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Quick Guide: Cashless Health Insurance

Aniket Thakkar Aniket Thakkar 30 May 2016

Cashless health insurance serves us when we suddenly encounter a medical emergency and have to get admitted to a hospital. The insurance company directly settles our bill with the hospital, and we do not have to worry about arranging big money on short notice. Here is all you need to know about how cashless health insurance works.

Cashless Health Insurance guide

What cashless health insurance can do

‘What to do if one of our family members or we suddenly fall ill and needs hospitalization?’ is among our greatest worries. We buy expensive insurance products or set aside vast sums of money, just to cover such emergencies. Despite the insurance, we have to pay a hefty sum upfront, out of our pockets; and hope to get reimbursed later. Cashless health insurance eradicates both our worries. It eliminates the need to save tons of money and pay upfront because the insurance company directly settles the bill with the hospital. It also eliminates the need to go through lengthy reimbursement procedures because we never pay anything.

Cashless health insurance scenarios

Cashless health insurance can be claimed for both planned and unplanned hospitalization. Planned hospitalization is when you get hospitalized for a pre-existing disease while emergency hospitalization is when you have to get suddenly hospitalized (such as in the case of an accident or an unexpected illness). In both cases, the claims are settled by a Third Party Administrator (TPS), who has an arrangement with some hospitals. However, the claims procedure is slightly different in the two cases.

Claiming cashless insurance for planned hospitalization

Claiming cashless insurance, in this case, is simple. All insurance companies have tie-ups with various hospitals, which form the insurer’s Preferred Provider Network (PPN). You can avail cashless hospitalization at any hospital that is in your insurer’s PPN. You simply need to fill out a claim form, with all the information about your hospitalization, and send the form to your insurance company/TPA. You may send the form by post or email. Upon approval of your application, the TPA will notify the hospital about the treatment amount. Once your treatment is over, the TPA/ insurance company will directly settle your bill with the hospital.

Claiming cashless insurance for unplanned hospitalization

In a case of sudden hospitalization, you or your family have to inform the TPA/insurance company within 24 hours of admission. You must also send your claim form to it at the earliest. The TPA will review your form in detail and inform you/ your family, and the hospital about the outcome (i.e. whether it will pay for your treatment or not).

The scope of the policy

It is important to remember that cashless insurance does not mean that your treatment will be entirely free. The insurer will only cover the direct expenses of your treatment. Admission/registration fees, toiletries, service charges, attendant's fees, costs on diapers, oxygen masks, syringes, etc.; are not covered by the insurer. However, if the direct cost of treatment exceeds the initially approved amount, the hospital can request the TPA/insurer to increase the cover. Even if your application for cashless settlement is denied, you can pay the expenses for the moment and ask your insurer to reimburse you later.

Cashless health insurance is one of the most valuable insurance services that you can come across. Good policy can relieve you/ your dear ones’ financial anxiety during significant medical emergencies. However, you must take note of a few things. Firstly, cashless insurance is only valid within your insurance company’s PPN. So make sure that your preferred hospital is a part of your insurer’s PPN before buying the policy. Also, make sure that you carefully read the terms and conditions that are given in the policy document, before purchasing a policy.

Last but not the least, it is critical to share a copy of your health insurance documents and identity card with your family/friends. Who knows what may befall whom and when!

Recommended Read : cashless health insurance dos and donts a policyholder must know

Aniket Thakkar
Written by Aniket Thakkar
He lives off TV shows, movies, junk food, comics and sarcasm. When he is not working as a freelance imaginary friend to other beings like him, he works as VP of Marketing at Coverfox.