Cashless Mediclaim Policy: Types, key features, inclusions and exclusions


6 min read

Know everything about the most beneficial feature of health insurance and how it can help you in medical emergencies.

Emergencies can come anytime unannounced. The same holds true for medical emergencies as well. Such times can be quite demanding, both in terms of time as well as money. There may arise an immediate need for money to be spent on hospitalization or urgent treatment for the patient. Such situations can create quite a panic if not prepared for in advance. This is why health insurance presents an extremely beneficial feature for the convenience of policyholders. It is known as cashless mediclaim.

Here we’ll talk all about a cashless mediclaim policy, how it works, what it covers and excludes, and also share the top insurance companies offering the cashless mediclaim feature. So let’s begin.

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What is Cashless Mediclaim Policy ?

As the name suggests, a cashless health insurance allows the policyholder to avail the benefit of hospitalization without paying immediate cash during a medical emergency. In other words, when an urgent need arises for a treatment at hospital, the policyholder can get hospitalized without having to pay for it immediately, with the benefit of a cashless mediclaim policy.

Also Read: What is Health Insurance with OPD Cover?

3 Types of Cashless Claim Policies in India

We learned what is cashless insurance in the section above. Now let us quickly understand the different types of cashless mediclaim policies that exist in India:

  1. Cashless Individual Health Insurance: These plans are specifically designed for individuals, offering them the cashless mediclaim benefit.
  2. Cashless Family Health Insurance: This can be purchased for the entire family, including spouse, kids, and parents (if applicable). All the members of the family can be covered by cashless health insurance under the same plan avoiding multiple payments of premium for different policies.
  3. Cashless Health Insurance for Senior Citizens: This is exclusively meant for the elderly aged 60 years and above. The plan covers besides cashless hospitalization expenses incurred on the ambulance as well as treatment of pre-existing diseases.

Read More: 8 Best Health Insurance for Cancer Patients

Top 7 Key Features of Cashless Treatment

Now that we know what cashless treatment is, let us look at some of its key features:

  1. Cashless treatment provides coverage for expenditure incurred on hospitalization of the patient for a period greater than 24 hours
  2. Coverage for single health checkup and diagnostic test is provided
  3. Cashless treatment means that the patient does not need to pay a single penny at the time of hospitalization
  4. Coverage for ambulance cost, organ transplant, and domiciliary treatment is also offered under cashless mediclaim policy
  5. Both pre- and post-hospitalization expenses are covered
  6. Daily hospital cash benefit provided
  7. No Claim Bonus (NCB) is granted to the policyholder for zero claims raised in a financial year

Also Read: List of Diseases Covered Under Star Health Insurance Plans

What is Included in Cashless Insurance?

A cashless mediclaim plan can be used to seek coverage for both:

  1. Planned hospital stay for treatment of a specific health condition; and
  2. Emergency hospitalization required during medical emergency

A cashless claim process can be followed in both of the above cases to file a claim for cost coverage on the expenses incurred. The insurance company has a collaboration with a wide network of hospitals and the policyholder can choose to get treatment done at any of those hospitals on the cashless treatment facility. In case of emergency hospitalization too, the patient can be taken to any of the network hospitals and get admitted without having to pay anything from their pocket.

Read More: Online Mediclaim Policy Premium Calculator

5 Exclusions of Cashless Mediclaim

There are certain features that are not included in cashless treatment health insurance. Let us look at some of them:

  1. Fee for the attendant
  2. Admission fees or registration charges at the hospital during the time of admission
  3. Expenses incurred on the purchase of items such as oxygen masks, diapers, syringes, and the like
  4. Purchase of toiletries for personal use
  5. Service charges in the final bill

What to Consider Before Buying Cashless Mediclaim?

So a cashless mediclaim plan does sound appealing but there are some pointers to keep note of before investing in one. Here are some of them:

  1. Make sure that your cashless treatment insurance covers both hospitalization expenses as well as day care treatment coverage under the plan. This is because not all treatments require the patient to be hospitalized and most of them can be taken care of with a brief stay at the hospital (for less than 24 hours).
  2. Make sure that your cashless health insurance plan comes with a lifetime renewability feature. This would be particularly helpful to you if there are dependent parents in your family.
  3. It would be ideal if cashless hospitalization insurance comes with added maternity coverage benefits too to help your spouse cover costs during pregnancy and delivery.
  4. Most cashless health insurance plans come with a single free health checkup and diagnostic test facility. Try and opt for such a plan.
  5. Always check for the list of network hospitals provided in your mediclaim policy where cashless treatment can be availed during emergency.
  6. The Claim Settlement Ratio (CSR) of the insurance company must always be considered before purchasing any mediclaim plan. The higher the CSR of the company, the better it is to invest in.

Know More: What is Disability Insurance Cover in Health Insurance Policy

Top Cashless Mediclaim Plans in India

With so many benefits to enjoy under cashless insurance, it’s only wise to invest in one. If you’re keen on doing so, here are at least 5 insurance companies that offer some of the best cashless treatment health insurance plans in India:

Name of the Plan Eligible Age Sum Insured Coverage Provided Waiting Period
Care Health Plan 5-18 years Rs. 3 lakh – Rs. 6 crore Pre and Post Hospitalization Expenses Pre-existing diseases covered after 4 years of the date of commencement of the policy
Bajaj Allianz Health Insurance Family Floater 18-65 years Rs. 1.5-50 lakh Pre and Post Hospitalization Expenses Pre-existing diseases covered after 2 years
Apollo Munich Optima Restore Health Insurance 5-65 years Minimum Rs. 3 lakh Pre and Post Hospitalization Expenses Pre-existing diseases covered after 3 years
Niva Bupa Health Insurance 18-65 years Rs. 5 lakh Pre and Post Hospitalization Expenses Pre-existing diseases covered after 2 years
ICICI Lombard Health Care Plus 5-65 years Up to Rs. 20 lakh Pre and Post Hospitalization Expenses Pre-existing diseases covered after 4 years

Read More: Does Hair Loss Treatment Cover Under Health Insurance?

Summing Up

Cashless mediclaim policy has a number of benefits for the policyholder, the most important being cashless hospitalization during medical emergencies. For more information on cashless mediclaim or various other health insurance plans in India, visit PayBima.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.


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FAQs on Cashless Mediclaim Policy, Their Types, Key Features, Inclusions and Exclusions

What is the procedure for cashless mediclaim?

To file a claim with the insurer under the cashless mediclaim plan, follow the steps as below:

Within 24 hours of hospital admission, call your insurance company or third-party administrator (TPA).
The insurer will issue you a claim intimation/reference number for your filed claim.
Make sure that the hospital authorities fill out and submit the cashless claim form to the insurance company.

Is cashless claim good?

A cashless claim is generally better than a reimbursement claim because it is far more convenient than the latter. The patient can be immediately hospitalized without having to pay a penny from their pocket.

What happens if cashless claim is rejected?

In case your claim gets rejected by the insurer, introspect and determine any errors that may be present in your claim form submitted to the insurance company. If determined, fix those errors and resubmit the form. You can also take the help of a Third-Party Administrator representative who would help you with the submission of accurate form and relevant documents. 

Dec 14, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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