Here's Everything you need to know about Cashless Mediclaim Policy
During a medical emergency, every minute is essential to save a life. In such a situation, arranging for cash to start the treatment can cause unnecessary delay in treatment. In order to avoid such a situation, it is advised to opt for the cashless health insurance policy.
What is cashless medical insurance?
A Cashless MediClaim Policy saves the policyholder the hassle of arranging for cash during a medical emergency. When you hold a cashless medical policy, the insurance company directly settles your medical bills. There is just one condition, the policy can only be availed in-network hospitals.
Each insurance company has a tie-up with a number of hospitals. Example- Insurance Company XYZ has a tie-up with 1500 hospitals across India. In case of a medical emergency, if you want to use the cashless facility then you must get treated from a hospital that has a tie-up with XYZ. The hospitals that the insurance company has a tie-up with are called Preferred Provider Network (PPA) Hospitals.
There are 2 options available-
• Planned claim- This can be used when the insured person knows about hospitalization in advance. For the claim to be approved, the policyholder should fill the pre-authorization form 2-3 days before hospitalization. This is advised because the form is sent to a third-party adviser (TPA) to approve the claim.
• Emergency Claim- In case of any medical emergency, an insured person can claim the insurance. This can only be used if immediate medical care is required. Once the insurance is claimed, the insurance company must be informed about on-going treatment at the earliest. As per the protocol, TPA should process the claim within 6 hours.
To ensure that the claim is approved-
• In case of medical emergency, ask your family members to inform TPA before hospitalization.
• Carry ID proof at the time of hospitalization.
• Carry the required investigation (in case of an accident) and medical reports with you.
• Give complete information about your insurance provider in the recommended format.
Types of Cashless MediClaim Insurance in India-
• Cashless Individual Health Insurance- This policy only covers an individual.
• Cashless Family Health Insurance- An entire family can pay a single premium and share the cover in such a plan.
• Cashless Health Insurance for Senior Citizens- Under this plan, the policy covers various charges or expenses like hospitalization and ambulance. It may or may not cover pre-existing diseases.
Even with the 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.
A cashless health insurance policy is the most hassle-free option available, making it one of the best mediclaim policy type. Especially in case of emergencies, it takes the huge burden of arranging ready cash for treatment off your chest.