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Cashless Everywhere Facility for Health Insurance – Things to Know
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The year 2024 started with some groundbreaking measures and initiatives in the health insurance sector to facilitate policyholders with better health coverage and benefits. One such new rule was initiated by the General Insurance Council (GIC) of India together with the general and health insurers of the country, which makes it possible for health insurance policyholders to avail of cashless hospitalization/treatment across all hospitals and not just the network or cashless hospitals.
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What is Cashless Health Insurance?
It is a type of health insurance policy in which policyholders can avail of healthcare treatment in a network hospital, and the insurer pays the bill for the treatment directly to the hospital. Hence, the policyholder doesn’t have to spend money from the individual’s pocket as the insurance provider settles the bill directly.
Antibiotics perform their function in two terms. They are:
- Minimum inhibitory concentration (MIC):
- Minimum bactericidal concentration (MBC):
This is the lowest antibiotic concentration that can stop bacterial growth at 24 hours.
This concentration of antibiotic can lower the density of bacteria by 1000 folds in 24 hours.
When it comes to children, antibiotics may not be used to treat sore throat, ear infections, and chest infections.
Claim Intimation Process
Below is the stepwise procedure to provide a cashless everywhere facility in a non-network hospital:
- MOU with Hospital (Letter of Consent)
- Co-payment
- Deductible
- Exclusions
When the final approval of offering a cashless facility is received from a hospital, the TPA should get an MOU signed (temporary and valid for 3 months) by the TPA and the hospital. This MOU serves as a part of the claim documents at the time of processing the claim. Once the MOU expires, a fresh MOU should be issued for new transactions.
Co-payment refers to the fixed portion of the medical expenses that the policyholder is required to pay out of pocket, while the insurance company covers the remaining portion. It is usually represented as a percentage of the total claim amount.
A deductible is the amount that the policyholder needs to pay out of pocket before the insurance company starts covering the medical expenses. It is typically an annual amount, and once it's met, the insurance coverage kicks in.
Exclusions are specific medical conditions, treatments, or services that are not covered by the health insurance policy. Policyholders need to carefully review the list of exclusions in their policy documents to understand what is not covered.
Terms and Conditions for ‘Cashless Everywhere’
Below are some terms and conditions related to the Cashless Everywhere initiative:
- Service is not available at excluded providers/hospitals. Hence, policyholders need to check the link for the list of blacklisted hospitals on the respective website of their insurer
- It is very important to inform in advance as indicated in the post above about hospital admission to the insurer for processing the request
- The cashless facility will be available only when the hospital or the service provider accepts the authorization request
- Policy terms and conditions shall apply
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What are Antibiotic Medicine?
You can purchase antibiotics from a chemist's shop by showing your doctor's prescription. Most antibiotics need a prescription when buying them from pharmacies.
You can purchase antibiotics from a chemist's shop by showing your doctor's prescription. Most antibiotics need a prescription when buying them from pharmacies.
You can purchase antibiotics from a chemist's shop by showing your doctor's prescription. Most antibiotics need a prescription when buying them from pharmacies.
Author Bio
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.
Other Health Insurance Products
Jan 08, 2025
Health Insurance
Latest Post
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Global coverage in a health insurance policy ensures access to quality healthcare services across different countries. Whether you travel frequently or seek advanced medical treatments abroad, a global health insurance plan provides financial security and peace of mind.
Surrendering a LIC policy is not recommended. However, sometimes policyholders want to surrender policy to invest in other products with greater returns. In this post, we are discussing the steps to follow to surrender LIC policies and how to calculate LIC surrender value.
LIC or Life Insurance Corporation of India is considered one of the most reliable insurers in India with high repute. The company offers varied plans and products to secure the lives of individuals and their families. LIC plans are available for different tenure with varied coverage options to benefit the policyholders accordingly.
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The most important thing required for an insurance policy to continue is to pay the premium of the plan on time. When you buy a health or life insurance plan from LIC or Life Insurance Corporation of India, the smoothest way of paying the premium is through LIC Merchant. Let us take a look at the LIC merchant portal.
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It is a matter of fact that buying health insurance plans does make a person carefree about the financial burden laid out at the time of a health care need. But does that mean anything, and everything used for medical treatment will be covered under a health insurance policy? You need to think about it twice, as there are a bundle of non medical expenses in health insurance, which are not covered under any health insurance plan. The surprising thing is that a majority of policyholders are not aware of the non-medical expenses listlaid out by the IRDAI or Insurance Regulatory and Development Authority of India.
If you are financially independent and want to plan your finances ahead, you must buy a Life Insurance Policy. It will give you coverage and in case of your death, the nominee will get the death benefit. Nevertheless, before you purchase an insurance policy, you must go through some insurance questions. Here are some of the life insurance FAQs.
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