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Know Everything About Cashless Mediclaim Insurance
Health emergencies come without warning. Most people are diagnosed with a disease or ailment after it escalates, making hospitalization inevitable. In such situations, they need to pay exorbitant hospital bills that not only affect their savings but are also a hassle. Thankfully, cashless health insurance takes care of your medical bills without any hassles. Read ahead to learn everything about cashless mediclaim insurance.
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- Know Everything About Cashless Mediclaim Insurance
What is Cashless Health Insurance?
Cashless health insurance allows policyholders to avail cashless treatment at a network hospital of their insurance company. It ensures that their insurer pays their medical bills directly to the network hospital upon completion of treatment. Cashless mediclaim insurance enables people to get the best treatment at a preferred network hospital without worrying about paying the medical bills upfront.
However, with the introduction of the Cashless Everywhere facility, people can now avail cashless medical treatment at any hospital of their choice, even if it is not a network hospital. All they need to do is inform the insurer about their hospitalization within the specified time.
How Does Cashless Mediclaim Work?
Here is how cashless health insurance works in India:
Step 1: Inform the insurance company about the hospitalization. For emergency hospitalization, notify them within 48 hours. For planned hospitalization, inform them at least 48 hours beforehand.
Step 2: Show a valid identity card and the health card issued by the insurer at the hospital.
Step 3: Fill up the pre-authorization form and submit it to the hospital.
Step 4: The hospital will submit the pre-authorization form and the required documents to your insurance company, requesting cashless treatment approval.
Step 5: The insurance company will review all the documents and accordingly authorize the cashless treatment.
Step 6: Obtain the treatment, and pay the bills that are not covered by your health insurance policy at the time of discharge.
Step 7: The hospital will send the remaining bills to the insurance company for settlement.
Step 8: After cross-checking all the documents, the insurer will pay the bill amount directly to the hospital.
Types of Cashless Health Insurance Plans in India
Take a look at the different types of cashless mediclaim plans in India:
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Cashless Individual Health Insurance
A cashless individual health insurance plan provides cashless medical coverage to a single person, covering their hospital bills without the need for upfront payments at the time of discharge.
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Cashless Family Floater Health Insurance
Cashless family floater health insurance plans are designed for families and extend cashless coverage to multiple members of the family, including spouse, children, and parents, for a single sum insured.
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Cashless Senior Citizen Health Insurance
Tailored for people aged 60 and above, this senior citizen health insurance policy provides cashless medical treatment to address the unique healthcare needs of senior citizens.
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Cashless Maternity Health Insurance
A cashless maternity insurance policy provides cashless coverage for maternity expenses incurred by pregnant women during pregnancy and childbirth, along with newborn baby's treatments and vaccinations.
Benefits of Cashless Health Insurance
Check out some of the significant benefits of cashless health insurance:
- No Upfront Payment - A cashless medical policy does not require the policyholder to pay the hospital bill upfront. This eliminates the hassle of arranging large sum of money in the middle of a health emergency.
- Convenient Process - Obtaining cashless hospitalization under mediclaim insurance is easy and more convenient, as the insurance company takes care of the documentation and payment of bills.
- Eliminates Financial Stress - It allows policyholders to focus on their health and recovery without worrying about arranging money or making immediate payments during health emergencies.
- Get Best Treatments - Cashless mediclaim insurance allows people to get the best possible treatment, even if it means getting admitted to the best hospital in the city, as the insurance company will pay the medical bills.
- Tax Benefits - Under Section 80D of the Income Tax Act 1961, policyholders can avail tax exemption on the premium paid to buy a cashless health insurance policy.
What is Not Covered in Cashless Health Insurance?
The following medical expenses are not covered in a cashless medical insurance policy:
- Medical treatments or expenses incurred within the first 30 days of the policy, except for accidental injury
- Injuries resulting from self-harm or suicide attempts
- Cosmetic or plastic surgeries, as well as hormone replacement procedures
- Coverage for pre-existing diseases is subject to a waiting period of up to 3 years
- Expenses related to the consumption or misuse of alcohol or drugs
- Non-accidental dental treatments
- Injuries due to adventure sports
NOTE: The exact list of exclusions may differ depending on the health insurance plan.
FAQs
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Q1. What is the process of cashless health insurance?
Ans: Cashless claim process involves informing your insurance company about your emergency hospitalization within 48 hours and planned hospitalization at least 48 hours prior. Send pre-authorization to the insurer to get cashless treatment approval. Get treated and pay for the bills not covered by your policy during discharge. Your insurer will pay the remaining bill amount directly to the hospital. -
Q2. Is cashless claim good?
Ans: Yes. It is good to file a cashless claim as it is more convenient and prevents financial stress. It saves you from the hassle of paying your hospital bills upfront and allows you to focus only on recovery. -
Q3. What is the time period for cashless health insurance?
Ans: The time period to intimate your insurer about your cashless hospitalization is 48 hours for emergency treatments and at least 48 hours prior to a planned treatment. -
Q4. What is the new rule for cashless medical insurance?
Ans: The new rule for cashless medical insurance allows policyholders to avail cashless treatment at any hospital of their choice, even if it is a non-network hospital with the cashless everywhere facility. -
Q5. What if a cashless claim is rejected?
Ans: If your cashless claim is rejected, you can file a reimbursement claim with your insurance company. -
Q6. Are cashless claims cleared in 3 hours?
Ans: Yes. All cashless claims are to be cleared within 3 hours as per the latest IRDAI rule. -
Q7. Is cashless health insurance good or bad?
Ans: Buying a cashless health insurance policy is a good idea, as your insurer will pay your medical bills directly to the hospital. -
Q8. Can a hospital deny cashless treatment?
Ans: With the introduction of the cashless everywhere benefit, hospitals cannot deny cashless treatment as long as all procedures are followed. -
Q9. How long does it take for cashless insurance to be approved?
Ans: Most health insurance companies approve cashless claims within 3 hours of receiving all documents. -
Q10. How to check cashless claim status?
Ans: You can check the status of your cashless claim on the official website of your insurer or by contacting their customer support team. -
Q11. What are the documents required for cashless health insurance?
Ans: The following documents may be required to file a cashless health insurance claim:- Health insurance policy
- Govt.-approved ID card
- Pre-authorization form
- Doctor's prescription recommending hospitalization
- Medical test reports
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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
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*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.
*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases
*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.
*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.
*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
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