The introduction of cashless hospitalisation in insurance policies has helped people not to worry about cash while admitting their close ones in a hospital. With the help of this facility, patients can undergo any necessary treatment without the worry of direct payment.
In case of cashless claims, the insurer settles all bills (if it does not exceed a sum insured amount) directly through coordination with the hospital without involving the policyholder.
Wondering how cashless hospitalisation works in India? Here’s everything that you need to know about cashless hospitalisation.
In India, there are three types of cashless hospitalisation facilities available:
Under this particular insurance policy, only the insured person can seek cashless benefits on seeking treatment from a network hospital.
Individuals can cover themselves alongside their family members under a single health insurance policy. The cashless benefits are available to all the family members covered under this single plan.
This plan offers cashless benefits to senior citizen policyholders. The plan typically covers ambulance charges, hospital expenses, and various pre-existing ailments subject to policy terms and conditions.
The benefits of cashless hospitalisation are manifold. These include:
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Health Insurance providers have an association with various private and Government hospitals in India. These firms first check the quality of services offered by these hospitals and then negotiate on prices before tying up.
These hospitals are known as network hospitals. On getting admitted to one of these hospitals, the expenses incurred in due course of seeking treatment are directly settled by an insurer.
In this case, policyholders are aware of their hospitalisation in the upcoming days. In such a situation, follow the below-mentioned cashless hospitalisation process:
To claim this facility, follow these steps prior to the cashless hospitalisation process:
There are, however, a few facilities that are not covered under cashless healthcare plans. A few of these are as follows:
Cashless claims can sometimes get rejected, barring an insured person from seeking treatment. Following are a few instances wherein a cashless claim can get rejected:
However, there is a judgment from the Bombay High Court that TPAs will not reject or partially disallow claims. The onus lies entirely on the insurer. Previously, TPAs got paid incentives to deny any claim. But with this judgment, an insured will now get penalised with regards to claims.
There are a few pointers that you must remember before choosing any health plan. Check them below:
Check the sum insured amount before buying cashless health insurance. A policyholder must pay any excess amount of expenses breaching the limit.
Recently, various health insurance providers have come up with cashless claim facilities in OPD as well. This means an insured will not have to get hospitalised for 24 hours to avail of cashless claims.
A cashless hospitalisation facility saves a lot of hassle for an insured or his/her family members during medical treatments. The claims get settled directly between an insurer and the hospital. It makes the claim process smooth. Finally, people must read about inclusions and exclusions carefully before proceeding to purchase any health insurance.
With Navi Health Insurance, you can get cashless claims within 20 minutes across 10,000+ cashless network hospitals. With Navi, you can enjoy a claim settlement ratio of 97% for cashless claims.
Ans: A cashless claim is better than reimbursement as it offers peace of mind to policyholders and their families. In a cashless process, your insurer will settle your claim with the hospital directly. While in reimbursement, you pay out your expenses during an event and get it reimbursed later.
Ans: TPA is a third-party entity that administers your health insurance policy and initiates the claim process and employee benefits for another company. These firms offer underwriting services and customer service within the insurance industry.
Ans: A cashless plan is valid for 1 year in most cases. Few other insurers offer a plan with a validity of up to 2 years.
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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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