Cashless Health Insurance Policy – Process and Benefits

5 min read

Sunil is a 27 year old young corporate who wants to give his family financial protection in case of medical emergencies. So, he wants to buy a medical policy offering coverage for the entire family. He was looking for a policy that could provide complete coverage to everyone in the family as well as can aid at times when he is short of cash. Sunil has heard about the cashless health insurance that it is hassle-free and makes hospital payments easy. However, he has some doubts about the policy terms and conditions of the cashless insurance. Thus, he is in doubt if he should purchase the cashless insurance policy or should go for some other policy.

Like Sunil, there are many other people who don’t have much knowledge about the cashless health insurance policies and the rules and regulations associated with it. In this article, we are taking you through the process and benefits of cashless health insurance and will let you know why and how to choose one. Let’s start with the understanding how cashless policy works.

How the cashless insurance functions?

As the name suggests, with cashless health insurance you can avoid the hassle of paying bills at the hospital in case of any medical emergency. Here, the insurance company gets in direct touch with the hospital authority at the time of payment of bills of the insured person and does the needful without you having to worry about the payment. However, the hospital you choose to get the treatment done should be included in the network of hospitals enlisted by the insurance company.

Why do you need a cashless health insurance?

The cashless health insurance is very much in demand lately as it saves the time and energy spent in a hospital while making the payments and does not put any financial burden on the patients family. This policy, especially comes handy at the time of any emergency, when you might not have enough cash in hand to pay your bills. Since this policy does not require any form of cash payments, it comes as a relief for people who do not have enough savings in their account. The only thing you should ensure is to choose a hospital that is available in the network of hospitals of your insurance provider. You can check for this information on the official website of the insurance provider.

By availing the best cashless health insurance, you can protect you and your family at the time of a medical emergency even if you don’t have cash in hand. Since health emergencies do not come with notice, people who do not have a huge amount of bank balance can access this policy at a time when you need emergency medical attention.

Types of cashless health insurance available in India

In general, there are two types of cashless health insurance.

  • Cashless family health insurance
  • Cashless health insurance for senior citizens

A cashless family health insurance provides coverage to all the members of your family. So, you can insure every family member with this policy. On the other hand, the cashless health insurance for senior citizens  provides cover for already existing diseases, hospitalization charges as well as the cost of ambulance charges.

Also Read: Is Health Insurance Important for Women?

Process for using cashless health insurance

The process for using cashless health insurance is very simple. Here’s what you can do:

  • If the hospitalization is planned, just make sure to choose the hospital from the network hospitals enlisted in your insurance company’s website.
  • Use the policy card offered to you by the health insurance company to avail the cashless facility at the hospital.
  • You would be required to fill a form of preauthorization at the hospital at the time of presenting the policy card.
  • The physician attending the patient is also required to fill this form stating the facts about the medical condition of the patient.
  • The form is then cross checked by the TPA or the Third Party Administrator to verify its legitimacy and eligibility.
  • Once TPA verifies and sanctions the policy form, a letter of approval for the treatment will reach the hospital.
  • Though this process might take a few hours in general hospitalization, it is accelerated in case of any emergency hospitalization.
  • The minimum time required by the TPA to approve a policy form is about 6 hours. So in case of an immediate medical need the person can make the payment from pocket and can get it reimbursed later from the insurance company.

Important things to remember

There are certain drawbacks of the cashless insurance, which are mentioned below:

  • You need to choose a hospital from among the network of hospitals as offered by the insurance provider to avail the facility of cashless payment.
  • In some cases, cashless claims get rejected by the TPA if the details offered in the preauthorization form is not correct or complete.
  • Many costs like for ambulance, oxygen masks, and nebulizer and so on are not covered by the insurance company under this policy.
  • Service charges and documentation charges are also not included in the insurance.
  • If the sum assured in the policy gets exhausted, the remaining amount needs to be paid by the insured person from his/her pocket.

Also Read: List of Cheapest Health Insurance in India for 2022

Conclusion 

The rising cost of medical treatment or health treatment has made it imperative for everyone to have a medical insurance. Buying a cashless insurance is hassle-free and beneficial in many cases, especially in case of any emergency. Also, cashless mediclaim policy for family is useful and worthwhile as it covers all members of the family with proper medical coverage.

However, like other insurance policies, it is important to read the document of policy carefully before choosing to buy a cashless insurance plan so that you know about all the terms and conditions mentioned in the policy beforehand.

It is also important to keep copies of all the bills and hospital documents safe, which you might need for future reference.

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Gayatri Prabhu, Head-Digital Business at Mahindra Insurance Brokers Limited (MIBL) is one those few digital leaders who has the width and depth that is required to execute an ROI driven holistic digital strategy. She cuts through the noise, identifies the critical levers and leads her team to successful execution of the defined strategy. Her core mantra to win new and retain existing customers is: understand the consumer behavior and craft experiences around it.

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