Cashless Health Insurance in India- Process and Benefits

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It is becoming increasingly difficult for common man to afford medical treatment due to the immense rise in healthcare costs. With the aid of health insurance, the policyholders are able to provide them-self and their families with the best possible medical help in the hour of need with the minimum amount of hassle. Instead of paying for the treatment, cashless health insurance offers a welcoming alternative where the policyholders can receive good quality medical care without having to pay anything from their end. The insurers negotiate with the hospitals on their network to directly pay the bills for the facilities availed by the insured person.

Importance of Cashless Health Insurance:

Cashless insurance is becoming increasingly necessary at the times of emergency when you do not have immediate access to cash. It saves us from financial hassles and all other inconveniences including lengthy paper works and makes the process easier and swifter. Many people might not have a large amount of liquid assets or their savings in a readily disposable form. A cashless insurance can be hugely beneficial in such a case.

How does a Cashless Health Insurance work?

The policyholder will have to choose a hospital from the network of hospitals provided by the insurance company. A policy card will be handed to you along with your policy, which you will be required to present to the hospital to employ the cashless facilities. After this, you will be handed a preauthorization form to be duly filled by you and the attending physician to ensure that the stated facts are true. The Third Party Administrator (TPA) will then verify the form to ascertain whether the form is genuine and eligible. The hospital will then get a consent letter from the TPA following which you are entitled to receive the treatment.

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However you will need to keep in mind that if you go to a hospital which is not a part of the network of hospitals specified in your policy, you will need to make the payment from your pocket initially and then get a reimbursement from the insurer after you present them with the hospital bills and the required documents.

Types of Cashless Health Insurance

Cashless Health Insurance are broadly of two types:  

  1. Cashless family health insurance, by which you can insure all the members of your family to a health care benefit.
  2. Cashless health insurance for senior citizens which, in addition to hospital charges, also includes previous diseases and ambulance charges.

Things you need to know before buying Cashless Health Insurance:

Cashless health insurance have certain constrains which you will be needed to remember:-

  • The service is available only at the network of hospitals specified in the insurance policy.
  • You will need to fill all the information in the preauthorization form, otherwise your cashless insurance claim may get rejected by the TPA.
  • You will be required to pay for certain expenses like service charge, attendant fees, ambulance fees, fees for oxygen masks and nebulizers which are usually not covered in the insurance policy.
  • You will have to carry a copy of the health insurance policy and the identity cards of your family members at the time of admission to the hospital.
  • If the cost of treatment exceeds the total sum approved by the insurance company, then you will be need to pay the remaining amount or the insurance company can request the hospital to increase the amount in accordance to the expenses.
  • You should also keep a copy of the hospital documents, bills, prescriptions and reports in case you need them in future.

Shailesh Kumar

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