All About Cashless Health Insurance Policy 

Introduction

How does cashless treatment work?

Typically, the insurance company has a large network of empanelled hospitals across the country for providing medical treatment to policyholders. If you have a cashless mediclaim policy, you will not have to pay for availing medical treatment. Instead, the expenses will be borne by the insurer.

Types of cashless treatment

There are two types of cashless mediclaims that you can avail -

• Planned claim: In the case of planned claims, you have to inform the insurer in advance about the details of the impending medical treatment. The insurer will then ask you to take pre-authorisation from an empanelled hospital. Once you complete the procedure, you will be admitted to the hospital, without requiring paying for your medical bills. You must always remember to inform the insurance company, a few days in advance, before starting the scheduled treatment.

• Emergency claim: What if you need to be hospitalised suddenly because of a life-threatening ailment? The cashless mediclaim policy also provides you the option of availing emergency claims. If you require immediate hospitalisation because of sudden onset of a critical disease, the cashless insurance policy will pay for your medical bills at an empanelled hospital.

Benefits of cashless treatment

A cashless health insurance policy will provide you with manifold benefits as enumerated below -

• Financial help: A cashless treatment will provide you financial succour during any planned or emergency medical treatment, requiring hospitalisation.

• Extensive coverage: The policy covers a wide range of medical procedures, like surgeries of eye, bones, skin, ear, etc. It also covers critical illnesses, including cardiac ailments, kidney failure, stroke, organ transplant and limb paralysis. The critical illness policy, however, can vary as per the type of policy selected. You can also avail cashless treatment for ailments, like piles, cataract, sinusitis etc. after having completed a minimum number of policy years as stipulated in the policy.

• Health protection during travel: Along with pre and post hospitalisation expenses, a cashless mediclaim policy also covers your health while traveling. In the case of an emergency during travel, you can avail cashless hospitalisation at an empanelled hospital.

• Tax benefits: You can avail tax-benefits under Section 80D of the Income Tax Act on premium payments made for availing a cashless health insurance policy.

Important points to remember before availing a cashless treatment

You must always remember to consider the following points -

• Treatment only at network hospitals: The cashless insurance policy is only valid at the empanelled network hospitals. You must verify the details of the hospital before getting admitted.

• Display health insurance card: You must display your health insurance card to the concerned authorities at the time of getting admitted in the network hospital.

• Timely intimation: All details pertaining to the medical treatment should be provided to the insurance company in a time-bound manner. Remember, delays could result in rejection of claims.

• Proper documentation: All original documents, including doctor’s prescription, medical test and laboratory reports etc. should be provided to the insurance company. In case you fail to submit the requisite documents, your claim can be rejected. 

• Careful perusal of the policy document: You must always read the fine print, or the terms and conditions, of any cashless health insurance policy carefully. This will help you know the scope and coverage of the policy.

Exclusion under cashless treatment

Any cashless mediclaim policy will invariably have exclusions. This simply means that these charges are not covered under the policy, and you need to make separate payments for them. The following charges are required to be paid by the policyholder:

• Service charges

• Registration fees

• Admission fees

• Charges on toiletries

• Attendant’s fees