What is the Cashless Medical Insurance Policy?
A cashless health insurance refers to a health insurance that gives you the choice to opt for your required treatment, without having to pay any cash out of your own pocket. The costs of the same are directly taken care of between 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!
Cashless Health Insurance – Simplified further
Let’s understand this better with some context. So, usually what happens in health insurance in India is that, when you need to make a health insurance claim because of an illness or accident - you can either opt for your treatment and later get your hospital bills reimbursed from your health insurer or, instead get approvals beforehand or at the time of admission (in case of an emergency) and go for a cashless claim; this means you don’t need to pay any cash up front and your hospital will directly take care of it with your health insurer.
Think of it like getting your hotel stay covered for by your company due to a partnership between your company and the hotel. Similarly, in a health insurance too, only hospitals that are part of your health insurer’s network (a.k.a have a tie up with your insurer), give you the option of cashless treatments.
At Digit, we have about 16400+ cashless hospitals across India where you will be able benefit from your cashless health insurance to opt for cashless treatments.
How does a Cashless Health Insurance work?
A cashless health insurance primarily comes to play when you need to make a claim. Here’s a glimpse through how it works, and how you can make a cashless claim in your health insurance.
Note: The following process is specific to Digit and the same may differ from insurer to insurer.
- When you need to make a health insurance claim, choose any one of our 16400+ network hospitals as these are the only hospitals, you’ll be able to claim for a cashless treatment. Don’t worry though, because we have a range of hospitals across India to choose from!
- Let us know at least 72-hours in advance if you’re going for a planned hospitalization or within 24-hours in case of a medical emergency.
- When you’re at one of our network hospitals, you will need to share your health e-card and ID proof with the hospital authority and get your pre-authorization form from the hospital.
- After your forms are all filled and signed, ensure the hospital shares these forms to the Third-Party Administrator (mediator between the hospital and your health insurer)
- The rest will be taken care of by your health insurer, i.e. us!
Digit's Cashless Network Hospitals
List of 16400+ Network Hospitals >What's great about a Cashless Health Insurance by Digit?
Simple online processes - From the process of buying a health insurance policy to making claims is paperless, easy, quick and hassle-free! No hard copies, even for claims!
No Age-based or Zone-Based Co-payment - Our health insurance comes with no age-based or zone-based copayment. This means, during health insurance claims, you need not pay anything from your pocket.
No Room Rent Restriction - We understand that everyone has different preferences. That’s why we have no room rent restrictions. Choose any hospital room you prefer.
SI Wallet Benefit - If you exhaust your Sum Insured during the policy period, we refill it for you.
Get treated at any hospital - Choose from 16400+ of our network hospitals in India for a cashless treatment or opt for a reimbursement.
Wellness Benefits - Get exclusive wellness benefits on the Digit App in collaboration with top-rated health and wellness partners.
What’s covered in our Health Insurance?
Coverages
Double Wallet Plan
Infinity Wallet Plan
Worldwide Treatment Plan
Important Features
All Hospitalization - due to Accident, Illness, Critical Illness or COVID
This covers for all hospitalization expenses including due to an Illness, Accident, Critical Illness or even pandemics like Covid 19. It can be used to cover for multiple hospitalizations, as long as the total expenses are up to your sum insured.
Initial Waiting Period
You need to wait for a defined period from the first day of your policy to get covered for treatment related to any non-accidental illness. This is the Initial Waiting period.
Wellness Program
Exclusive Wellness Benefits like Home Healthcare, Tele consultations, Yoga and Mindfullness and many more available on our App.
Sum Insured Back Up
We provide a back-up Sum Insured which is 100% of your Sum Insured amount. How does Sum Insured Back Up work? Suppose your policy Sum Insured is Rs. 5 lac. You make a claim of Rs.50,000. Digit automatically triggers the wallet benefit. So you now have 4.5lac + 5 lac Sum Insured available for the year. However, one single claim, cannot be more than the base Sum Insured as in the above case, 5 lac. .
Cumulative Bonus
Digit Special
Digit Special
No claims in the Policy year? You get a bonus -an additional amount in your total sum-insured for staying healthy & claim free!
Room Rent Capping
Different categories of rooms have different rents. Just like how hotel rooms have tarrifs. Digit plans give you the benefit of having no room rent cap, as long as it is below your Sum Insured..
Day Care Procedures
Health insurance covers medical expenses only for hospitalizations exceeding 24 hours. Day care procedures refer to medical treatments undertaken in a hospital, requiring less than 24 hours due to technological advancement such as cataract, dialysis etc.
Worldwide Coverage
Digit Special
Digit Special
Get a world class treatment with the Worldwide Coverage! If your doctor identifies an illness during your health examination in India and you wish to get a treatment abroad, then we’re there for you.You’re covered!
Health Check-up
We pay for your health check-up expenses upto the amount mentioned in your Plan. No restrictions on the kind of tests! Be it ECG or Thyroid Profile. Make sure you go through your policy schedule to check the claim limit.
Emergency Air Ambulance Expenses
There may be emergency life-threatening health conditions which may require immediate transportation to hospital. We absolutely understand this and reimburse for expenses incurred for your transportation to a hospital in airplane or helicopter.
Age/Zone Based Co-payment
Digit Special
Digit Special
Co-Payment means a cost sharing requirement under a Health Insurance Policy that provides that the Policyholder/Insured will bear a specified percentage of the admissible claims amount. It does not reduce the Sum Insured. This percentage depends on various factors like age, or sometimes also on your treatment city called zone based copayment. In our plans, there is no age based or zone based Co payment involved.
Road Ambulance Expenses
Get reimbursed for the expenses of road ambulance, in case you are hospitalized.
Pre/Post Hospitalization
This cover is for all expenses before and after hospitalization such as for diagnosis, tests and recovery.
Other Features
Pre-Existing Disease (PED) Waiting Period
The disease or condition that you are already suffering with and have disclosed to us before taking the policy and has been accepted by us has a waiting period as per plan opted and mentioned in your Policy Schedule.
Specific Illness Waiting Period
This is the amount of time you need to wait for, until you can make a claim for a specific illness. At Digit it is 2 years and starts from the day of policy activation. For the full list of exclusions, read Standard Exclusions (Excl02) of your policy wordings.
Inbuilt Personal Accident Cover
If You sustain an Accidental Bodily Injury during the Policy Period, which is the sole and direct cause of Your Death within twelve (12) months from the date of accident, then We will pay 100% of the Sum Insured as mentioned in Policy Schedule against this cover and as per plan opted.
Organ Donor Expenses
Digit Special
Digit Special
Your organ donor gets covered in your policy. We also take care of the pre and post hospitalization expenses of the donor. Organ donating is one of the kindest deeds ever and we thought to ourselves, why not be a part of it!
Domiciliary Hospitalization
Hospitals can go out of beds, or the patient’s condition may be rough to get admitted in a hospital. Don’t panic! We cover you for the medical expenses even if you get treatment at home.
Bariatric Surgery
Obesity may be the root cause of so many health issues. We absolutely understand this, and cover for Bariatric Surgery when it is medically necessary and advised by your doctor. However, we DONOT cover if hospitalization for this treatment is for cosmetic reasons.
Psychiatric Illness
If due to a trauma, a member has to be hospitalized for a psychiatric treatment, it will be covered under this benefit, upto INR 1,00,000. However, OPD consultations are not covered under this. The waiting period for Psychiatric Illness Cover is same as Specific Illness waiting period.
Consumables Cover
Before, during & after hospitalization, there are many other medical aids & expenditures such as walking aids, crepe bandages, belts, etc.,which need your pocket’s attention.This cover takes care of these expenses that are otherwise excluded from the policy.
Key Benefits of Health Insurance by Digit
| Co-payment | No |
|---|---|
| Room Rent Capping | No |
| Cashless Hospitals | 16400+ Network Hospitals across India |
| Inbuilt Personal Accident Cover | Yes |
| Wellness Benefits | Available from 10+ Wellness Partners |
| City Based Discount | Up to 10% Discount |
| Worldwide Coverage | Yes* |
| Good Health Discount | Up to 5% Discount |
| Consumables Cover | Available as an Add-on |
*Available only on Worldwide Treatment Plan
What are the Advantages of a Cashless Medical Insurance?
Difference Between Cashless Claim and Reimbursement Claim?
As mentioned above, in a health insurance- there are two types of processes you can opt for during claims. A cashless claim or a reimbursement claim. Here’s a quick table to help you understand the key differences between the two!
| Cashless Claim | Reimbursement Claim | |
| What does it mean? | A cashless claim means your health insurer will take care of the bills, right from the start with the network hospital. You don’t need to pay any cash up front. | In a reimbursement claim, you will have to first make all payments for your hospital bill and post hospitalization, your medical documents will need to be submitted for your claim approval and reimbursement. |
| Do you need prior approvals for claims? | You need to get your claim approved beforehand. At least 72-hours before in case of a planned hospitalization, and within 24-hours in case of a medical emergency. | You don’t necessarily need to get your claim approved beforehand. However, it is recommended to check with your insurer if your treatment will be covered or not, just to be sure. The reimbursement process is initiated after your treatment. Typically, the timeline to get all the formalities done is between 2 to 4 weeks. |
| Is it applicable in all hospitals? | Cashless claims are only applicable with your insurer’s network hospitals. | Reimbursement claims can be done through any hospital. It doesn’t matter if it is part of a network hospital or not. |
FAQs about Cashless Health Insurance
Do I need to opt for a cashless health insurance while buying a health insurance policy?
No, you don’t need to opt for it. It will already be included as a claim option within your health insurance policy.
How to choose the best cashless medical insurance in India?
One of the primary reasons people buy a health insurance is because of the benefit of cashless claims. To choose the best cashless medical insurance, always look for features such as claim settlement process (to get an idea of how efficient your insurer is with cashless claims), number of network hospitals (more than the number, also check if hospitals you prefer are available in their network or not), processes (how simple or complicated it is), copayment (see whether your claims will be completely cashless or do you have to pay a percentage of the bill or not) and finally, check for the brand’s overall reviews and reputation and you’ll be able to make the right choice.
How many network hospitals does Digit Insurance have?
Digit’s Health Insurance has 16400+ network hospitals available across India for cashless claims.
Do I have to pay anything from my pocket during a cashless claim?
This depends whether your health insurance comes with copayment or not. If it comes with a percentage of copayment, then at the time of claim you will have to pay a small amount from your pocket depending on your hospital bill (for example; if your copayment is 10%, you will have to pay 10% at the time of discharge and rest 90% will be cashless). However, if your health insurance has no copayment then you don’t need to pay anything from your pocket, as long as your hospital bill is less than your total sum insured available.
Is OPD covered in cashless health insurance?
This depends on your health insurance policy chosen since some health insurers provide OPD benefit while some don’t.