Cashless Health Insurance

Cashless health insurance is beneficial to a family or a patient in a dire emergency and cannot arrange for money at the last minute. A cashless medical insurance facility serves as a boon to the patients in such acute circumstances.

Table of Content:

• What is Cashless Health Insurance?
• Importance of Cashless Health Insurance
• Cashless vs Reimbursement Claims
• How Does Cashless Medical Insurance Work?
• How to Avail Cashless Health Insurance?
• Why Should I Buy Cashless Medical Insurance
• Important points to consider while buying health insurance
• Exclusions
• FAQs

What is Cashless Health Insurance?

Due to medical inflation, Cashless health insurance is amongst the essential features that a health insurance policy must cover. This facility ensures that one can bypass the reimbursement formalities at any network hospitals by handling the treatment cost. With cashless health insurance, you do not need to worry about cash arrangements. You can go for the best treatment without worrying about finances.

Importance of Cashless Health Insurance

In an unforeseen event such as a medical emergency, a family goes through a lot of stress, and arranging finances to pay for the medical treatment is an added stress factor that would cause a delay getting timely treatment.In an unforeseen event such as a medical emergency, a family goes through a lot of stress and arranging finances to pay for the medical treatment is an added stress factor, since that would cause a delay in getting timely treatment.

Thanks to the facility of cashless health insurance, one can skip the hassles of paying medical bills during hospitalization.  We directly settle the expenses with the hospital, subject to policy terms and conditions. The cashless feature has changed the way people pay for their medical treatment and offers a lot of convenience in saving time, money, and effort. Cashless hospitalization is one of the most significant advantages that health insurance policies provide to customers. It keeps families free from any financial worry and minimizes the burden of making payments from their pockets during any medical situation.

Cashless vs. Reimbursement Claims in Health Insurance

While filing a claim, the choices available to a policyholder include a cashless claim and a reimbursement for the expenses incurred during medical treatment.

Policyholders must be aware of the claim process under health policy to ensure hassle-free claims. It is also essential to understand the claim settlement process of health insurance policy, which can either be cashless or reimbursement mode, as discussed below:

Cashless Claim:

Under a cashless claim, policyholders do not require to make any payment from their pockets during a medical emergency. In the event of hospitalization or related medical expenses, the claim will directly settle with the hospital, subject to policy terms and conditions. However, to avail of this facility, the policyholder must get treatment at any of the insurer's network hospitals only.

Reimbursement Claim:

For reimbursement, the policyholders have to bear the medical expenses from their pockets. The policyholder has to submit the required medical bill and necessary supporting documents to get reimbursement. This feature is beneficial when the person avails treatment at any non-network hospital.

How Does Cashless Health Insurance Work?

Cashless health insurance is a feature of health policies that can be availed by the policyholder when he or she gets medical treatment at a network hospital listed by the health insurance company. Network hospitals are healthcare facilities that have a tie-up with the health insurance companies to provide cashless treatment. The insurer is responsible for settling cashless health insurance claims. It may accept or deny the patient's claims for cashless medical insurance, depending on the case. That is, only after proper verification, the hospital gets the approval for treating the patient.

Health insurance companies like us ensure that the network hospitals maintain their standards through stringent quality checks and yearly contract renewals; they offer some of the best cashless health insurance.

How to Avail Cashless Health Insurance?

To claim cashless health insurance, the policyholder must follow the steps given below:

• Choose a listed network hospital empaneled with us
• Get the pre-authorization form from the hospital insurance desk 
• Submit duly completed and signed pre-authorization form
• Approval letter send by our claim management team
• Hospital/Insured to response to the query raised by the claim management team
• You may initiate the treatment and file for reimbursement

During emergency intimation to the claim management team within 24 hours of hospitalization is required and before 48 hours in case of planned hospitalization.

>> Also Read: Health Insurance for Parents

Why Should I Buy Cashless Health Insurance?

Cashless health insurance offers multiple benefits. Read below why you should opt for it:

Immediate Treatment: With cashless health insurance, you can immediately get admitted to any of the network hospitals in case of a medical emergency. You are not required to wait and full fill cash deposit formalities. You have to inform to help desk in the hospital and to your insurer about your hospitalization. Later, after submitting all the required documents, your insurance company pays hospital bills directly.

Tax Benefits: Under Mediclaim 80D, the premiums paid for health insurance for self, dependent parents, children, and spouses are exempted from tax. Thus, you can have saved a fair amount of money and enjoy the tax benefit. It also reduces your taxable income, which reflects less tax liability.

Treatment in Network Hospitals: During any medical exigency, you do not need to get confused about the hospitals. Under cashless health insurance, you can admit to the network hospitals nearby to your residence. These hospitals provide advanced healthcare services and treatment and also have trained medical professionals. You can rely on their medical treatment and get your bills paid by the company.

Peace of Mind: Cashless health insurance gives you peace of mind. You can stand firm in any medical emergency. You do not need to borrow extra money for your or your family member's treatment. From hospitalization to daily cash allowance, ambulance cover, second opinion, all you get under this cover.

Important points to consider before choosing the best cashless health insurance plans

For selecting the best among various cashless health insurance plans, it is essential to keep some points in mind, as we discuss them below:

• COVID-19 Coverage: We know that you have lots of sleepless nights because of COVID-19. Thus, go for the plan that gives you corona treatment coverage as well.
• Pre and Post-Hospitalization: Ensure that your health policy should include pre and post-hospitalization expenses that reduce your pocket burden.
• Emergency or planned hospitalization: Medical emergency can hit anybody anytime, so opt for the policy covering emergency or planned hospitalization expenses.
• Network hospitals list: Before selecting the policy, check the list of network hospitals emplaned with the health insurance company to get the best healthcare facility.
• No Claim Bonus(NCB): Do you know health insurance policy rewards you for your good health. Look for the cashless health insurance that offers no claim bonus as well.
• Preventive Annual Health Check-Ups: Regular health check-ups are good to keep track of your health. Opt for the policy that offers annual health check-ups under the policy coverage.
• Daycare Expenses: Now, you do not need to be hospitalized when you can get daycare treatment. Companies like us cover 541 daycare procedures.
• Ambulance Cover: You will get the ambulance coverage if you avail of it during an emergency. So, opt for the cashless health policy that offers you this cover. 
• AYUSH: If you believe in alternative treatment, opt for the policy with AYUSH (Ayurveda, Unani, Sidha, and Homeopathy) cover and go for sustainable treatment worry-free now.
• Claims Procedure: Also, make sure to understand the procedure to file claims. We have a simplified process for initiating a health insurance claim to make things easier for you. CHI ensures 2-hour cashless claim processing. 
• Claim Settlement Ratio: It is a good indication of any insurer's track record. The higher the Claim Settlement Ratio, the higher your chances of getting a claim. CHI had a Claim Settlement Ratio of 92.3% for FY 2019-20. 
• Policy Inclusions and Exclusions: Before going ahead with a cashless health insurance plan, know what is covered in the policy and what is not. Also, check the benefits covered under the cashless facility.

Also, to get the best health insurance with cashless cover for family, always review the various features. The plan should include benefits like annual health check-up, no claim bonus, and maternity cover. Moreover, the sum insured you are selecting should be high enough to provide adequate coverage for the insured persons.

Exclusions under cashless health insurance

When selecting a cashless medical insurance policy, the insured persons should check the policy document to know the exclusions - the expenses that are not covered in the policy. Some exclusions are:

• Expenses related to the treatment of illnesses within 30 days from policy period start date
• Expenses attributable to self-inflicted injury, attempted suicide, or suicide
• Injuries attributable to consumption/use/ misuse/ abuse of drug or alcohol
• Expenses related to cosmetic treatments or plastic surgery
• Hospitalization or medical expenses resulting from war, riot, strike, and nuclear weapons

FAQs on Cashless Health Insurance

What if Cashless Claim is Rejected?

Policyholders must be aware of the claim settlement process and must adhere to the same when making a claim. It will enable them to get cashless health insurance benefits and save them from additional cost burden 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.

As health plans are supposed to cover medical expenses, it could be disappointing when a claim gets rejected and, you end up paying for the medical bills. Some reasons for claim rejection are:

• When the policyholder avails treatment at the non-network hospital where cashless treatment is not possible, and the claim could be rejected
• If the pre-authorization request is not shared on time
• In case the hospital or treating doctor does not provide sufficient details to the insurer
• If the health policy is not valid and has lapsed
• If treatment cover for the particular medical condition is not covered under the health policy
• If there is a waiting period for covering treatment for a particular medical condition
• If a cashless claim gets rejected, the policyholder can refile it for reimbursement. 

When the cashless treatment is denied at a hospital, then the policyholder must approach the insurer to know if the expenses could be reimbursed.

What Could be the Possible Reasons for Denying my Request for a Cashless Settlement?

A policyholder's claim for cashless settlement may get rejected due to various reasons that include:

• If admitted to the non-network hospital
• If the pre-authorization request is not shared on time
• If sufficient details are not given to the insurer by the hospital
• If the health policy is not valid
• If the medical condition is not covered under the health policy or if there is a waiting period

Can I Opt for Cashless Treatment for OPD Procedure?

A policyholder can avail cashless treatment facility for OPD procedure, including doctor visits if the healthcare facility or hospital is listed as the network hospitals.

How Long Can I Renew a Cashless Health Insurance Policy?

Before the expiry date of the cashless health policies, the policyholders are required to renew their policy. The policyholders can renew a cashless health insurance policy throughout their entire lifetime.

What is the Policy term of Cashless Health Insurance Plans?

Usually, cashless health insurance plans come with a policy term of one year, at the end of which the policyholder must renew their plans. Some plans also come with a term of two years.

>> Check: Best Family Floater Health Insurance in India

What Key Points Should be Kept in Mind while Selecting the Cashless Health Insurance Plan?

Few key points that must be considered while selecting the best cashless health insurance plan are:

• Co-payment
• Insured sum
• Limits on Treatments
• Maximum Renewable Age
• Allowance for Hospital Room Rent
• Waiting Period
• Day-care treatments
• Impanelled Hospitals

How can I Know the list of Hospitals to Avail Cashless Health Insurance?

Cashless Health Insurance facility is available at any of the network hospitals. You will get the list while buying health insurance. You can also know about the network hospitals nearest to their location by visiting the official website.

How does a cashless mediclaim policy help me?

A cashless mediclaim policy helps the insured by preventing even a temporary impact on savings during any planned medical treatment or emergency hospitalization. One does not need to pay for the medical expenses from the pocket and then apply for a health policy reimbursement claim. It helps one get immediate access to medical care at a network hospital in any exigency without worrying about arranging money to pay medical bills. 

Can I avail of cashless treatment in any hospital?

You can avail of cashless treatment at any network hospital empaneled with us. The cashless facility is not available at non-network hospitals.

In how many ways can cashless treatment be availed? 

You can avail of treatment under your cashless medical insurance plan in two scenarios: 
1. In case of emergency hospitalization, where you have to notify us within 24 hours 
2. In any planned hospitalization, where you must notify us 48 hours before admission to the hospital

What happens if my cashless health insurance policy lapses during hospitalization?

Cashless health insurance will provide coverage only during the policy term for which the premium has been paid. The insured person will have to bear the costs incurred after the policy lapse. Thus, it is crucial to renew your policy on time.