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 and you have incurred huge medical bills? In such situations, you might need to rush to arrange cash for medical treatments. Medical emergencies often strike unexpectedly and can impose a severe financial burden for necessary treatments.

In such cases, a 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, known as 'network hospitals'. Under this feature, if you avail treatment at network hospitals, the insurance company directly settles the bills, freeing you from worrying about exorbitant expenses.

In case of a medical emergency, 'Cashless Mediclaim' proves to be a blessing, providing comprehensive coverage, financial support, and 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 individuals to receive cashless treatments at select network hospitals. To receive cashless treatment, the policyholder must notify their insurance provider within 24 hours of being admitted to the hospital. The insurance provider then settles the medical expenses directly with the hospital, allowing the policyholder 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 need for cash payments at hospitals during medical care. The plan is activated at the insured person's request and covers hospital fees for treatments received by the policyholder. Cashless health insurance plans operate at network hospitals designated by insurance providers and are responsible for claim settlement without involving the policyholder. As soon as an individual is admitted to the hospital, they can concentrate on receiving the best medical care possible without having to worry about settling hospital bills, as the insurance providers or TPAs linked with them will handle this procedure. Most cashless medical insurance policies now cover OPD charges that do not require 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 this makes it easier to avail cashless medical insurance in times of an emergency. Once the patient is admitted to a network hospital, you must notify the insurance provider. The insurance provider will then handle the process of fulfilling all formalities and may only contact you if any additional documents related to the hospitalization are required. Cashless treatment commences once your insurance information has been verified.

Types of Cashless Health Insurance Policies in India

You can financially protect yourself and 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 cashless medical insurance policy offers a certain amount of medical coverage for a specific period. The coverage can be used to cover hospitalization costs whenever the insured person receives treatment at a company-affiliated network hospital.

Family Floater Cashless Health Insurance Policy

All family members are covered in a single policy with one fixed sum insured under a Family Floater Cashless Mediclaim Policy. This policy usually covers self, spouse, and dependent children.

Senior Citizen Cashless Health Insurance Policy

These policies are carefully crafted to cover senior citizens' hospitalization expenses when needed. They typically cover hospitalization expenses, ambulance charges, and treatment expenses for pre-existing diseases, as specified by the policy document.

Importance of Investing in 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 ensure individuals can avail the best medical care without worrying about funds.

Benefits of Cashless Facilities

• A cashless facility empowers insured individuals to avail medical treatments in their choice of network hospitals without having to make any cash payments, as payments are handled by the insurance provider.
• When an individual is admitted to a network hospital for planned or unplanned hospitalization, they can be guaranteed the best medical care and facilities, as insurance providers are stringent with their quality checks before empanelling a hospital as a network hospital.
• Since the insurance provider and the hospital are directly in contact, the insured individual need not worry about paying the hospital bills.
• You can avail tax benefits under Section 80D for your cashless health insurance policy.
• Cashless health insurance also covers specialized treatments 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.

• Pre-hospitalization and post-hospitalization expenses coverage.
• No Claim Bonus (NCB) availability.
• Hospital Daily Cash benefit.
• Coverage for emergency expenses, such as ambulance charges.
• Domiciliary treatment coverage.
• No upfront payment required at network hospitals.
• Lifelong renewability feature.
• Access to a vast network of cashless hospitals, available 24/7.
• 24/7 customer support.
• Discounts at network pharmacies.
• 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 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 cases: Planned & Emergency Hospitalization:

Cashless Claims for Planned Hospitalization

In case of planned hospitalization, you have enough time to select the most appropriate hospital from your insurer's network hospitals. The procedure for receiving cashless treatment in the case of planned hospitalization is as follows:

1. Select Network Hospital: Choose a network hospital from the list available on your insurance company's official website, or connect with your insurer's customer care for assistance.
2. Fill Pre-Authorization Cashless Request Form: Once 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 obtained at the network hospital's insurance desk.
3. Verification of Information: Submit 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.
4. Approval or Rejection of Request: The insurance desk or TPA will either approve or reject the request, depending upon the documents and terms & conditions of the policy.
5. Amount Approval: The hospital will receive a sanction letter from the insurer, stating the approved amount.
6. Claim Payment: Once 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.

1. Show Your Policy Documents: Show your policy document/card to the network hospital where you are admitted. The document must include information such as the policy number, policy type, insurance company's name, etc.
2. Fill Pre-Authorization Request Form: Within 24 hours of hospitalization, contact the hospital's insurance desk and fill up the pre-authorization request form.
3. Verification of Documents: The insurance company or TPA will review your pre-authorization request and other submitted documents.
4. Approval or Rejection of Request: The TPA 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.
5. Settlement of Claim: Once 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 Process: Claim rejection might occur when people are unaware of the correct claim process. For example, failing to submit a claim within the specified time frame may result in rejection. Cashless claims can also 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 Conditions: Some pre-existing diseases (PED) are not covered under the cashless claim policy for a certain waiting period, which may vary from 2 to 4 years. During this waiting period, if you file any claim for a PED, expenses incurred for the treatment would not be covered under cashless mediclaim policies.
• Non-Disclosure of Information: One of the most common reasons for claim rejections is hiding information when buying a cashless mediclaim policy. For example, not revealing information about a pre-existing health condition while purchasing a cashless mediclaim policy could result in a claim rejection.
• Exclusions: Health insurance policies come with a set of certain exclusions, i.e., treatments or illnesses which are not covered under the policy. For example, treatment related to sexually transmitted diseases like HIV/AIDS is not covered under cashless mediclaim policies. Raising a claim for any such treatment or ailment leads to rejection.
• Policy Period: A cashless mediclaim policy is a type of insurance contract that lasts for a set period, known as the policy period. When a policy expires, the coverage becomes invalid. Any claim raised after the policy period and before the renewal date leads to rejection.

Points to Remember Before Buying a Cashless Mediclaim Policy

Choosing the best Cashless Health Insurance Policy can be difficult due to the plethora of health plans available in the market. Mentioned below are a few points to remember for your benefit:

• Network Hospitals: Benefits of cashless claims can be availed only at network hospitals. Therefore, you must check network hospitals associated with your insurer in your vicinity for convenience.
• Record of Documents: You must keep photocopies of all relevant documents like the claim form, medical bills, discharge summary, diagnostic reports, etc.
• Terms & Conditions: Always read the terms & conditions carefully, as certain conditions can make you ineligible to avail the benefits of cashless hospitalization.
• Claim Settlement Ratio: The claim settlement ratio of the insurer is one of the important things to consider while buying a cashless mediclaim policy. Insurance companies with a higher claim settlement ratio ensure quick and hassle-free claim settlement.
• 24/7 Customer Support: A good customer service team is required to answer all your questions about your cashless health insurance policy. Policyholders 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 & conditions, and other important documents to determine whether the policy meets all their 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 Covered in Cashless Health Insurance?

Generally, the following things are not covered under Cashless Mediclaim Policy:

• Attendant Fees
• Service Charges
• Patient Hygiene Products
• Medical Consumables
• Documentation Charges

A cashless mediclaim policy protects your finances in case of a medical emergency. The 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.