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With growing medical costs in India, treatments for major diseases and illnesses have become much more expensive. This can cause financial hardships for many people who are already struggling to make ends meet. There is a growing number of patients who are unable to afford to pay for the services that they feel are important for their health. This has led to the growth of cashless health insurance plans.
Cashless health insurance plans are those medical insurance policies where the insured individual does not need to pay any out-of-pocket expenses in order to receive treatment from any network hospital. This article will offer everything you need to know about cashless health insurance plans in India.
Health emergencies are often unexpected and unplanned. People do not recognise they have a disease until it has progressed to the point where they have to be hospitalised. In such a case, paying overdue medical expenses might have a negative impact on your financial stability. Nevertheless, cashless health insurance eliminates the need for you to face such hurdles.
Since the hospital invoice and other medical bills are settled by the insurance provider directly with the medical facility, you do not need to pay any out-of-pocket expenses other than any co-pay, deductible or non-covered expenses. This is extremely useful in situations where the treatment expenses surpass the amount that the insured can spend at the time.
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|
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|
Here is details of some popular cashless health insurance plans:
Rebranded as HDFC ERGO health insurance, HDFC ERGO Optima Restore health insurance plan is an indemnity health insurance policy which offers sum insured from 3 lakhs to 50 lakhs at both individual and family floater basis.
Care health plan is an indemnity medical insurance policy with sum insured ranging from INR 3 lakhs to 75 lakhs. The policy is available only on a family floater sum insured basis.
If you are looking for the best health insurance policy that offers cashless facility, these plans are a good place to start. However, it is recommended to compare health insurance plans in India before you get it. Whenever you do decide to buy health insurance online, it should be able to provide you with the highest coverage within your budget restrictions.
A cashless health insurance policy is one where the insured's medical bills are immediately reimbursed between the insurance provider and the partnered medical facility. It offers cashless hospitalisation, which means that the insured does not need to spend cash to receive care. Nevertheless, cashless health insurance policy healthcare is only provided in the insurance provider's network hospitals and medical facilities.
The salient features of cashless insurance policies are decided by insurance companies and, therefore, vary between insurers and insurance policies.
Here is a step-by-step procedure for availing cashless health insurance claim filing:
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:
A cashless health card can be defined as a documented proof of your medical insurance identification that contains your personal details, policy details, as well as the sum insured under your active health insurance policy. It provides cashless payment solutions for medical expenditures incurred during hospitalisation as well as other medical expenses. When you submit your cashless card to the hospital TPA, the hospital administration will digitally evaluate the financial cover available to you in order to prepare for your healthcare.
When you buy your medical insurance policy, you will be granted access to your cashless card. The health insurance card, as well as policy papers, will be provided by the insurance company at the time of policy acquisition. If your entire family is covered by a health insurance plan, each member will obtain a distinct and unique cashless card.
If you are covered under a health insurance plan but have not received access to your health card yet, it is highly recommended to contact your insurance provider and ask for the same. Ideally, you should get one before you renew health insurance.
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 growth of cashless health insurance plans in India will help to ensure that more people can get the medical treatment they need. Whether you need surgery, diagnostic tests or any other kind of health care, a cashless health insurance plan will provide the coverage you need without putting your finances at risk.
So, if you do not have proper health insurance coverage in place, it is advisable to shop around for the best health insurance plan in India. The best health insurance in India offers both cashless, and reimbursement claims to the insured, which makes them incredibly valuable in medical emergencies.
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.