What is cashless Health Insurance and how does it work?

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.


ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address –
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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