Traditionally, many people avoided buying a health insurance policy since the claim settlement took a long time. Sometimes, the insurance company misplaced the bills submitted by the policyholder, and they had to go back to the hospital to get duplicate copies. Also, there were numerous instances where the insurer settled only a part of the claim amount. Even when the entire claim amount was approved, disbursal could take a long time. As a result, policyholders needed to keep a separate stash of funds to manage medical emergencies despite having mediclaim insurance. To leverage the benefits of health insurance, it was important to ensure that claims were settled faster and in a hassle-free manner. Hence, insurance companies started offering cashless health insurance plans where they paid directly to the hospital without the policyholder having to pay first and then wait for the claim to be settled.
What is Cashless Health Insurance?
Cashless insurance is a medical insurance policy where the insured person does not have to pay at the hospital to get the treatment done. The insurance company pays the hospital directly. However, the treatment needs to be done at a network hospital.
How Does Cashless Claim Settlement Work?
Once you get admitted to any of the network hospitals, you can avail of cashless claim settlement. Here is how it works:
- If you are opting for a planned medical procedure, make sure you inform the insurance company at least 48 hours in advance. In case of an emergency, ensure that the insurer is informed within 24 hours of being hospitalised.
- The hospital will have an insurance desk where you will be required to fill out a pre-authorization form and submit certain documents.
- The insurance company will review the documents and approve/reject the claim.
- Once approved, the hospital is informed, and your cashless treatment begins.
However, it is important to remember that if there is a medical emergency where the hospital cannot delay the procedure, then you might be asked to make an upfront payment that can be claimed from the insurer later.
What if I Cannot Reach a Network Hospital?
Cashless health insurance is available only at network hospitals. If you cannot get to one, you will have to bear the expenses of the treatment and file a claim for reimbursement later.
Things to Keep in Mind for Cashless Health Insurance
If you are availing of a health insurance policy and want cashless claim settlement, keep these things in mind:
- Go through the policy wordings carefully and take a look at the inclusions and exclusions
- Go through the list of network hospitals and check if there are any available in your vicinity
- Check if there are any limits on room expenses and other hospital charges
How Long Does a Cashless Claim Take?
Usually, policyholders are required to inform the insurance provider at least 48 hours in advance if the procedure is planned. For emergencies, the insurer needs to be informed within 24 hours of being hospitalised. The insurance company usually approves or rejects the cashless claim within a few hours.
Cashless health insurance is preferred by most people since it allows you to get the treatment done without having to liquidate your savings. Also, since this facility is only available at a network hospital, the insurer already has a tie-up. Therefore, the documentation required to get approval is minimal. If you want to buy a health insurance policy, then make sure you understand the terms and conditions around cashless claim settlement. Also, research the market and compare providers and policies to find the best coverage for your needs. Good Luck!