There are times when during a medical emergency we are struggling to arrange the funds required for proper treatment. During such times the benefits of cashless health insurance can be like a gift from heaven. Here is all that you need to know about cashless insurance.
What is cashless medical insurance?
When you choose a cashless insurance, you don’t need to worry about arranging cash to pay for medical treatment. The insurance company will directly pay your hospital expenses.
Each insurance company has a certain number of hospitals in its network. Example- Insurance Company ABC has a tie-up with around 1000 hospitals across India. If you have some medical emergency and want to avail the cashless facility, then you need to get treatment from a hospital that is in a tie-up with ABC. It is mandatory that you avail treatment from a preferred provider network (PPA) hospital, i.e. a hospital in the company’s network.
Types of claims that can be made in a cashless health insurance
• Planned claim- This can be used when the policyholder knows about impending hospitalization at least 2-3 days in advance. In such a case, s/he must fill out pre-authorization before hospitalization. These are sent to the insurance company which will then approve or dismiss the claim.
• Emergency Claim- In case of a medical emergency like an accident or grave illness, a policyholder can still claim insurance. In an emergency case, the insurance company must be notified about the on-going treatment at the earliest. As per the protocol, the third-party adviser (the insurance company) should process the claim within 6 hours.
Points to keep in mind while availing of cashless medical insurance
• Ask your family members to contact or inform the third part advisers at the earliest in-case of hospitalization in an emergency situation.
• At the time of hospitalization, carry an original ID proof.
• Submit the required investigation and medical reports to the insurer.
• Give complete information about your insurance provider in the prescribed format.
• Other types of cashless health insurance in India
• Apart from cashless policies for individuals, the following plans are available
• Cashless Family Health Insurance- In this the sponsor owns the policy and individuals
covered under it are called its members. You can get your whole family insured with a single premium under the family health plan.
• Cashless Health Insurance for Senior Citizens- Under this plan, the policy covers various charges or expenses like hospitalization, ambulance and pre-existing diseases.
Rejection of cashless insurance claims
Even after submitting proper documents and after choosing a PPA hospital, your claim could be rejected. Some causes of claim rejection are-
• The illness is not covered by the insurance.
• You have exhausted the sum assured for that period.
• The information provided in the form is insufficient.
• Delay in informing TPA about hospitalization.
One of the main benefits of health insurance with a cashless facility is clear- you are freed from the hassle of arranging cash at the already stressful time of medical trouble.