image title
HEALTH INSURANCE

Why is Mediclaim the Best and What are its Benefits?

Karan SharmaKaran Sharma28 February 2020

Cashless mediclaim has recently become popular among policyholders. Read this article to know the benefits of a cashless mediclaim policy.

Mediclaim Benefits

What is Cashless Mediclaim?

Cashless mediclaim is a feature in which medical/hospital bills are directly settled by the insurance company. The insurer has a list of network hospitals where cashless mediclaim services are provided, as long as the total amount falls within the sum assured limit. Cashless facilities provide relief in case of an emergency where the family might not be able to make substantial monetary arrangements for the medical treatment.

How does Cashless Mediclaim Work?

To begin with, every insurer has a list of hospitals which comes under their authorized service provide umbrella post due diligence.

These hospitals are known as network or empaneled hospitals and the tie-ups are renewed on an annual basis. The entire process of hospital selection is strict and based on the best health facilities provided by the hospital. In case a particular hospital fails to meet the standard criteria maintained by the insurer, the insurer will remove the hospital from its network list. This process ensures that only the best hospitals are brought on board to the list of network hospitals offered by an insurance company. A cashless mediclaim facility will only be available in the list of network hospitals.

If you want to avail this facility, you are required to submit the necessary documents to the insurance company representative or a Third Party Administrator. The TPA is responsible for coordinating with the hospital and settling the cashless claims with the insurance company.

How to avail Cashless Mediclaim?

You can make a cashless mediclaim only if you are admitted in a listed network hospital. Prior to admission, you are required to fill the pre-authorization form from the hospital’s insurance desk and submit the same to the TPA. The Insurer/TPA will either accept or reject your claim with a valid reason. Here are a few conditions under which you can avail cashless hospitalization:

  • Planned Hospitalization:When you are aware that you will have to be hospitalized in the next few days, you are required to fill the pre-authorization form prior to your hospitalization date. This form has to be submitted to the insurer/TPA along with your policy card. Once the form is submitted, the insurer/TPA will either accept or reject your claim with a valid reason.

  • Emergency Hospitalization:In case of an emergency where you are unable to fill the cashless claim form, it is advisable to do the same within the next 24 hours. One of your family members can fill and submit the pre-authorization form to the insurer/TPA. The insurer/TPA will process the claim request within 6 hours. If not possible, you can also get the expenses reimbursed later from the insurance company.

Exclusions under Cashless Mediclaim

Pre-existing diseases like HIV/AIDS, and injuries caused by terrorist acts, non-medical expenses or illegally caused damages, dental procedure, non-medical expenses, war, etc. are excluded undercashless mediclaim plans.

Conclusion

In comparison to reimbursement, cashless claims are a better option because you can undergo hospital treatment, even if you do not have the required funds. In addition, cashless mediclaim also provides tax benefits which can be renewed every year throughout the lifetime of the policyholder.

Karan Sharma
Written by Karan Sharma
Content Specialist and Strategist, foolishly creative and always ready for a game of 'Call of Duty'.
MUST READ