Health insurance has become a necessity due to a significant surge in medical expenses. It works as a financial safety net during challenging times of medical crisis. Insurance companies offer a choice of hospitals in their network hospital list so you can get cashless treatment without paying money from your pocket. Moreover, with the cashless facility, you can avail quality treatment without worrying about arranging money at the last moment. Read the following sections to know more about network hospitals and their benefits.
Every health insurance company has agreements with several hospitals to provide cashless treatment to its policyholders. These are called network hospitals and are an integral part of your health insurance policy.
Depending on the policy, your medical insurance company will provide cashless cover for hospital fees and expenses incurred before and after hospitalisation. This works only when you get treatment from a network hospital. Therefore, it is vital that you take note of the health insurance network hospitals in your vicinity.
Here is how you can make a cashless claim following a few easy steps:
The various documents required to make claims during network hospital bill payments include:
Day-Care procedures and facilities covered in network hospitals are:
Mentioned below are the points you should know to have a better understanding of how network hospitals work:
In the present times, the importance of network hospitals has increased to a great extent. Given are some of the benefits of getting treatment at network hospitals.
Network hospitals play a significant role while claiming health insurance benefits. It makes the process more convenient. Moreover, it will guarantee that the hospital will not overcharge the individual for the treatment and other hospital expenses. Network hospitals also ensure that the beneficiary gets the utmost comfort when they are hospitalised. The billing and mediclaim process also simplifies when one chooses to get treated from the network hospitals.
A network hospital is registered under an insurer’s list of hospitals that provide cashless treatment. When getting treatment from a network hospital, you have to contact the TPA to get a letter of authorization. The insurance company will then bear the expenses so that you do not have to spend money from your savings.
Unlike network hospitals, non-network hospitals are not registered under the network hospital list of health insurance companies. So, if you get admitted to a non-network hospital, you have to pay the bills from your pocket.
Post-discharge, you have to submit the required documents. This involves a lengthy process of compiling and filing paperwork. The insurer will approve the expenses he/she finds reasonable. After a few days, the patient will receive the refunded amount.
An individual suffering from a medical condition before purchasing a health insurance policy is said to have a pre-existing disease (PED). It is rather difficult to claim health insurance for PEDs. Policyholders have to undergo a waiting period of 2-4 years to get coverage for a specified ailment.
On 10 February 2020, the Insurance Regulator and Development Authority of India (IRDAI) made significant amendments to the definition of pre-existing diseases.
As per the new clause, individuals who had their conditions diagnosed within three months of purchasing a health plan must be covered. Their conditions need to be registered on the pre-existing disease list.
Now your insurance policy can cover diseases such as asthma, diabetes, high blood pressure, thyroid, cancer, and more.
The exclusions of services in cashless network hospitals are:
It is advisable to keep a list of network hospitals for reference in case you need to get hospitalised urgently. With cashless claims, you can get treatment easier and without much hassle. Get yourself health insurance from Navi App and free yourself from the burden of hefty hospital bills and concentrate on your recovery.
Ans: The most important document you have to provide is your official health card. Apart from this, you have to provide one of the following as photo identification proof:
• Voter ID card
• Driving license
• PAN card
• Aadhar card
Ans: Once your insurer receives all the required documents, they will check if you are eligible for a cashless claim. After the completion of the verification process, they will issue an authorization letter. This usually remains valid for 15 days.
Ans: It is advisable to begin the cashless claim request at least 5 days ahead of your hospitalisation. This way, you can save the time needed for paperwork and processing the pre-authorisation form.
Ans: The age of entry for health insurance policy differs with different policies and insurers. According to IRDAI’s regulations, all health insurance policies must have an entry age of at least up to 65 years. There are insurance policies that cover even older people.
Ans: Given are some tips to make sure that your cashless claim does not get rejected:
• Read the policy document to know all exclusions.
• Inform the insurer/TPA well before hospitalisation.
• Provide accurate information when filing claims.
• Keep the insurer’s contact details at hand.
Ans: These days many hospitals and insurers are entering into agreements for procedures like knee replacement. These types of agreements are called preferred or agreed-on network hospitals. As a beneficiary, the entire claim will be cashless for you. This is one of the major benefits of preferred network hospitals and additionally, the claim will be cleared faster.
Ans: Yes all medical insurance policies offer a list of hospitals when you buy that particular policy. These hospitals present in the mediclaim hospital list are called network hospitals.
Ans: In order to find the hospital list for your health insurance policy you need to follow the steps below:
Step 1: Visit the official website of your health insurance provider
Step 2: Click on the search for hospital tabs
Step 3: Select the state from where you bought the insurance
Step 4: Select the state and city from where you will be getting the treatment
After completing these steps you will be shown the list of hospitals that are covered in your health insurance policy.
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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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