Cashless Health insurance claims

Cashless Health Insurance

A medical emergency can seriously affect your finances. In addition to the emotional pain, you may have to fork out your savings for hospitalisation and medical care expenses. This is where the Health Insurance plan will come to your rescue during a medical emergency and comes in handy. 

 

What is cashless Health Insurance?

Cashless health insurance plans for family eliminates the need to pay cash at the hospital when you or your family member is hospitalised, and the claim is admissible/payable as per the policy terms. The Insurance company takes the onus to ease your burden of hospital bills and ensures the payment directly to the hospital

How does Cashless Health Insurance work?

Mr Raj having a Health insurance policy, met with an accident and was admitted in a network hospital for the treatment of an accidental injury. Upon hospitalisation, he shares the policy details and valid ID proof with the Insurance desk in the hospital to avail Cashless facility. On the admissibility of the claim and approval given to the hospital, Mr Raj leaves the hospital peacefully without the burden of paying the hospital bill.

Network Hospitals

Network Hospitals are the major aspect of a cashless Insurance Policy. Insurance companies have a direct network with a particular set of hospitals. The policyholder is not eligible for cashless hospitalisation for that specific treatment if they receive medical care at a hospital that is not included in the list of Network Hospitals.

Hospitals empanelled with the Insurance company are called Network hospitals, and the insured can avail cashless facility for inpatient hospitalisation.

Ways to avail a cashless Health Insurance Policy

On submission of the valid policy copy and ID proof to the Insurance desk, the hospital will provide further information and the treatment details in the Pre-authorisation form and send the same to the Insurance for processing cashless.

1. Planned Hospitalisation

When the Insured has been advised for Surgery which is planned for a future date, the insured can go to the Network Hospital and share the policy details and the necessary documents with the Insurance desk. The hospital will further send the documents along with the duly filled Pre-authorisation form to the Insurance company, and cashless approval will be authorised subject to the claim is admissible, and the approval is valid for 7 days from the date of approval.

2. Emergency Hospitalisation

When the Insured person is admitted for any unforeseen or unexpected illness in the Network Hospital and shares the policy details and the necessary documents with the Insurance desk. The hospital will further send the documents along with a duly filled Pre-authorisation form to the Insurance Company, and cashless approval will be authorised subject to the claim is admissible.

 

Be aware of exclusions

All the Health Insurance policies are subject to waiting periods for specified diseases / Conditions, for 1 year / 2 years, of pre-existing illnesses 48 months, 36 Months, 24 Months,12 Months and 6 months according to the policy opted by the Insured. Pre and Post-hospitalisation expenses are covered for specific days as stated in the policy.