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Cashless health insurance helps you receive hassle-free medical treatment without worrying about immediate payment and breaking down your savings.
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Under health insurance, cashless insurance refers to a medical 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 authority. This way, you get complete financial support while bearing the burden of emergency or planned hospitalisation expenses.
At Care Health Insurance, we offer multiple plans with cashless benefit as an in-built feature catering to the various needs of the individual. Some of our best-selling products are:
Ideal for families looking for capless coverage
Health insurance for domestic and global coverage up to 6 crore
Health insurance for elderly with no pre-policy checkup.
Think of cashless health insurance as a helping hand in reducing the financial pressure of receiving quality healthcare. Its unique features make it a reliable resource that allows individuals quick access to healthcare services without needing immediate payments. The two most prominent features of cashless health insurance include:
With a cashless health insurance plan, you receive comprehensive coverage of medical expenses, including daycare procedures, surgeries, hospitalisation and pre- and post-hospitalisation costs.
Another significant feature of cashless health insurance is round-the-clock support by the insurer. Even in case of emergencies, policyholders can expect this support, ensuring prompt resolution of issues and doubts.
To understand the procedure of cashless insurance, let’s take an example:
This way, you can avail of a cashless treatment facility at a network hospital without any hassle.
There are seven types of cashless health insurance plans;
Given the skyrocketing medical inflation and unprecedented spread of diseases, it is essential to have adequate financial bandwidth. If you come from a middle-class family background having a single income source, bearing the cost of medical emergencies can drain your savings. This is where cashless health insurance can take care of your hefty medical bills keeping your hard-earned savings safe. Some other reasons for opting a cashless health insurance include:
By filing a cashless claim, you can avail instant medical treatment in case of planned hospitalisation as well as emergencies.
Cashless insurance policies offer peace of mind while obtaining treatments as you don’t have to worry about paying the hefty medical bills from your pocket.
Another significant advantage of cashless insurance is it removes the hassle of settling the hospital bill
Cashless medical insurance policies offer financial security by protecting you from sudden medical expenditures.
When you’re assured that your treatment charges are going to be paid by the insurance company, you can mindfully focus on your recovery.
The best part about cashless medical insurance 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.
You can easily avail of cashless treatments in case of emergency hospitalisations and ensure that your bills are directly settled between the insurer and the network hospital.
Here are the expenses covered under Cashless Health Insurance:
If you’re required to get admitted to the hospital for treatment, your cashless health insurance will cover your room rent, and other related expenses.
Whether it’s a minor or a major surgery, you can rely on cashless health insurance to bear its cost without burning a hole in your pocket.
Fees of doctors responsible for your treatment are covered under cashless health insurance. So you can stay assured and focus on getting better.
Costs of medicines prescribed by your doctor as per your condition are covered, so you can take a sigh of relief as your treatment has been taken care of.
Costs of diagnostic tests relevant to your condition are covered. So, you don’t have to worry about expensive medical bills.
Pre-hospitalisation expenses- consultation fee, diagnostic tests and medicines and post-hospitalisation expenses- follow-ups are covered in cashless health insurance.
In case you require an ambulance to reach the hospital, cashless insurance has got you covered.
Certain treatments don’t require you to stay overnight. They are known as daycare procedures and are thoroughly covered in cashless health insurance.
Since we have already discussed the factors covered under cashless health insurance, let’s also know about the ones which are not covered. Here’s their breakdown;
If you are diagnosed with a disease before purchasing the policy, the treatment cost would not be immediately covered as insurance companies have a set waiting period for such diseases.
A cashless health insurance policy will strictly not cover non-medical expenses.
Any kind of alternative therapies including naturopathy, aromatherapy, etc. are not covered under a cashless health insurance policy.
Cashless health insurance policies don’t provide coverage for treatment of mental health conditions.
Any other treatments including dental or optical treatments are not covered until the policyholder has opted for their coverage as an add-on.
Treatments which haven’t been proven to be successful in treating certain conditions are not included in the coverage.
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.
Cashless insurance can be availed during planned hospital stays. Here’s the process you need to follow:
Emergencies don’t announce their arrival and are required to be handled with utmost delicacy and urgency. If can of emergency hospitalisation, here are the steps you need to follow to avail of cashless insurance:
Cashless hospitalisation in India requires policyholders to keep certain relevant documents handy. The below table includes these documents;
| Type | Document |
|---|---|
| Insurance Document | Health Insurance Card or copy of policy document including policy number, coverage and insurer’s contact |
| ID Proof | Aadhar card, passport, driving license or voter ID |
| Hospital Pre-Authorization Form | Filled and signed pre-authorization form available at the network hospital TPA or insurer’s website. |
| Medical Reports and History | Previous medical reports and test results relevant to your current disease |
| Claim Form | Filled and signed claim form obtained by the insurance company |
| Emergency Contact Details | Contact details of family members or friends with name, number and relationship |
Note: Depending on your insurance provider, there might be a requirement for additional forms.
Here are some factors you must consider before opting for best cashless health insurance for yourself and your family:
If the insurer empanels your hospital, it becomes effortless when trying to claim the cashless feature. Always make sure that your preferred hospital is there in the list of network hospitals.
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.
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.
It is recommended to pick a cashless mediclaim policy with a higher lifelong renewable age so that you do not need to switch the policy now and then.
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 Citezen Health Insurance offers the lowest co-payment of 20% to ensure maximum coverage and support to senior citizens.
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 cataracts if you are dealing with pre-existing diseases.
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 medical 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.
There could be situations when your claim may get rejected. It is imperative to understand the scenarios when the claim can get rejected. Some reasons for claim rejection are:
If a cashless claim gets rejected, then you can refile it for reimbursement. When the cashless treatment is denied at a hospital, you must approach the insurer to know if the expenses could be reimbursed.
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 differences 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. However, 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 Health 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 are discharged 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. |
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:
Still confused about the ideal health insurance for your family? Here, choose the right health insurance plan to match your budget and healthcare needs.
Look for hospitals around you
A policyholder can avail cashless treatment facility for OPD procedures, including doctor visits if the healthcare facility or hospital is listed as the network hospital.
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.
Usually, cashless health insurance plans come with a policy term of one year, at the end of which the policyholder must renew their plans. You can also opt for multi-year policy terms.
Here is the list of all the cashless network hospitals and healthcare providers associated with Care Insurance. You can search for your region by entering your pin code and state from the drop-down list.
You can avail of a cashless treatment either through emergency hospitalization, where you have to notify us within 24 hours. Also, for any planned hospitalization, where you must notify us 48 hours before admission to the hospital.
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 lapses. Thus, it is crucial to renew your policy on time.
When you buy a health insurance plan, you should be aware of the factors that can affect the premium paid towards a cashless mediclaim policy. The factors include family medical history, pre-existing medical conditions, gender, age, sum insured, location, etc.
Yes, you can avail tax benefit under cashless mediclaim plan.
^^Number of Cashless Healthcare Providers as of 31st March 2024
**Number of Claims Settled as of 31st March 2024
^10% discount is applicable for a 3-year policy
*Premium calculated for an individual (Age 18) for sum insured 5 Lakhs in Zone 2 cities.
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