How many times do you remember getting a call from a relative or friend telling about an emergency hospitalization and need for cash? Many a times you run to the nearest ATM and withdraw money to get your family member admitted in a hospital. Cashless hospitalization is a service that is designed to avoid those tensed moments during hospitalization. All the medical bills are directly settled by the insurance company, provided the amount doesn't exceed the sum assured. There's just one catch to a cashless mediclaim policy, it can only be availed in network hospitals.
Cashless hospitalization is proving to be beneficial for users, especially in emergency situations as a seriously ailing patient may not be able to arrange money before being treated. In addition, it is also very likely that he does not know many people in the city. A cashless hospitalization can simply solve this situation.
There are many types of cashless health insurance in India which can be broadly classified into following categories:
This is the cashless family health insurance policy where sponsor owns the policy and the people covered under it are called its members. One can get his whole family covered under one policy or plan.
This is the cashless health insurance for senior citizens who cover hospitalization expenses, ambulance charges, and pre-existing diseases subject to terms of the policy.
Health insurance companies tie up with different hospitals after checking quality of their medical services and negotiating rates for different procedures. These hospitals are known as network hospitals and when you get hospitalized in any one of them, you do not have to settle the bill with the hospital. Your insurance company that is represented by TPA (third party administrator) will coordinate and settle the bill with the hospital.
Basically, there are two ways through which you can avail cashless hospitalization-
You know beforehand that you will be hospitalized in next few days and it means, you have ample time to decide from which hospital you want to avail services.
Here is what you need to do-
This is where you need immediate medical care. You should make sure that you initiate the cashless mediclaim facility within 24 hours of hospitalization.
Things you will need to do are-
The protocol says that in emergency conditions, a TPA should process a claim within 6 hours.
Read In Detail: How Does Cashless Mediclaim Work
There are some expenses which are not even covered by cashless hospitalization-
Wondering why your claim is rejected by the insurance company? We have listed below some of the top reasons of rejection-
“TPAs cannot reject or partially disallow claims”= Bombay High Court
The Bombay High Court has held that decisions to reject or partially disallow health insurance claims are to be taken by insurance companies and not by TPAs who offer various services to policyholders on the behalf of insurance companies. The move is likely to bolster the claim process because it has been seen that TPAs are given incentives by insurance companies to reject claims and in their attempt to earn incentives, TPAs reject claims at the first stage.
Recently, health insurance companies are lining up cashless OPD to make life easier for patients. It means now patients don’t need to be hospitalized for minimum 24 hours to avail cashless hospitalization. Apollo Munich’s Maxima is offering vouchers for consultancy and pharmacy and similarly, ICICI Lombard is also planning to launch cashless OPD product.
Making the complicated insurance comparison an uncomplicated process, the team at PolicyBazaar is at its best when it comes to finding a right cashless hospitalization plan. By entering basic details like name, age, annual income, etc, you will be able to get mediclaim quotes at free of cost!
Compare health policies from various providers at PolicyBazaar and ensure that you get the right cover for yourself and your family.
What is Cashless Mediclaim Policy?
A Cashless Mediclaim policy enables the insured to get hospitalization benefits without having to pay directly out of his/her pocket. Put simply, the medical bills of the insured are borne by the insurance company and settled directly with the hospital.
Is there a prerequisite for Cashless Mediclaim Policy?
Cashless Mediclaim facility can only be availed in a network hospital listed with the insurer.
How to make a Claim in a Cashless Hospitalization?
The insured needs to inform the TPA 48 hrs prior to getting admitted (planned hospitalization) or within 24 hrs of getting admitted (unplanned hospitalization). After intimation, the insured needs to fill the relevant form along with the supporting documents to get started.
What are the Key Documents required?
The insured should have his/her health insurance card (issued by the insurer) to avail the cashless facility. Other documents required are filled preauthorization/claim form, medical bills and lab reports.
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