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In case of any medical emergencies, like an accident, the patient or their family members might not have the emergency funds for the treatment and hospitalization. Having a cashless health insurance policy helps you with cashless hospitalization at the network hospitals of the insurer. This will save you from the hassle of arranging money for the treatment.
Buying a cashless health insurance can help you in dealing with medical emergencies in an efficient manner. Hence while buying a health insurance policy, always go for the one that offers cashless treatment and hospitalization benefits.
Cashless Individual Health Insurance policies offer cashless claims to individuals, that is the policyholder, against hospital expenses and other benefits, as per the terms and conditions of the policy.
In a Cashless Family Health Insurance plan, one can get all the members of his/her family covered by the same family health plan. The individuals in the policyholder’s family that is covered by such a cashless health insurance plan is known as ‘members’.
As the name suggests, this cashless insurance plan offers covers that are especially designed for senior citizens. It covers ambulance costs, hospitalization expenditures, pre-existing diseases as specified by the policy document, etc.
|Best Cashless Health Insurance Plans||Sum Insured||Waiting Period||Coverage||Eligibility|
Apollo Munich Optima Restore Health Insurance
|Rs. 3 Lakhs minimum||3 years for pre-existing diseases||Pre & Post Hospitalization||5 years to 65 years|
ICICI Lombard Health Care Plus
|NA||Pre-existing diseases are covered after 4 years||Pre & Post Hospitalization||5 years to 65 years|
Care Health Plan (formerly known as Religare)
|Rs. 3 lakhs to Rs. 6 Crores||Pre-existing diseases are covered after 4 years||Pre & Post Hospitalization||5 years to 18 years above||
Niva Bupa Health Insurance
|Rs. 5 lakhs||Pre-existing disease waiting period of 24 months||Pre & Post Hospitalization||18 to 65 years|
Bajaj Allianz Health Insurance Family Floater
|1.5 Lakh to 50 Lakh||Pre-existing disease waiting period of 24 months||Pre & Post Hospitalization||18 years to 65 years|
If you face a medical emergency or meet with an accident, you are likely to be hospitalized for a while. In-patient hospitalization is expensive. If you do not have emergency funds, cashless hospitalization is the best option available. Under a cashless facility, the insurer directly settles the bill with the network hospital rather than you having to pay the expenses first and then getting the same reimbursed. Therefore, always buy a health plan which comes with a cashless facility.
Cashless health insurance policies are designed with the sole intention of providing the much-needed financial relief to the policyholder at the crucial time of hospitalization. It is an arrangement of the insurance companies and their network hospitals, where the claims are settled without involving the insured. Under this arrangement, Third Party Administrator (TPA) acts as a bridge between the hospitals and the insurance company in settling the claims. In most cases, these TPAs set up a desk at the network hospital to facilitate smooth processing of such claim requests.
The salient features of cashless insurance policies are decided by insurance companies and, therefore, vary between insurers and insurance policies.
For the treatment of a pre-existing disease
Every insurance company has a tie-up with certain hospitals that forms a part of their Preferred Provider Network or PPN. When you plan to get treated in such hospitals, you can avail the cashless claim settlement facility. To avail it, you need to do the following:
For an unexpected event like an accident or a critical illness
In an unforeseen situation like an accident or a critical illness, if hospitalization is required, then the policyholder or his/ her family members should follow the following procedure:
While your medical insurance policy tackles any financial blows resulting out of hospitalization, there are certain items that are not claimable in spite of being a part of your medical expense. Some of them are mentioned below:
Health insurance companies collaborate with hospitals across locations in India to prepare a list of network hospitals. Policyholders of cashless health insurance plans, on getting hospitalized at any of these network hospitals for any medical treatment, would be eligible for availing cashless claims whenever the need arises. The medical expenses incurred up to the applicable sum insured will be paid by the relevant health insurance company directly to the hospital.
Planned hospitalization implies that you are aware that you will be hospitalization in a few days and, therefore, you have some time on your hands to make certain arrangements. Here’s what you should do before a planned hospitalization with a cashless health insurance policy:
When you require emergency medical treatment, you have to initiate the cashless health insurance facility within 24 hours of hospitalization.
The detailed list of all the network hospitals is available with your insurance company. If you have still not received the same, please contact your insurance company for an update. Simultaneously, you can also access this information through the online portal of your insurer.
As per the strict IRDAI guidelines, the insurance company/TPA cannot deny your request for cashless treatment unless there’s a valid reason to do so. Some of these reasons could be that:
Because OPD treatments are not covered in your health insurance policy, you cannot opt for cashless treatment for them. However, if it’s a part of hospitalization that is covered by the insurance company, you can claim the amount.
Congratulations and all the best! The good news is – yes, you can opt for the cashless treatment. You will have to refer to your policy wordings to check the waiting period and the scope of coverage related to maternity.
If you have lost your health card, you should intimate your insurance company/TPA as soon as possible. Further, it's entirely at the discretion of the insurance company/TPA to accept or reject your request for cashless treatment. Some TPAs/insurers allow their policyholders to proceed with treatment on the basis of KYC documents, if the health card is not available. Cashless settlement of hospitalization expenses is one of the biggest advantages of health insurance. In times, when you are already emotionally fragile, what can be more comforting than a financial respite to reduce your worries and stress?
Cashless health insurance policies can usually be renewed throughout the policyholders’ lifetime.
Here are some of the exceptions to the benefits of cashless health insurance:
Cashless health insurance is a form of payment system under which the insurance company pays the treatment expenses directly to the network hospital where treatment has taken place up to the sum insured opted under the plan. This facility of payment is available under both types of plans i.e. family floater and individual health insurance plans.
Similar to most health insurance products, cashless health insurance policies are generally offered for a standard policy tenure of 1 year. They have to be renewed annually. Some insurance companies also offer a term of 2 years or 3 years on some of their health insurance policies.