What is the Cashless Medical Insurance Policy?

Imagine needing urgent medical care—wouldn't it be a relief to focus solely on recovery rather than worrying about bills and payments?

With a cashless health insurance policy, you can do just that. Think of it as “peace of mind in your pocket,” letting you walk into a network hospital, show your insurance card, and receive treatment without paying upfront.

This “hands-free” approach to health coverage ensures that finances don't add to your stress in moments when your health comes first.

Cashless health insurance refers to a health insurance plans that gives you the choice to opt for your required treatment, without having to pay any cash out of your own pocket. The same costs are directly taken care of by the hospital and your health insurer (us!).

For example: If you or a family member is affected with the coronavirus and needs to be admitted for treatment, a cashless medical insurance will ensure you don’t need to pay upfront for the costs of the same.

All you need is an approval from your health insurer or third-party administrator and the rest will be taken care of by your health insurer!

Imagine being admitted to a hospital because of an illness and you have to pay nothing! Unbelievable, Right? But yes, this is possible because of Cashless Claims.

In a cashless claim, the hospital and your insurance company/TPA will work together to arrange and pay the bill according to your policy's coverage, but only if you undergo the treatment in an affiliated hospital.

A cashless claim is a simple process. Cashless health insurance ensures cashless treatment anywhere, removing the inconvenience of paying cash at hospitals when necessary:

• Choose Your Insurance Company: You start by selecting a health insurance provider that meets your requirements.
• Select Your Plan: Based on your needs and financial situation, you choose a health insurance plan with cashless benefits.
• Purchase the Plan: Pay the premium and purchase the policy to get the benefit in emergencies.
• Locate a Network Hospital: Look for a network hospital that has partnered with your insurance company for treatment.
• Use Your Health E-Card: When you visit a network hospital, you must download your health E-Card containing all your information and show it to the hospital.
• Your Insurance Pays the Bill: Depending on your policy, the hospital and insurer will cover the cost of the treatment.

Cashless health insurance ensures cashless anywhere, removing the inconvenience of having to pay cash at hospitals when necessary. Insurance companies bargain directly with hospitals in their network to pay for the insured person's medical care.

Here’s a glimpse into how it works and how you can make a cashless claim with your health insurance.

For Planned Hospitalisation

• When you need to make a health insurance claim, choose any one of our 9000+ network hospitals. These are the only hospitals where you’ll be able to claim for cashless treatment.
• Let us know at least 72 hours in advance if you’re going for a planned hospitalization in your preferred location hospital.
• When you visit one of our network hospitals, you must share your health e-card and ID proof with the hospital authority and obtain your pre-authorization form from the hospital.
• After your forms are all filled and signed, submit them and ensure the hospital shares these forms with the Third-Party Administrator (mediator between the hospital and your health insurer)
• Your request will be reviewed, and the insurance company will contact the hospital for pre-authorization. They will evaluate the coverage and medical necessity.
• The rest will be taken care of by your health insurer, i.e. us and the hospital!

For Emergency Situations

• You should start the cashless mediclaim facility within 24 hours of hospitalisation since you immediately require medical attention.
• At the network hospital, present your health insurance card, which will include your policy number, the name of your insurance provider, and the kind of policy you have.
• After completing the pre-authorization form, the insurance desk employee will accelerate the processing of your claim.

You must have a few important documents when visiting a cashless hospital in India. With no upfront fees, this procedure makes your hospital stay easy and hassle-free. The documents include:

• Health E-Card (if any)
• Identity Proof: Driving Licence, Adhar Card, etc. 
• Medical Documents: Doctor’s Prescription, Admission Form, etc.
• The hospital Pre-Authorization form filled
• Previous Medical History Reports
• Claim form downloaded from your insurance company website
• Any additional document required by your insurance company

Although we hope that never occurs, you can file a reimbursement claim at any other hospital of your choosing in its place. Here's how to submit a claim for reimbursement:

• Notify us about your treatment within 48 hours after the date of hospitalisation
• Avail your treatment and settlement bills that you have done out of your pocket
• Submit and upload all the necessary documents on your company’s portal to get the reimbursement
• The insurance company (us) will verify all the documents and settle your claim after verifying.

One excellent strategy to lessen the financial strain of medical bills in India is to use a cashless mediclaim policy coverage. Nonetheless, claims made under this policy may be denied for specific reasons.

Let's dissect it to make it easier to understand:

• Incomplete Waiting Period: There is a waiting period for specific conditions under every policy. You risk denying your claim if you file for a condition during this waiting time. Be sure you understand these waiting times for the specific treatment you are undergoing.
• Non-Disclosure of Information: Your claim may be denied if you hide any information regarding your health or any pertinent health information. Always fill out your policy application accurately and truthfully.
• False Information: The claim form may be rejected if it contains any false information. To prevent such issues, double-check all the information before filing the claim.
• Insufficient Documents: Failure to provide all required documentation is one of the primary causes of health claim rejection. Ensure that you provide the insurance company with all your medical documents, bills, and reports as requested.
• Pre-existing Conditions: Your claim may be denied if you haven't disclosed any pre-existing medical conditions when applying for insurance. Always provide your whole medical history to prevent your claim from being denied.
• Timeframe Crossed: If you fail to notify your insurance company of your hospital stay within the predetermined time window, your claim can be rejected.

The General Insurance Council (GIC) started the 'Cashless Everywhere' program to recreate the Indian health insurance market. By altering the traditional methods of filing health insurance claims, this program gives policyholders greater ease and versatility.

In the past, policyholders who wanted cashless treatment had to choose a network hospital. If they sought medical attention outside of these networks, they had to pay the full hospital fee before filing a reimbursement claim. However, the Cashless Everywhere Hospitals campaign lifted these limitations, enabling policyholders to get cashless care at any hospital, independent of network ties.

This is how Everywhere Cahsless works:

• Check if your hospital is on the list of everywhere cashless hospitals.
• Confirm with the hospital if they accept Anywhere Cashless.
• Inform your insurance company before the 48-hour planned hospitalization or within 24 hours of admission during medical emergencies like accidents.
• You have to fill out your claim form and ask your hospital to mail it to your insurance company.

In India, cashless health insurance has transformed the way people approach healthcare, offering peace of mind in times of medical need. With a simple e-card at a network hospital, policyholders can focus on their recovery. At the same time, the insurer takes care of the financial side—no waiting in long queues or arranging last-minute funds.