Cashless Mediclaim Policy
  • Different types of Cashless Mediclaim Policies
  • Cashless Claims for Different types of Hospitalizations
  • Checklist of Buying Cashless Mediclaim Policy
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Cashless Mediclaim Policy?

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. Cashless Mediclaim Policy 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.

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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.

Types of Cashless Mediclaim Policy

You can financially protect yourself & your family by investing in different types of Cashless Mediclaim policies available in India.

Individual Cashless Mediclaim 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 Mediclaim 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 Mediclaim 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.

Features of Cashless Health Insurance

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

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 Mediclaim Policy can be difficult due to the huge number of plans available in the market. Following are the points to remember while buying a Cashless Mediclaim Policy:

  • 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.

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.

Written By : Naval Goel

Last Updated : October, 2021

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.

Frequently Asked Questions (FAQs)

1. What are the factors that affect the Cashless Mediclaim policy's premium?

  • Age
  • Pre-Existing Medical Diseases
  • Habits such as alcohol or smoking
  • Profession
  • Family Health History
  • Marital Status

2. Can I have more than one Cashless Mediclaim Policy?

Yes, you can have more than one Cashless Mediclaim Policy.

3. What is a Network Hospital?

Network Hospitals are specific hospitals which partner with Insurers for providing Cashless Claim facility to the policyholders.

4. 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.

5. 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.

Find Out What the Customers Are Saying

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- 4.5/5 (1176 Total Rating)

November 22, 2021

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Ahmedabad

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November 22, 2021

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Hyderabad

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November 22, 2021

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Delhi

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November 17, 2021

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Bhopal

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October 28, 2021

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Bengaluru

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