Health Insurance 101: Cashless Mediclaim Policy

The term “cashless health insurance” describes a mediclaim policy in which the medical insurance company and the network hospital immediately cover the insured’s medical costs. It offers cashless hospitalisation options so that the insured person can receive care without having to pay cash. However, the insurance company’s network hospitals are the only places where cashless health insurance is available.

In India, there are primarily three different kinds of cashless health insurance, which are as follows: 

1. Family health insurance without payment – The policyholder’s entire family can receive cashless care under this cashless family health insurance coverage. 

2. Senior health insurance without cash – This is a cashless health insurance programme for elderly persons that, subject to the terms of the policy, covers hospital bills, ambulance fees, and pre-existing conditions. *

3. Critical illness health insurance with no cash outlay – People with critical illnesses, such as cancer, heart attacks, etc., can receive cashless care with a cashless critical illness health insurance policy. 

What makes cashless health insurance important? 

In the event of a medical emergency when you might not have fast access to cash or be tight for cash, cashless health insurance is essential. It is intended to do away with all monetary payments in order to provide timely medical care. 

What is the process for cashless health insurance? 

In essence, cashless health insurance eliminates the inconvenience of having to pay cash at the hospital when you’re in need. In order to pay for the care received by the covered person, insurance companies directly negotiate with the hospitals in their network under cashless health insurance. You can check out the premium amount you would have to pay using a health insurance premium calculator.

How do I use a cashless hospital? 

In general, there are two methods for obtaining cashless hospitalisation: 

1. Hospitalization Scheduled 

When you know ahead of time that you must be hospitalised in the coming days, this is referred to as planned hospitalisation. In this situation, if you want to use cashless services, you must select a network hospital. In the event of a planned hospitalisation, follow these steps to receive cashless hospitalisation: 

1. To find the closest network hospital, call the insurance company’s toll-free number. 
2. Take your coverage card to the hospital and request a pre-authorization form once you have chosen the network hospital. 
3. This form is available at the hospital’s insurance desk or online through the website of the insurance company. 
4. Your application should be turned in to the insurance desk where it will be reviewed to guarantee its validity. 
5. The TPA will process the form and either approve or reject it after it is sent to them. 
6. The TPA will issue you an authorization letter outlining the sanctioned amount for the therapy if your pre-authorization request is approved. 

2. Hospitalization in an Emergency 

You must start the cashless mediclaim facility within 24 hours of admission if you require emergency medical attention and are hospitalised. How to receive cashless hospitalisation is as follows: 

1. Present your health insurance card, which will include your policy number, the name of your insurance provider, and the kind of health plan you are now holding, at the hospital in the network. 
2. Fill out the pre-authorization form, and the insurance desk employee will speed up the claim procedure. 
3. A TPA shall handle an emergency hospitalisation claim in accordance with the emergency protocol within 6 hours. 

What does cashless health insurance not cover? 

There are some medical costs that cashless health medical insurance does not cover. Check them out below: 

• Visitor/attendant fees 
• Hospital fees 
• Service fees for toiletries 
• Costs for diapers, nebulizers, oxygen masks, etc. 
• Charges for documentation 

* Standard T&C Apply

** Currently, there are 2 tax regimes in India – new and old. To get the tax benefit you desire, choose the correct one after consulting an expert. You can opt for a regime change during the next financial year.

# Visit the official website of IRDAI for further details.

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. Standard T&C apply

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