Cashless Health Insurance Policy Online In India

Cashless health insurance policy allows free of cost treatment to policyholders. It is hassle-free as it does not require you to wait for the reimbursement formalities. Under a cashless mediclaim, the bills are settled directly by the insurance company provided that the treatment is availed in a network hospital and the treatment cost falls within the sum insured limit of the health insurance plan. 

 

How does cashless mediclaim work?

 

A health insurance company partners with various hospitals after checking their facilities, doctors availability, quality of treatment offered. Such hospitals are known as ‘network hospitals’ of that particular insurer. If an insurance company claims to have 10000+ network hospitals across the country, it means you can get cashless treatment in all these hospitals.
 

How do you avail the cashless mediclaim insurance?

 

As said earlier, you need to first inform your insurer about your hospitalisation. After reaching the hospital, you or your family members are required to fill a pre-authorization form. You can get the form either at the insurance desk of the hospital or on the website of your TPA (Third Party Administrator your insurance company has a tie-up with). The TPA will then decide to accept or reject your request for cashless treatment based on the terms and condition mentioned in the policy wording.

 

Cashless treatment can be availed in two cases -

 

  • Planned hospitalisation: In the case of planned treatment, you are generally aware that you will get hospitalised in a few days. You need to intimate the insurance company about your hospitalisation before being hospitalised. On reaching the hospital, fill the pre-authorisation form and submit it to the TPA. Your form will then be checked and verified by the TPA service provider. On approval, the insurance company facilitates cashless treatment to you by paying hospital bills and other expenses related to the treatment. This way, you can avail cashless treatment as per the terms and conditions mentioned in the policy. 

 

  • Emergency hospitalisation: In case of an emergency, the pre-authorisation form must be filed within 24 hours of hospitalisation by one of your relatives. Your request will then be processed within 6 hours by the TPA. If its gets approved, you won't have to pay anything to the hospital. However, you can also choose to pay in cash and seek reimbursement later if you cannot wait.

 

In which case is the claim rejected?

 

Almost all the health insurance plans offer cashless mediclaim facility. But, there are some specific conditions when your health insurance provider may disapprove your claim. The conditions may be pre-existing illness like HIV/AIDS, sleep disorders, sexually transmitted diseases, injuries caused due to self-harm, injuries arising during war or warlike incidents, etc. 

 

FAQs on Cashless Mediclaim

 

Q 1. How does a cashless mediclaim policy help me?

Cashless mediclaim helps you deal with medical emergencies by paying for your hospital bills. In a cashless mediclaim policy, all the medical bills are directly settled by the insurance company provided the amount falls within the sum insured limit. This leaves the insured tension free. 

 

Q 2. Can I avail cashless treatment in any hospital?

No. Cashless treatment can only be availed at the network hospitals. If you are hospitalised in a non-network hospital, then you will have to pay the hospital bill and file reimbursement claim to the insurer. 

 

Q 3. In how many ways can cashless treatment be availed?

Cashless treatment can be availed in two ways: planned hospitalisation and emergency hospitalisation. In planned hospitalisation, you need to inform the insurer about the hospitalisation 24 hours in advance. In emergency hospitalisation, you need to inform the insurer 24 hours after being hospitalised. The timing in both cases can vary from insurer to insurer.

 

It is advisable to read the policy wording to understand the cashless mediclaim facility in your policy. Or give us a call at our toll-free number 1800-1205-698. Our experts will help you file a claim for cashless treatment as well as answer your questions related to health insurance.

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