Cashless insurance policies are healthcare plans under which the insurance provider directly settles the bill with the concerned hospital. This means that the policyholder does not need to pay any amount directly to the hospital for treatments undergone.
Most insurance companies have existing tie-ups with medical facilities, called network hospitals. Individuals need to seek treatment at any of these network facilities to avail cashless benefits against their claim. For instance, with the Navi Health Insurance plan, you can access cashless benefits across more than 10,000 network hospitals in India.
At the same time, they must make sure their medical procedure and cost are admissible, according to the policy’s terms and conditions. Accordingly, the insurer will arrange bill clearance post-treatment.
Cashless medical insurance schemes serve as viable alternatives to those policies wherein policyholders pay for treatments directly from their pockets. In such cases, insurance providers reimburse the expense incurred at a later date after the policyholder raises the claim.
Before opting for a cashless medical insurance scheme, individuals must be aware of its different categories. They can opt for the one best suitable for their requirements accordingly.
Here are the scheme types available:
If you are looking for an insurance plan covering the requirements of all of your family members, opt for a family floater scheme. This way, all beneficiaries listed under this plan can avail cashless hospitalization and other benefits within the given coverage limit.
This can make for a more focused and high-coverage cashless mediclaim since it concerns only one person. You can also opt for an individual plan besides a floater plan for any family member with specific health concerns to enjoy an increased coverage limit.
Cashless senior citizen health insurance plan is specially curated for older individuals, who generally have a greater and periodic requirement of medical aid. Such plans exclusively cover pre-existing diseases, day-care expenses, and other costs besides hospitalization.
Here is a step-by-step guide on how to file a cashless medical claim once a requirement arises.
Upon approval, the insurance company will sanction the maximum treatment cost to settle hospital bills post completion of treatment.
While having a health insurance policy in place is crucial, a cashless one helps to enhance the benefits such as:
A cashless health insurance policy is the best solution for emergencies. All you need to do is inform the policy provider at the earliest for speedy commencement of treatment. The whole process becomes highly convenient with immediate medical assistance.
Insurance companies perform several quality checks on medical institutions before including them in their network. Therefore, policyholders can rest assured about the quality of healthcare they can receive from these reputed hospitals. Additionally, policyholders can also consult trained healthcare experts free of cost to avail advanced assistance.
Individuals can enjoy a hassle-free claim process with cashless plans compared to the reimbursement process. You can apply via the Navi Health Insurance app to reduce paperwork while filing a cashless claim.
As already mentioned, a cashless insurance plan covers a wide range of expenses. These include diagnosis, consultation fees, and medical expenses, among other treatment procedures. Therefore, individuals need not worry about ready cash availability.
Policyholders afraid of draining their savings also need not seek external funding for a medical emergency. All they need to do is pay a periodic premium to avail cashless benefits as and when required.
Individuals can also avail tax deductions on the insurance premium under Section 80D of the Income Tax Act.
Illustrated below are the unique features of cashless health insurance policies:
All insurance policies come with certain exclusions. Cashless medical policy plans are no different. This is why it is important to keep a note of the expenses and treatments covered under your plan.
Here is a list of the standard inclusions:
A more comprehensive plan may include other benefits like customised coverage, reduced waiting period, wellness rewards, and more.
With such benefits under cashless health insurance policies, you can effectively eliminate the need to arrange for cash should any medical emergency arise.
Generally cashless health insurance policies cover the following:
Given below is the list of expenses not covered by cashless health insurance policies:
The insurance company directly pays the hospital when a cashless health insurance policy holder is admitted into an in-network hospital.
However, one should carefully check the list of the network hospitals that the insurance company covers.
Cashless health policies are ideal if you fulfil any of the of the following criteria:
Given below are the different ways one can avail cashless hospitalisation:
If there is a medical emergency, then the cashless medical insurance policy holder will have to show the insurance card at the network hospital. This card contains your policy number, type of health policy and the name of the insurance company.
The pre-authorisation form has to be filled for availing the benefit of the insurance policy. An emergency hospitalisation claim is generally processed within 6 hours.
Given below are the steps to avail cashless health insurance policy benefits for planned hospitalisation:
This table illustrates their difference:
|Cashless Health Insurance Policy||Reimbursement Claim|
|Insurance provider makes the payment directly to the hospital||The patient pays the bill and later gets it reimbursed from the Insurance provider|
|Applicable in network hospitals only||Applicable in any hospital across the country|
Enumerated below are the points to consider before one buys a cashless health insurance policy:
Enumerated below are the important reasons why claim can get rejected in a cashless health insurance policy:
Cashless hospitalisation works in the following way:
Now that you are aware of the claim process and benefits of cashless health insurance policies, you can easily apply for one and ensure that you are well-prepared during emergencies. Stay financially secure and avail the best of healthcare without eroding your savings. Make sure to go through all terms and conditions before opting for a policy.
Ans. Yes, there are tax benefits associated with cashless health insurances. Section 80D of Income tax Act, 1961 enables people to avail these tax benefits. People aged below 60 years are eligible for a tax benefit upto Rs. 25,000 while senior citizens can avail tax benefit upto Rs. 50,000.
Ans. No. Cashless health insurance policy holders can avail of its benefits only at a hospital which is part of its network.
Ans. Yes, many cashless medical insurance policies cover pre-existing diseases. However it is subject to many terms and conditions. It is advisable to check them properly as conditions vary from one insurance provider to another.
Ans. The number of claims varies from one insurance provider to another. Irrespective of the number of claims, the sum of the insured amount will remain fixed. It is advisable that patients check the terms and conditions of the policy to see the number of claims that they are allowed.
Ans. Individuals can file a complaint to their concerned insurance provider in case they do not get their claim settled.
Ans. No, cashless plans generally do not include documentation and service charges. However, it depends on company policies, which may vary.
Ans. No, in case you are getting treatment from a non-network hospital, you need to clear the bill yourself first. Post payment, you can approach your insurance provider for reimbursement.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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