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. Moreover, with the cashless facility, you can avail quality treatment without worrying about arranging money at the last moment.
Insurance companies offer a choice of hospitals in their network hospital list so you can get cashless treatment without paying money from your pocket.
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 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.
Mentioned below are the points you should know to have a better understanding of how network hospitals work:
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 in the pre-existing disease list.
Now your insurance policy can cover diseases such as asthma, diabetes, high blood pressure, thyroid, cancer, and more.
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.
1. With network hospitals, you do not have to worry about losing valuable time.
2. Your health insurance provider will cover all the medical expenses under the specified terms and conditions of the policy.
3. Extensive bills will not weigh you down from getting quality treatment. Refer to your network hospital list to find a cashless hospital near your residence.
Here is how you can make a cashless claim following a few easy steps:
It is advisable to keep a network hospital list close 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
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.
Before you go…