What is Cashless Mediclaim Policy?
Cashless mediclaim is the facility that as a policyholder, you get under your mediclaim policy. You do not need to pay a single penny out of your pocket in case of hospitalization. All the medical, surgical, and treatment bills, will be directly paid by the insurance provider to the network hospital. These are the hospitals that have tie-ups with the insurance companies, and you are eligible for cashless mediclaim here only.
Why Cashless Mediclaim?
Ritika, 28 years old fashion journalist, realized this fact and started looking for a sound mediclaim policy for herself and her family. But the moment she began with browsing the websites, she lost in the Tsunami of information. Then, her best friend, who already has a mediclaim, suggested her to go for a cashless mediclaim policy. She got overwhelmed with her friend’s suggestion and opted for the same. In this article, you can read why it’s wise to buy a cashless mediclaim cover.
How does Cashless Mediclaim Work?
When a patient gets admitted to a network hospital, they will have a choice to make use of the cashless mediclaim feature. A network hospital is a hospital that is tied up with the health insurance companies. 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. They will settle the cash as well as the cashless claims. This representative has the authority to accept or deny the patient’s claims for cashless mediclaim.
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 mediclaim.
How to Avail Cashless Mediclaim?
The following steps illustrate how you can claim cashless mediclaim:
- Make sure the hospital is a network hospital and is partnered with your insurer.
- You must fill out a pre-authorization form a few days before the hospitalization.
- The form is then sent to the company representative, who will accept or reject the claim.
- Other supporting documents are also submitted by the hospital. These include the hospital bill, discharge summary, pharmacy bills, payment receipts, investigation reports as well as the doctor’s consultation papers. There may be other documents that you will have to submit if necessary.
- If your claim is approved, it will be directly settled by the insurance company. You will only have to sign on some papers.
>> Check: Health Insurance for Senior Citizens
How to Choose the Best Cashless Mediclaim Policy?
Here are some points that you must consider before picking a cashless mediclaim policy:
- Insured sum: This is the total amount that is liable under the policy every year. It is recommended to select a plan that has the highest coverage, while still being within your budget.
- Limits on particular treatments: There are certain treatments like cardiac treatments or cataracts that have limits imposed by the insurers. You must ensure that you read the limits carefully.
- Maximum renewable age: It is recommended to pick a cashless mediclaim policy that has a higher renewable age, especially if you intend to pick a good cashless mediclaim for parents.
- Co-payment: This is a fixed amount that must be paid by insured patients before they avail any medical services. Although this is generally negligible compared to the insured amount, it is essential to ensure that a balance is struck between the features offered by the policy and the co-payment.
- Waiting Period: This is a variable interval that is defined based on the disease for which you are making the claim. You must read the conditions of the policy to know what the different waiting times are. Then, make sure that you pick a plan that has the least waiting period.
- Day-care treatments: Since there will be a range of day-care procedures covered, you should compare different policies before selecting the ideal option. Ensure that you pick a cashless mediclaim policy that covers the maximum number of treatments.
- Hospital room rent: There will be an upper bound here, so you must always check if the coverage of the policy is sufficient to absorb the rent charges at your preferred hospital.
- Impanelled hospitals: If your hospital is impaneled by the insurer, it becomes very easy when trying to claim the cashless feature. Always make sure that your preferred hospital is a network hospital.
Can Cashless Mediclaim Policy be Denied?
Cashless mediclaim facility can be denied under the following circumstances:
- A cashless mediclaim policy can be denied if the medical condition in question is not covered by the policy.
- Lack of information sent by the network hospital can also be a potential reason for denial. This can be due to the fact that the doctor has not identified the problem yet, so the insurer does not know if the cashless mediclaim policy covers it.
- Cashless mediclaim can also be denied if the pre-authorization request is not sent on time.
Cashless mediclaim has risen to become a preferred solution to the problem of arranging for financial resources in case of medical emergencies. If you are looking for a cashless mediclaim policy to aid you in unforeseen circumstances, Religare Health Insurance offers some of the best policies that are certain to match your requirements.