opt for Cashless Treatment for OPD Procedure?

A policyholder can avail cashless treatment facility for OPD procedure including doctor visits if the healthcare facility or hospital is listed in the insurer's network hospitals.

How Long Can I Renew a Cashless Health Insurance Policy?

Before the expiry date of the cashless health policies, the policyholders are required to renew their policy. A cashless health insurance policy can be renewed by the policyholders throughout their entire lifetime.

What is the Policy term of Cashless Health Insurance Plans?

Usually, cashless health insurance plans come with a policy term of one year, at the end of which the policyholder must renew their plans. Some plans also come with a term of two years.

>> Check: Best Family Floater Health Insurance in India

What Key Points Should be Kept in Mind while Selecting the Cashless Health Insurance Plan?

Few key points that must be considered while selecting the best cashless health insurance plan are:

  • Co-payment
  • Insured sum
  • Limits on Treatments
  • Maximum Renewable Age
  • Allowance for Hospital Room Rent
  • Waiting Period
  • Day-care treatments
  • Impanelled Hospitals

How can I Know the list of Hospitals to Avail Cashless Health Insurance?

Cashless Health Insurance facility is available at any of the network hospitals listed by the insurer. The list of hospitals is provided to the policyholder by the insurer at the time of buying the policy. Policyholders can also know about the network hospitals nearest to their location by visiting the insurer's website.

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