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Cashless Health Insurance - Process and Benefits

With rising medical expenses, buying a health insurance policy has become imperative. Most insurance providers are also coming up with cashless health insurance services, which will save you the hassles of paying cash at the hospital.

How does cashless health insurance work?

Cashless health insurance basically removes the hassles of having to pay cash at the hospitals at the time of need. For cashless health insurance, insurance providers enter into direct negotiations with hospitals in their network to pay for the treatment availed by the insured person.

Why is it important to have cashless health insurance?

Cashless health insurance is gradually catching up for all the right reasons. It is especially necessary at times of emergency, when you might be cash strapped or do not have immediate access to cash. The service is designed to eliminate any form of payment by cash.

You just have to ensure that the hospital chosen is present in the network of hospitals covered by the insurance provider. You will easily find this list of third party administrators (TPA) in the health insurance policy.

What are the types of cashless health insurance in India?

Broadly, cashless health insurance is of two types – cashless family health insurance and cashless health insurance for senior citizens. You can insure your family members through a family health insurance and the second health insurance for senior citizens covers pre-existing diseases and ambulance charges apart from covering hospitalisation charges.

What is the process?

In case of a planned hospitalisation, you have to narrow down on the choice of hospital from the network of hospitals provided by the insurance company. With your policy, you will be handed a policy card, which will be required at the hospital to avail the cashless facility.

Upon presenting the policy card, you will need to fill a preauthorization form. This form will also be duly filled by the attending physician, so as to ensure that the facts stated are true. This form will be checked by the TPA to determine its authenticity and eligibility. Following the sanction from the TPA, the hospital will receive a letter approving the treatment.

However, in the case of emergency hospitalization, the process has to be hastened. Usually the TPA should approve the cashless treatment in six hours. In case you require immediate medical attention, you can make the payment first and get the amount reimbursed from the insurance provider.

Things to keep in mind:

There are a few limitations of a cashless health insurance policy. You have to stick to the network of hospitals as provided by your insurance provider to avail the cashless facility.

Your cashless insurance claim can also be rejected. Make sure that the information provided in the preauthorization form is complete, to prevent rejection by the TPA.

Expenses like ambulance charges, equipments like oxygen masks, nebulizers etc. are not covered by the insurance provider. Also, documentation charges and service charges are not included in the policy.

Make sure you read the documents carefully before buying a policy to make sure you are aware of the terms and conditions specified.

Keep a copy of all the hospital documents and bills in case of future reference.

If the sum assured is exhausted, you will have to pay the remaining amount from your own pocket.

To make it easier for you, here we provide a table of insurance companies that provide cashless insurance facility:

Company

Insurance Amount

Premium (Annual)

Facilities

BharthiAxASmart Health(Basic)

 Rs 5 Lakhs

Rs 4, 102

  1. Unlimited room rent eligibility
  2. Four years waiting period for pre-existing diseases
  3. Nil copay

Religare Health InsuranceCARE

Rs 5 Lakhs

 Rs 5,260

  1. Eligibile for single private room
  2. Four years waiting period for pre-existing diseases
  3. Nil copay

HDFC ERGOHealthSuraksha

Rs 5 Lakhs

 Rs 5,688

  1. Unlimited room rent eligibility
  2. Four years waiting period for pre-existing diseases
  3. Nil copay

Star HealthMEDICLASSIC - INDIVIDUAL

Rs 5 Lakhs

 Rs  5,817

  1. Rs 5,000 room rent eligibility per day
  2. Four years waiting period for pre-existing diseases
  3. Nil copay
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