The evolution of cashless health insurance has revolutionised the overall scenario of the Indian health insurance industry. As the name suggests, cashless health plans are those where the beneficiary enjoys the option to avail of treatment at network hospitals without any requirement of immediate payment. The network hospitals are those with which the insurance providers maintain a tie-up and they are spread across the country.
The insurance company and the hospital authorities settle the dues amongst themselves as per the plan terms. The beneficiary only needs to settle the dues that are not covered under the chosen health insurance.
Considering the steep medical inflation rate, you must note that a couple of days of hospitalisation is enough to deplete a significant amount of your hard-earned money. Having competent health insurance has become a necessity nowadays to ensure efficient finance management.
Among all sorts of health policies available, cashless health insurance is increasingly gaining rapid popularity because of its convenience and user-friendliness. Ensuring comprehensive coverage and negating the requirement of immediate upfront payments, a cashless health insurance policy has become an indispensable part of our lives.
Cashless health insurance claim settlement is comparatively much easier involving nominal paperwork. It ensures to retain your peace of mind and lets you focus on treatment and recovery rather than worrying about finances.
Having cashless health insurance is like opening a doorway to access quality healthcare at a wide number of network hospitals operating throughout the country. This implies that you can enjoy the option of choosing your preferred network hospital considering the plan terms.
A competent cashless health insurance policy acts as a safe financial protective shield that aids you in efficient and effective health and finance management, especially during medical contingencies.
Several types of cashless health insurance plans are currently available in India. Each of these variants is unique in its characteristics and has been specifically crafted to meet unique requirement criteria. Some of the most popular variants include:
Individual health insurance: This is a health plan uniquely designed to meet the health and medical requirements of a specific individual.
Family floater health insurance: This is a unique umbrella health cover that covers all the family members under one policy. The total number and types of family members to be covered may vary from plan to plan. However, they usually cover self, spouse, dependent children up to a specific age, parents, and parents-in-law.
Senior citizen health insurance: As the name suggests, this sort of health plan has been specifically designed to meet the unique requirements of people aged 60 years and above.
Critical illness health plans: These health plans cover specific illnesses that are listed as critical as per the terms of the plan concerned. It includes ailments like cancer, heart attack, liver/kidney failure, etc.
Maternity health insurance: It involves coverage for all sorts of maternity and child-birth-related expenses, including costs for both C-sections as well as normal delivery.
Group health insurance: These health plans are offered by employers for their employees. As long as you remain a part of that respective organisation you can enjoy this benefit.
Personal accident health insurance: This is like a backup safeguard for protection against unforeseen accidents. It offers you financial support in the case of any disability or fatality as a result of any accident.
If you are planning to buy a cashless health insurance plan, you must be aware of some of its unique characteristics and features:
Convenience: Utilising the benefits of cashless health insurance is very easy and user-friendly. You simply need to produce your health insurance card to begin the treatment without any immediate financial payment. The insurance company and the hospital authorities mutually settle the dues among each other on discharge, you just need to pay the dues that are not covered under the selected plan.
Network hospitals: The health insurance providers maintain tie-ups with standard hospitals and healthcare facilities across the country. It's like they are mutual partners of each other. You can immediately begin your treatment at any of these network hospitals simply by producing your health insurance card and without worrying about any immediate cash payment.
Now, with the feature of “cashless everywhere” being rolled out by the Government in 2024, you can avail of cashless treatment even in non-network hospitals. However, since there are no standardised rates or tie-up between non-network hospitals and the insurer, the process might be longer and there could be requirements for additional documents. So, if you are looking for a confirmed cashless treatment, it is best to get admitted to a network hospital.
Treatment without financial worries: In the case of cashless health insurance, you do not need to make any immediate upfront payment. Moreover, even if you need to pay during discharge, it is simply a part of the total bill.
Easy claim settlement: The process of cashless claim settlement is comparatively easier. You simply need to produce your insurance card to the hospital authorities and you’re done. The insurance provider and the hospital authorities mutually liaise with each other and settle the dues.
Financial protection: Health issues may arise suddenly out of the blue. Having a competent cashless health plan ready at hand saves a lot of trouble, ensuring efficient finance management without compromising on the quality of healthcare and treatment required.
Pre-approved: Certain treatments require pre-approval. The procedure is made all the more easier with the aid of cashless health insurance. The hospital and your insurance provider mutually sort these out without causing any delays to your treatments.
Peace of mind: When it comes to treatment using a cashless health plan, acts like a caring friend. It ensures to retain your peace of mind and focus more on recovery, rather than getting stressed regarding financial worries.
According to several policyholders, cashless health insurance seems to be an excellent option to access quality healthcare both in the case of planned hospitalisation and medical emergencies. Some of the most highlighting benefits of cashless health policies include:
Wide coverage: Cashless health insurance offers wide comprehensive coverage for almost all sorts of health ailments and during hospitalisation depending on the terms of the chosen plan. Certain insurance providers even offer additional rider facilities like maternity coverage, parental care, neonatal cover, reinstatement of the sum insured, etc. to ensure enhanced coverage.
Immediate cashless treatment: Accessing a cashless health insurance facility is very convenient as you can access quality medical treatment immediately on hospitalisation simply by producing your health card. Most health insurance providers have tie-ups with healthcare facilities, hospitals, and hospital chains to prevent you from making any payment immediately. The bills are mutually settled by the insurance company and the network hospital during treatment.
Zero waiting: You need not have to see if you need a planned or emergency hospitalisation to ensure easy utilisation of your cashless health insurance. These health plans are designed such that they can be utilised immediately irrespective of the circumstances.
Security: Medical emergencies may arise at any point causing serious tension and trouble. Having cashless health insurance acts as a financial safeguard despite challenging unprecedented circumstances.
Tax savings: The premiums paid towards health insurance premiums qualify for tax benefits as per the provisions of the IT Act of 1961 u/s 80D.
Streamlined procedure: Cashless health insurance claim settlement is a well-streamlined procedure and saves a lot of paperwork of filling out reimbursement claim forms and waiting for it to be approved.
Buying a competent cashless health insurance policy is simple and easy. But, it would help if you considered certain crucial factors like benefits and coverage, network hospitals, claim procedure, claim settlement ratio, waiting period, PED coverage, inclusions & exclusions, costs & premiums, plan renewal age, customer service, customer reviews, etc. to know the scenario well. It is best if you compare cashless health insurance plans offered by different competent companies to know which deal suits you the best at the most affordable cost fulfilling your requirements.
Once you have finalised your choice, you can either buy cashless health insurance online or choose to follow the conventional offline method.
To buy a cashless health insurance plan online, you need to follow these simple steps:
| POINTS OF DIFFERENCE | CASHLESS HEALTH INSURANCE | HEALTH INSURANCE |
|---|---|---|
| What is it? | A specific health insurance coverage plan that does not require any upfront cash payment during hospitalisation as the dues are settled by the insurance company | A unique financial protective shield offering coverage for specific medical costs under pre-defined terms and conditions of the chosen plan. |
| Types | Individual health plan, family floater plan, senior citizen health insurance, group health plan, critical illness insurance, maternity plan, ailment-specific plan | Individual health plans, family floater plans, maternity plans, critical illness plans, group health plans, top-up plans |
| Benefits | Financial security; convenience; wider and easy accessibility to quality medical facilities; preparedness during emergency; ensured peace of mind; no requirement for immediate cash arrangement | Coverage for in-patient hospitalisation, pre- and post-hospitalisation costs up to a specific limit; domiciliary treatment coverage; tax benefits, enhancement of coverage using add-ons, sum insured reinstatement facility, compensation benefits under specific conditions |
The coverage span of every cashless health insurance varies from each other depending on the terms of the plan chosen. However, some standard inclusions are:
Hospitalisation: In-patient hospitalisation costs are covered in the case of both planned and emergency hospitalisation.
Consultation fees: A standard cashless health plan covers doctors’ consultation charges.
Surgeries: Surgery costs are taken care of under a cashless health insurance plan.
Medicines: The cost of all the medicines required as per doctor’s prescription gets covered.
Investigations: Any physical investigation or diagnostic tests conducted get coverage.
Pre- and post-hospitalisation: All standard cashless health plans allow pre- and post-hospitalisation coverage up to a pre-defined stipulated time as mentioned in the plan.
Daycare charges: Cashless health plans usually cover daycare costs like cataract surgery, dialysis, etc.
Ambulance charges: Cashless health plans cover ambulance charges.
Even the best cashless health insurance plan will also not offer 100% coverage. Although the types of exclusions may vary from the terms of the plan concerned, however, certain standard exclusions are:
A cashless health card is a very crucial document that effortlessly serves as evidence of your cashless health insurance holding identification. It contains all the relevant personal information and the plan details including the details of your sum insured under your active health insurance plan. You can make cashless payments for costs incurred due to medical emergencies during hospitalisation.
As soon as you purchase a cashless health insurance plan, you receive a softcopy of this card at your registered email address along with the policy papers. If you do not receive it, you must contact the company authorities to sort it out immediately. You can make a printout of this card or use the soft copy only. It can be used throughout the country at any network hospital.
In the case of a family floater plan, each of the family members covered receives individual cashless cards.
As the name suggests, cashless hospitalisation acts as a saviour during medical emergencies and prevents you from undergoing any upfront OUP payments during hospitalisation. The health insurance companies maintain tie-ups with hospitals to cover for the treatments that their beneficiaries undergo.
If you possess cashless health insurance you need not have to pay anything during discharge, except for the ones that do not come under the purview of your chosen health plan. Your insurer will settle all the relevant dues directly with the hospital authorities.
You simply need to inform your insurer regarding your hospitalisation at the earliest or even beforehand in the case of planned hospitalisation and submit the pre-authorisation form. The rest will be taken care of by your insurance provider.
| Points Of Difference | Cashless Claim | Reimbursement Claim |
|---|---|---|
| What is it? | A cashless health insurance can be utilised immediately during planned or emergency hospitalisation | Reimbursement health insurance can be utilised after discharge from the hospital |
| Claim procedure | The beneficiary is required to inform the insurance provider beforehand and then proceed with claim filing. The bills are directly settled by the insurance provider with the hospital. | The beneficiary must file a reimbursement claim application after discharge within a specific stipulated tenure by submitting all the bills, receipts, prescriptions, reports, documents, etc. |
| Claim settlement | Depending on the plan parameters, the insurance company directly settles all the hospital dues | The beneficiary must settle the hospital dues out of pocket and then claim for reimbursement after discharge |
| Approval | In the case of planned hospitalisation, approval is required before 72 hours and in the case of emergency, it is necessary within 24 hours | No claim approval is necessary |
| Time | Usually comparatively faster than reimbursement claim | Takes a comparatively much longer span for claim processing |
| Documents necessary | You simply need to duly fill and sign the claim form as given by the TPA during hospitalisation | You have to submit all the receipts, documents, reports, etc. issued during treatment |
| Flexibility | The beneficiary is required to seek treatment at any network hospital | You can avail of treatment at any non-network hospital of your choice. Claim settlement will require the verification of the treatment. |
| Hospital availability | It can be utilised exclusively at any network hospital | Treatment can be undertaken at any hospital within the policy scope |
The essential documents that you need to purchase cashless health insurance include:
Age-proof documents like an Aadhaar card, birth certificate, passport, DL, PAN card, Voter’s ID, 10th or 12th certificates/mark sheets
Address proofs like an Aadhaar card, voter’s ID, passport, ration card, utility bills, DL
Identity proofs like voter ID, PAN card, Aadhaar card, DL, passport
Medical investigation reports as needed by the specific insurance company
Recent passport-size photographs of all the beneficiaries
To ensure smooth claim settlement under cashless health insurance, you need to submit the following documents:
The duly filled-in and signed request form within 24 hours of emergency hospitalisation
In the case of planned hospitalisation, this form needs to be submitted preferably 4-5 days beforehand
Submit this form along with valid identity proof, and documents like an Aadhaar card/PAN card/DL/passport and insurance health card
A copy of the policy document
Duly filled-in KYC form
Depending on the requirements of the concerned insurance company, certain specific additional documents might be needed
Due to its convenience and user-friendliness, cashless health insurance is very popular in India and experiencing enhanced popularity, especially after the COVID-19 pandemic outbreak. However, under certain circumstances, your cashless claim may get rejected. Some of those reasons include:
We can well understand the importance and convenience of having competent cashless health insurance. However, before purchasing, you must consider all the benefits & coverage, list of network hospitals, claim procedure, premium value, inclusions & exclusions, renewal age criteria, claim settlement ratio, customer reviews, ridders, etc. to know the minute details of your chosen plan. This will save you a lot of disputes and misunderstandings during claim settlement.
We can well understand the importance and convenience of having competent cashless health insurance. However, before purchasing, you must consider all the benefits & coverage, list of network hospitals, claim procedure, premium value, inclusions & exclusions, renewal age criteria, claim settlement ratio, customer reviews, ridders, etc. to know the minute details of your chosen plan. This will save you a lot of disputes and misunderstandings during claim settlement.
Every health insurance company ties up with hospitals to ensure cashless claim settlement. Such hospitals are termed network hospitals.
This depends if your chosen health insurance offers any co-payment clause. Under such circumstances, you need to pay a pre-defined fixed percentage of the total bill amount. Moreover, no cashless health insurance offers 100% coverage. You need to pay for the costs incurred that are excluded under your plan.
Cashless health plans typically exclude OPD coverage. They primarily tend to cover in-patient hospitalisation costs.
Yes, cashless health plans exclusively allow direct settlement of hospital bills according to the coverage span of the chosen plan.
The usual coverage tenure for standard cashless health insurance spans 1 year. You have to renew the plan annually to ensure uninterrupted coverage.
The standard approval procedure for cashless health claims may vary but is usually limited to 24-48 hours, provided, all the necessary genuine documents are submitted correctly. Exceptional delays may happen due to insufficient documentation or during complicated procedures.
You can make multiple claims in a policy year till the exhaustion of the sum insured amount.
The tax benefit is provided to the policyholder for health insurance premium payment irrespective of the type of claim. So, technically there is no correlation between the two. However, if you avail of a Cashless Health Insurance Plan for yourself, spouse and dependent children, the premium would be considered tax-free upto Rs 25,000 per annum under section 80D of the IT Act of 1961.
