What is Cashless Insurance?
Under health insurance, cashless insurance refers to a mediclaim facility wherein you can settle the hospital bill without paying anything out of your pocket. With a cashless facility, you can avail of medical treatment at a network hospital, and your insurer shall settle the entire hospital bill directly with the hospital’s billing desk. This way, you get complete financial support while bearing the burden of emergency or planned hospitalisation expenses.
Some prominent features of cashless health insurance include:
- Available across Network Hospitals: You can avail of a cashless treatment insurance facility across the list of network hospitals associated with the insurer. At Care Insurance, we offer a wide network of 22900+ network hospitals– offering better cashless facilities.
- Applicable to Emergency and Planned Hospitalisation: Whether you are dealing with a medical emergency or going for planned hospitalisation treatment, cashless insurance helps you cover the expenses without worrying about fund arrangements.
Let’s further elaborate on the concept of a cashless policy with the help of an example.
How Does Cashless Insurance Work?
To understand the procedure of cashless insurance, let’s take an example:
- Suppose you opt for a mediclaim policy with a sum insured of 5 lakh and a facility to file either a cashless or reimbursement claim.
- During a medical emergency, you rush to one of the network hospitals nearest to your place.
- While the doctors examine your condition, you can ask a companion or the hospital’s TPA desk to inform your insurer about the emergency.
- Now, you can avail of proper treatment without worrying about the total expenses.
- Once you are about to get discharged, you can reach the TPA desk and show your health card as given to you by the insurer.
- As the TPA desk shares the claim amount with your insurance provider, you can check the billed items and charges.
- If your billed amount is within the sum insured limit of 5 lakh, and your condition meets other policy terms, your insurer will directly settle the claim with the hospital.
- In case your billing amount exceeds 5 lakh, you need to bear the additional amount yourself.
This way, you can avail of a cashless treatment facility at a network hospital without any hassle.
How Does Cashless Health Insurance Benefit You?
Given the skyrocketing medical inflation and unprecedented spread of diseases, it is essential to have adequate financial cushioning. Especially for middle-class families with limited income sources, bearing the cost of medical emergencies can drain their savings. That’s when buying cashless health insurance in India supports policyholders in paying off hefty medical bills without breaking their own savings. Here are other reasons why you should always opt for a cashless insurance procedure:
Immediate Treatment without Delays
Whether you are undergoing emergency treatment or planning hospitalisation, a cashless insurance facility helps you get proper treatment without any delays. Once you receive the verification and intimidation from the insurance company, you can continue with the treatment procedure and file for a cashless claim at the time of discharge.
Timely Claim Settlement
With Care Insurance’s in-house claim settlement team, it becomes easier and quicker for you to file for a cashless insurance claim. Our claims team responds to all your claim-related queries within the given time and helps you close hospital bills without much hassle.
Zero to Minimum Expenditure
The best part about cashless medical insurance in India is that you do not have to pay anything from your pocket. The insurance company covers all valid treatment expenses without any conditions. However, there may be exceptions like the co-payment clause and deductibles wherein you need to bear a partial claim amount.
No Additional Documents Required
Under a cashless facility, you need to present your health card only. Post-verification, the TPA desk and claims team shall coordinate to fill out the rest of the documentation and claim requirements. You need not produce any further documents unless asked by the underwriter
Cashless Medical Insurance Policies by Care Insurance
At Care Insurance, we offer several medical insurance policies offering a cashless claim settlement facility with wide-ranging coverage options and benefits. We ensure that our health plans meet the healthcare needs of people of all ages while supporting people financially during medical emergencies. Here are our top-selling cashless health insurance plans in India:
- Care Family Health Insurance
- Care Senior Citizen Health Insurance
- Health Insurance with Coverage up to 6 Cr
- Medicalim for Critical Illnesses
Still confused about the ideal health insurance for your family? Here, choose the right health insurance plan to match your budget and healthcare needs.
Care Family Health Insurance Health Insurance with Coverage up to 6 CrMedicalim for Critical Illnesses
Cashless Vs Reimbursement Insurance Procedure
While a cashless procedure protects your wallet immediately, a reimbursement process takes some time to support your financial loss during a medical event. Here are the between the cashless and reimbursement insurance procedures:
| Factors |
Cashless Insurance Policy |
Reimbursement Claim Process |
| Meaning |
Under a cashless facility, the insurance provider pays for your hospitalisation expenses directly to the hospital. The policyholder need not pay anything from the approved amount. Though in some cases, the policyholder might need to bear the claim partially. |
Under a reimbursement process, the policyholder must initially pay the hospitalisation bill. Later, he can file a claim by submitting all the documents to the insurance provider and receiving full or partial repayment of the hospital bill paid. |
| Claim Settlement Time |
A cashless claim is settled within 4 to 5 hours of filing the request. Thanks to our in-house claim settlement team, Care Insurance processes your claim within 2 hours of the request. |
For filing a claim reimbursement, the policyholder should submit the required documents within 15 days of discharge. At Care Insurance, we respond to reimbursement claim requests within 7 days of receiving them. |
| Availability |
Cashless mediclaim services are available only across the network hospitals associated with the insurance company. |
For all non-network hospital admissions, you can raise a reimbursement request post-discharge. |
| What if Rejected? |
If your cashless insurance claim is rejected, you can file for a reimbursement facility once you discharge from the hospital. The process for re-request would be the same as a regular reimbursement request. |
If your reimbursement claim is rejected, you can enquire about it with the claims team. However, you cannot file a cashless claim request if your reimbursement request is rejected. |
How to Raise a Cashless Health Insurance Claim?
Below are simple steps for availing cashless facility:
Step 1: Admit the patient at the listed network hospital is required to avail of a cashless hospitalisation facility.
Step 2: Fill out the pre-authorization form available at the hospital's insurance / TPA Desk.
Step 3: Send the completed form to our claim management team.
Step 4: Receive an approval letter after verification.
Step 5: Respond to any further queries from the claim management team.
Step 6: Carry on with your treatment as per the doctor's advice.
Step 7: You will receive communication about whether your cashless claim is approved or rejected within the standard TAT. Thereby, file a reimbursement claim if a cashless request gets rejected.
Tips to Choose the Best Cashless Health Insurance Policy in India
Here are some factors you must consider before opting for cashless health insurance for yourself and your family:
- Impanelled hospitals: If the insurer empanels your hospital, it becomes effortless when trying to claim the cashless feature. Always make sure that your preferred hospital is a network hospital.
- Sum Insured: This is the total amount that is payable by the insurer under a given policy every year. Always choose sum insured coverage based on your annual healthcare budget, needs, and location.
- Exclusions: Whether cashless or reimbursement, your policy may have exclusions for certain treatments or surgeries, like cardiac treatments or cataracts. Always check for such exclusions beforehand to avoid last-minute disappointments.
- Lifelong Renewability: It is recommended to pick a cashless mediclaim policy with higher lifelong renewable age so that you do not need to switch the policy every now and then.
- Co-payment: If your age and medical condition make you liable for co-payment, you should go with a cashless plan with the lowest co-payment percentage. For instance, Care Senior Health Insurance offers the lowest co-payment of 20% to ensure maximum coverage and support to senior citizens.
- Waiting Period: Always check the underlying waiting period before buying a cashless health plan. Besides the initial waiting period of 30 days, check the waiting period for named ailments like diabetes or cataract if you are dealing with pre-existing diseases.
- Sub-limits and Deductibles: Under a mediclaim plan, sub-limits are the maximum limit payable against an insurance benefit. As for deductibles, you must pay a fixed amount before the insurer covers your claim. Thus, it is essential to check these expenses to make a wise decision.
Choosing the best cashless insurance policy in India is challenging but possible. All you need to do is drop us your contact details, and we will reach out to you to help you select the right health cover.
What if Your Cashless Claim is Rejected?
Policyholders must be aware of the claim settlement process and must adhere to the same when filing for a claim. It will enable them to get cashless health insurance benefits and save them from additional cost burdens during any medical emergency. However, there could be situations when their claim may get rejected. It is imperative to understand the scenarios when the claim can get rejected. Some reasons for claim rejection are:
- When the policyholder avails treatment at the non-network hospital where cashless treatment is not possible– the claim could be rejected.
- If the pre-authorization request is not shared on time.
- In case the hospital or doctor does not provide sufficient details to the insurer.
- If the health policy is not valid and has lapsed.
- If treatment or surgery for a particular medical condition is not covered under the health policy.
- If there is a waiting period applicable on the treated medical condition.
If a cashless claim gets rejected, the policyholder can refile it for reimbursement. When the cashless treatment is denied at a hospital, the policyholder must approach the insurer to know if the expenses could be reimbursed.
Disclaimer: The above information is for reference purposes only. For more details about the health insurance plans, please refer to the sales prospectus, policy terms, and conditions.
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