Make the Most of Cashless Claims in Your Health Insurance Policy

We all experience a medical emergency sometimes, so it’s best to prepare in advance. In emergency hospitalisation, an urgent need for money is common. While purchasing a suitable health insurance plan can help you deal with such situations, you should also be aware of the cashless claim facility in your mediclaim policies.

What is a cashless claim in a health insurance policy?

A cashless claim in health insurance is a term used to describe the facility offered by health insurance companies that provide cashless hospitalisation. It refers to the service that allows patients to avoid reimbursement paperwork following treatment.

Under a cashless health insurance claim process, the insurer would pay all your medical bills directly to the hospital (provided it doesn’t exceed the sum assured). The only requirement for cashless coverage under a health insurance plan is receiving treatment in a network hospital. This might be of great assistance in case the patient or their family cannot make last-minute financial arrangements for the necessary treatment in an emergency.

How does a cashless mediclaim policy work?

After evaluating service quality, medical procedures, and costs, health insurance companies partner with renowned hospitals in various Indian cities. They then refer to the affiliated hospitals as “network hospitals” and compile a list to be distributed to policyholders. This networking process ensures that insurers include only the most reputable healthcare institutions on their list of network hospitals. You can receive cashless facilities at these network hospitals. * Standard T&C Apply

Features of a cashless mediclaim policy: The most common health insurance benefits with cashless claim facilities are –

• No need to make large payments at network hospitals
• Pre- and post-hospitalisation expense coverage
• Health insurance no claim bonus or cumulative bonus for each year where no claims might be filed

Benefits of buying cashless mediclaim:

• Access to the best medical care for medical emergencies without financial concerns
• Depending on the plan selected, extensive insurance coverage might be provided.
• Tax incentives under section 80D of the 1961 Income Tax Act.

* Standard T&C Apply

Please note that tax benefits are subject to change in prevalent tax laws.

How to avail of cashless mediclaim benefits?

You have two options for receiving insurance benefits under a cashless mediclaim policy:

1. Planned hospitalisation: Here, you generally might be aware that you may be hospitalised soon and can choose the appropriate network hospital to receive treatment. To receive cashless hospitalisation benefits, please follow the below steps:

1. 1. Consult your policy’s list of network hospitals or inquire about nearby network hospitals with your insurer.
   2. Bring your policy card to the network hospital to fill out a pre-authorisation form at the insurance counter.
   3. Once the TPA approves or rejects your application, they shall send you a letter detailing the amount that has been authorised for your treatment.
   4. You can then proceed with receiving the necessary care. *

1. Emergency hospitalisation: You have to initiate the cashless insurance claim procedure within 24 hours of hospitalisation if you or your insured family require immediate health care services. Here’s how to proceed in such circumstances:

1. 1. Visit a network hospital and present your health insurance card, which includes your policy number, insurer’s information, and policy type.
   2. Complete the pre-authorisation form to expedite the reimbursement process.
   3. If you cannot wait for TPA approval, you may pay the bills out of pocket and request reimbursement from the insurer later.
   4. In emergencies, according to the protocol, a TPA has to process the claim within six hours.*

* Standard T&C Apply

Remember, selecting a health insurance plan that has your preferred hospital in its list of network hospitals can be a smart move. In addition, having your preferred hospital close to your residence or workplace does prove life-saving in many cases of emergency.

‘Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.’