Cashless Everywhere Facility for Health Insurance – Things to Know

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:

1. Minimum inhibitory concentration (MIC):

This is the lowest antibiotic concentration that can stop bacterial growth at 24 hours.

2. Minimum bactericidal concentration (MBC):

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:

1. MOU with Hospital (Letter of Consent)

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.

2. Co-payment

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.

3. Deductible

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.

4. Exclusions

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