An out-of-the-blue medical emergency can dig a deep hole into one’s lifetime savings, apart from all the emotional suffering. This is the reason why one must invest in a good health insurance policy so that (s)he get sufficient financial aid during any kind of emergency.
Despite a health insurance policy provides the policyholder a coverage against hospitalization costs, still (s)he might still be required to pay for it from his/her own pocket before raising a claim. However, this may not be the most ideal situation for people with no extra savings to shell out. These are the situations where cashless hospitalization acts as a savior.
Meaning of Cashless Hospitalization
Hospitalization and its associated treatments are becoming costlier with the alarming rate of inflation and upsurge in medical expense. One needs a proper plan to tackle any medical emergency, unless (s)he is born with a silver spoon. Supplemented with cashless claim settlement, a health insurance policy is one such element that surely needs to feature in your financial plan.
So, basically, if someone is admitted in the hospital, but do not have any emergency funds to pay off for his/her hospital bills, cashless hospitalization acts as a savior. If (s)he informs his/her insurance company about the hospitalization, they would directly settle the bills with the hospital rather than the patient having to first pay the expenses and then wait for the insurer to reimburse the money to the patient.
States With The Highest Hospitalization Costs in Urban India
According to a recent survey:
Average cost of hospitalization
On average people using the public hospital
On average people using the private hospital
Rs 32, 370
Rs 31, 653
With a sole intention of providing the much-needed financial relief to the policyholder at the crucial time of hospitalization, the cashless mediclaim insurance policies are designed. It is an arrangement of the insurance companies and their network hospitals, where the claims are settled without involving the insured. Under a cashless health insurance policy, a Third Party Administrator (TPS) acts as a bridge between the hospitals and the insurance company in settling the claims. These TPAs set up a desk at the network hospital to facilitate the smooth processing of such claim requests in most of the cases.
Salient Features of Cashless Mediclaim Insurance
The salient features of cashless health insurance policies are decided by insurance companies and, therefore, vary between insurers and insurance policies. Here’s a list of some of the standard features that are included in most cashless health insurance plans:
- Pre and post hospitalization medical expenditures
- No Claim Bonus
- Inpatient Care
- Daily cash benefits
- Cover for ambulance services
- Cover for critical illnesses like cancer, stroke, heart attack, etc.
- Cover for domiciliary treatment
- Complementary medical check-up and diagnostic tests
- Tax benefits under the Income Tax Act, 1961
- Free-look period
Benefits of Cashless Health Insurance
Here are the benefits that a cashless health insurance policy offers to its policyholder:
- A helping hand for medical emergencies: Whether a medical emergency is unforeseen or not, it burns a hole in one’s pocket when (s)he doesn't financially plan for them in advance. Cashless claim saves critical time that a patient’s family requires to arrange for hospital expenses, so it is very important. In fact, it can get the necessary treatments started simply by showing their cashless health insurance policy card to the relevant hospital authorities.
- A relief for the policyholder and his/her family: It is a great matter of relief in case a need arises, a cashless health insurance policy gives the assurance that finance would not be a concern for the policyholder or his/her family. One can get started with the necessary treatment while being admitted in the hospital, without any delay through a hassle-free cashless claim. The policyholder and his family can solely focus on the treatment and recovery without finance being a cause for worry.
- Exclusive range of coverages: Comprehensive coverages like pre and post hospitalization expenses, ambulance expenses, inpatient care, domiciliary treatment, etc. are generally included in cashless mediclaim insurance policies. However, certain cashless health insurance plans also offer health check-ups and diagnostic tests at regular intervals.
- Safeguarding health when traveling: In case a medical emergency arises while you are traveling, the uncertainties of a new location often prevent you from accessing the right treatment. In such situations, a cashless health insurance assures the policyholder of reliable medical services at a network hospital, and that too, without the hassle of arranging for hospitalization and medical expenses.
- Tax benefits: Premium payments made towards cashless mediclaim insurance policies are eligible for tax benefits under Section 80(d) of the Income Tax Act 1961, up to Rs 25,000 for individuals below 60 years of age and up to Rs 50,000 for senior citizens.
Kind of Cashless Health Insurance Policies in India
- Cashless Individual Health Insurance: Cashless Individual Health Insurance policies offer cashless claims against hospital expenses and other benefits, as per the terms and conditions of the policy, to an individual that is the policyholder.
- Cashless Family Health Insurance: One can get all the members of his/her family covered by the same family health plan, In a Cashless Family Health Insurance plan. The individual in the policyholder’s family that is covered by such a cashless mediclaim insurance plan is known as ‘members’.
- Cashless mediclaim Insurance for Senior Citizen: As the name suggests, this cashless health insurance plan offers covers that are specially designed for senior citizens. It covers ambulance costs, hospitalization expenditures, pre-existing diseases as specified by the policy document, etc.
Top Cashless Health Insurance Policies in India
Here’s a list of five cashless mediclaim insurance policies in India penned down by PolicyX:
- Apollo Munich Optima Restore Health Insurance
- ICICI Lombard Health Care Plus
- Religare Health Care
- Max Bupa Health Insurance
- Bajaj Allianz Health Insurance Family Floater
- Reliance Cashless Health Insurance Plan
- New India Assurance Cashless Health Insurance Plan
- HDFC Life Easy Health Plan
- Cigna TTK Cashless Insurance Term
1. Apollo Munich Optima Restore Health Insurance
Considered as one of the most effective and efficient cashless mediclaim insurance policies, Apollo Munich Optima Restore Health Insurance is very easy to avail the benefit from.
Salient features of Apollo Munich Optima Restore Health Insurance:
- Offers a wide range of coverage on an individual as well as family floater plans
- Offers restore benefit, multiplier benefit and critical illness benefits
- Provides everyday cashless benefits for shared accommodation
- It also covers organ donor charges
- Alternative treatment like Ayurveda is also covered
- Boasts of a wide range of network hospitals
- Includes lifetime policy renewal feature
- Offers tax benefits under Section 80(d) of the Income Tax Act, 1961
2. ICICI Lombard Health Care Plus
Occupying the second place among health insurance companies in India that offer cashless facilities throughout their network hospitals, ICICI Lombard Health Care Plus is loved by its customers.
Salient features of ICICI Lombard Health Care Plus are:
- For every family member of the policyholder, ICICI health care plus offers Individual health insurance cover
- Non-applicable sub-limits on hospital accommodation, doctor’s charges and medical tests
- Add-on features like Maternity Benefit and discounts on treatment for outpatients
- Includes flexible sum assured and deductibles
- Cashless approval within 4 hours
- Quick claim settlement process
3. Religare Health Care
The salient features of Religare Health Care policy are:
- Includes more than 4600 network hospitals
- Comprehensive coverage on pre and post hospitalization
- In case it has exhausted, it provides auto recharge facility to the sum insured
- Lifetime policy renewability
- Coverage on alternative treatments like Ayurveda and Homeopathy
- Speedy claim settlement
4. Max Bupa Health Insurance
The salient features of Max Bupa Health Insurance policy are:
- No sub-limits on hospital accommodation
- Lifelong policy renewable feature
- On each claim free year, an increase of sum insured
- Cashless facility applicable to its wide range of network hospitals
5. Bajaj Allianz Health Insurance Family Floater
Salient features of Bajaj Allianz Health Insurance Family Floater are:
- Boasts of an extensive range of over 6000 network hospitals – the highest among its competitors
- 10 percent co-payment for non-network hospitals
- No sub-limit applicable to hospital accommodation
- Quick and hassle-free cashless claims across network hospitals
- Offers up to 10 percent discount for covers for a maximum of 6 members of the policyholder’s family.
6. Reliance Cashless Health Insurance Plan
The salient features of Reliance Cashless Mediclaim Insurance Plan are:
- Comprehensive coverages on family floater plan and individual plan
- More than 4000 network hospitals with cashless hospitalization
- Offers lifelong policy renewal
- Offers seamless and easy claim settlements
- Quick medical claim settlements feature
7. New India Assurance Cashless Health Insurance Plan
The salient features of the New India Assurance Cashless Health Insurance Plan:
- Comprehensive coverage
- Offers critical care benefit
- Includes critical illness cover
- Offers cashless benefit
- Offers coverage for the family
- Hassle-free claim process
8. HDFC Life Easy Health Plan
The salient features of HDFC Life Easy Health Plan are:
- Cost-effective premium rates for comprehensive coverage
- Covers expenses towards hospital room rent, ICU, medicines, nursing, etc.
- Maternity benefit
- Wide range of network hospitals
- Paperless, hassle-free claim settlement process
9. Cigna TTK Cashless Insurance Term
Salient features of Cigna TTK Cashless Insurance Term are:
- Includes hospitalization expenses as well as pre and post-hospitalization expenses
- Daycare cover
- Emergency ambulance cover
- Restoration benefit
- Maternity expenditures
- Critical illness additional cover
- Tax benefit according to Section 80D of the Income Tax Act, 1961
- Seamless claim settlement
How to Use Cashless Hospitalization
As we all know, the insurance companies collaborate with hospitals across locations in India to prepare a list of network hospitals for the health insurance they provide. On getting hospitalized at any of these network hospitals for any medical treatment, the policyholders of cashless health insurance would be eligible for availing cashless claims whenever the need arises. The medical expenses incurred up to the applicable sum insured are paid by the relevant health insurance company directly to the hospital.
Planned Claim for Cashless Health Insurance
As the name suggests, planned hospitalization implies that you are aware that the policyholder will be hospitalization in a few days. So this is obvious that (s)he have some time on his/her hands to make certain arrangements. Here are a few important points to consider before a planned hospitalization with a cashless mediclaim insurance policy:
- Call the customer care number of your insurance company or go well through the cashless health insurance policy document to become aware of the list of network hospitals.
- The policyholder needs to fill up a pre-authorization form once (s)he decides the choice of network hospital where (s)he would like to be treated. The form can be downloaded from the TPA website or can the policyholder can get it from the insurance desk at the chosen hospital. The first section of the form has to be filled up by the policyholder, while the second half is meant for the attending physician.
- The form needs to be filled with accurate details. One has to ensure that there is no suppression or misrepresentation of information. The hospital authorities will evaluate the authenticity of the details provided in the form, after submission.
- The form is then needed to be faxed to the TPA, which will either approve or reject it.
- If the application is approved, the TPA will send the authorization letter back to the chosen hospital, along with details about the sanctioned amount that they will provide for the policyholder’s medical treatment.
How to Claim for Cashless Health Insurance in an Emergency
When the policyholder requires emergency medical treatment, (s)he has to initiate the cashless health insurance facility within 24 hours of hospitalization. Here is the process to claim the same:
- The policyholder needs to show the cashless mediclaim insurance card to the relevant hospital authorities at the time of hospitalization. This card comprises of the name of the insurance company, the policy number and the type of health insurance plan that the holder have opted for.
- After this, the pre-authorization form, available at the insurance desk, needs to be filled up and submitted, this will lead the claim settlement process. Under emergency medical situations, it is mandatory for the TPA to process claims within six hours of it being initiated by the cashless health insurance policyholder or his/her family. However, if the policyholder prefers not to wait for the approval for TPA, (s)he can pay his/her hospital bills, and later initiate the claim settlement process to get the reimbursements.
Things to Remember While Buying Cashless mediclaim Insurance Policy
- The insured sum: The suitable insured sum depends on the city that the policyholder belongs to. For instance, in a small city, the insured sum between Rs 3 lakh to Rs 5 lakh is believed to be a good amount, whereas a sum of Rs 5 lakh will be essential for metro cities.
- The ratio of claim settlement: One of the most essential factors that one should check before taking a final decision about the policy is the claim settlement ratio of health insurance companies. The higher the ratio, the greater are your chances of a quick and hassle free claim settlement process.
- Network hospitals: Cashless health insurance is claimed only at network hospitals of a health insurance company. It is suggested to assess the list of network hospitals and check whether they include ones in and around the policyholder’s locality and/or the ones that (s)he usually visit. Also, it is important to ensure that the policyholder will be able to avail cashless claims across locations in India.
- Pre and post hospitalization: Before and after hospitalization, there are certain medical expenditures that are incurred. These expenses include medical check-ups and follow-ups, diagnostic tests, recovery treatments, etc. Only expenditures related to the treatment for which the individual had to be hospitalized is considered.
- Co-payment: Co-payment implies the pre-determined percentage of the claim amount that the policyholder has to bear, while the rest will be borne by the insurance company. This is a common clause of group and individual/family health insurance policies of most insurance companies.
- No Claim Bonus: When the cashless health insurance policyholder has not made a claim, several insurance companies offer a no claim bonus. In such an event, either the premium is reduced or the sum insured is increased or both.
- Daycare coverage: Earlier, the traditional health insurance policies make it mandatory for individuals to be hospitalized for at least 24 hours to be eligible for this coverage. But due to advancements in medical technology, there are many treatments which do not require 24 hours hospitalization and are covered under the head of Day Care Treatment. Cashless mediclaim insurance from most insurance companies includes this benefit. It is advisable to make sure that your cashless health insurance policy includes this feature.
- Maternity benefits: It is always advised by experts to keep a check on the waiting period for claiming maternity expenses. This will keep women covered against maternity expenses, enabling them to tide over the inflationary effects on such expenditures.
- Free medical check-up: It is very convenient to opt for a cashless health insurance policy that offers free medical check-ups and diagnostic tests to make the maximum of a cashless mediclaim insurance policy.
- Lifetime renewal: This feature in a cashless health insurance policy eliminates the hassle of renewing it annually. The fact that it covers individuals across ages proves to be beneficial for the policyholder, especially if (s)he have elderly dependent parents in his/her family.
When a Cashless Claim Settlement Can Opt
Planned Hospitalization (For the treatment of a pre-existing disease)
All insurance policy offering companies have a tie-up with certain hospitals that forms a part of their Preferred Provider Network or PPN. It is advised that when one plans to get treated in such hospitals, you can avail the cashless claim settlement facility.
To avail the same, one needs to follow the procedure:
- The policyholder has to fill a detailed claim form with all the information pertaining to the impending hospitalization
- Then the form has to be sent r Emailed to the insurance company/TPA for their approval
- Post-approval, the TPA or insurance company then notifies the hospital regarding the approved amount
- The TPA or insurance company directly settles the expenses with the hospital after the treatment is done
Emergency Hospitalization (For an unexpected event like an accident or a critical illness)
Unfortunately, if an unforeseen situation like an accident or a critical illness happens, hospitalization will be required. Then the policyholder or his/ her family members should follow the following procedure:
- Within 24 hours of hospitalization, the policyholder will have to intimate the insurance company/TPA. Also, (s)he has to send along with the claim form
- After a detailed review of the form, the TPA/insurance company decides to approve or reject the cashless settlement request
- The decision is then duly communicated to the policyholder/contact person and the treating hospital
What Cashless Health Insurance Doesn’t Cover
Despite the fact that a health insurance policy tackles with any financial blows resulting out of hospitalization, there are certain items that are not claimable in spite of being a part of the medical expense. Here is a list of few of them:
- Admission or registration fees
- Service Charges
- Attendant's fees
- Expenses pertaining to diapers, oxygen masks, syringes, etc.
By all means, we can conclude that cashless health insurance is the key to convenience when an unforeseen medical emergency falls on us. However, the thing to keep in mind is that a cashless service is available only at the network hospitals. If the request for cashless settlement is denied, one can still pay for the expenses at the hospital from his/her pocket and then request for reimbursement. To avail of the cashless facility, it is important to send a timely intimation to the insurance company/TPA. It is mandatory to display the health insurance card at the time of admission in the hospital to avail cashless settlement. However, a cashless settlement of claims is purely subject to the terms and conditions mentioned in the policy wording.
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