Comparing Cashless Hospital Networks for Health Insurance Plans

Cashless Claims at Work: Health Insurance Plan 

It is said that “Life Happens”. In today’s hectic world, it is a luxury to dream of a completely healthy life with no unwanted surprises. It can be an accident, a sudden ill health or even a pandemic that can dig deep into your savings. To face such emergencies with confidence, a cashless scheme is a welcome step in any health insurance plan.  

If you opt for a cashless scheme, your medical bills, treatment expenses and pharmacy bills will be directly settled by your insurer with the network hospital without your intervention. It means you can focus on recovery, and the monetary end is taken care of by the plan. It is extremely helpful at times when you are the one carrying the financial burden of your family and need to be hospitalised. Family members might not be in a position to arrange funds overnight for admission, treatment or even surgery. A cashless arrangement of the insurer with the empanelled hospital becomes a blessing which brings much relief to your family.  

Health insurance companies have direct tie-ups with hospitals all over India. These partnered hospitals are called network hospitals. They are selected after an extensive check on the background and medical services, amenities, tariffs and quality of staff possessed by the hospitals. These tie-ups are on a renewal basis and are renewed annually after a detailed review of its services. This establishes the credibility of the insurer as well. This list is shared by the insurance company with the policyholders at the onset of the policy.  

The company’s representative or Third Party Administrator (TPA) usually takes care of all the formalities. This TPA acts as a coordinator between you and the insurance company. It is responsible for making your claim settlement seamless, but it has the authority to deny your claims as well.  

The documents that are essential for cashless claim processing are :  

1. Duly signed cashless claim processing form 
2. Original bills issued by the hospital with details  
3. Original Receipts of paid bills of tests and pharmacy 
4. Original discharge summary report from the hospital 
5. The reports from medical tests performed 
6. Prescription from doctor stating hospitalisation required 
7. ID proof, and address proofs for know your customer documentation.  

Follow these 5 simple steps to get your cashless claim :  

1. Visit any empanelled hospital only to avail required treatment 
2. Download the pre-authorisation form from the insurer's website or hospital insurance helpdesk. 
3. Sign and submit this form along with your valid ID proofs to the hospital 
4. The form is then verified by the TPA of the insurer and approved by the company. The treatment is then initiated. 
5. Post-treatment completion, the bills are settled directly by the insurer with the hospital  

To make your cashless claim experience even smoother, inform your insurer at the earliest whether planned or unplanned hospitalisation, give detailed and correct information about the patient’s medical history and pre-existing conditions and check for the inclusions and exclusions in your policy to avoid any surprises.  

Empanelled Hospitals for Major Insurers 

Here is a list of empanelled hospitals for some of the top insurers in the health insurance market:  

Choosing the Right Insurer for Cashless Claims :  

Since the process of cashless claims in health insurance plans heavily depends on the quality of service of the insurer and its empanelled hospitals, the first step to avail of this benefit involves choosing the right insurance company. Remember, it not only takes away the financial stress but also can give you access to the best of hospitals with the best of doctors and advanced facilities which is so crucial in medical treatments. Some checkboxes that need to be ticked are :  

1. The process of claim settlement needs to be convenient, simple and hassle-free. The claim settlement ratio is an indicator that an insurer is efficient and able in this area and your claim can be expected to be settled quickly.  
2. Keep a lookout for the coverage amount which varies with pre-existing diseases and other eligibility factors. If you have a family floater, the sum insured will include all the members and the coverage to be availed may be restricted for individual members. Do check these specifications once you receive your policy documents.  
3. It is best to go for a lifetime renewal policy as the premium amount increases considerably with age and pre-existing health conditions. If you have a regular policy continued the premium amount may increase marginally as compared to buying a fresh policy.  
4. The more number of network hospitals available from the insurer, the better the possibility to avail varied and advanced medical treatments in any part of India. Hence, go through the list of hospitals as well, after the issuance of your policy.