Cashless Health Insurance
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Health insurance is one of the best investments you can make. It comes to your rescue, especially during unplanned or emergency hospitalisation. Most customers focus on the premium amount and the sum insured to decide on a health insurance policy; however, there are various other benefits that we sometimes overlook. The cost of healthcare is inflating every day in India, and along with the hassle of raising a claim and getting reimbursed, medical insurance is sometimes cumbersome or difficult. So, how to choose the best health insurance plan? While there are several features and benefits that your medical insurance should provide, one of the most important benefits is “Cashless Health Insurance”.
What Is Cashless Health/Mediclaim Insurance?
One of the challenges we face during hospitalisation is paying the required medical fees and completing lengthy paperwork during medical emergencies. All these hassles can be eliminated through the process of cashless hospitalisation. It avoids the hassle of reimbursement and the difficulties of arranging funds to pay your medical bills.
Cashless health insurance lets you settle medical bills directly to the hospital, facilitated by the insurance company. To avail this benefit, you can claim up to the sum insured and the hospitalisation should be at one of the network hospitals listed by the insurance company.
Types of Cashless Health Insurance Policies in India
Cashless medical insurance is broadly categorised into three types of policies, they are:
Cashless Individual Health Insurance
Cashless hospitalisation is provided to individuals who have opted for an individual health insurance policy and are hospitalised in one of the network hospitals.
Cashless Family Floater Health Insurance
Under this type of cashless health insurance, all the family members, who are the beneficiaries of the insurance plan, can avail cashless hospitalisation and the benefits of the policy.
Cashless Senior Citizen Health Insurance
This type of cashless health plan offers coverage to senior citizens which offers benefits such as hospitalisation costs, ambulance costs, amongst others, as per the terms and conditions of the contract.
Why is Cashless Health Insurance Important?
Be it planned or unplanned hospitalisation, we need funds to pay medical expenses for healthcare. Cashless insurance policies offer several benefits to the policyholder and their family. Let’s understand why cashless health insurance is important.
Quality Medical Care
You can avail quality medical care, which is expensive, through the cashless insurance plan. It acts as a cushion in case of emergency hospitalisation.
Comprehensive Coverage
It offers comprehensive coverage by covering costs towards doctor fees, medical tests costs, pre- and post-hospitalisation costs and ambulance expenses.
Cashless Hospitalisation Benefits
Cashless hospitalisation offers several benefits to the policyholder, read on to find out the details:
Reduces Financial Burden
Cashless hospitalisation is especially useful during unplanned or emergency situations. During this time, there may be a situation to arrange funds for the hospitalisation costs, this is where cashless insurance plans or hospitalisation comes to your rescue. It acts as a financial cover during hospitalisation and you don’t have to pay from your pocket.
Peace of Mind
Instead of worrying about how to arrange funds during hospitalisation, cashless treatment offers to pay the bills, thereby offering you peace of mind. You also get to avail yourself of quality healthcare at one of the network hospitals.
Coverage While Travelling
There may be a medical emergency situation while traveling, especially if you are in an unfamiliar place. You can visit any of the network hospitals listed by the insurer (e.g. ACKO) to avail of emergency hospitalisation without having to worry about medical expenses.
What is Covered in a Cashless Health Insurance?
Generally, insurance providers offer different coverages in their health insurance policies. However, there are some standard coverages that are part of the cashless health insurance plan, below are the details.
1. Pre- and post-hospitalisation expenses are covered.
2. Expenses related to in-patient care are included.
3. Daycare treatment such as cataract surgery, chemotherapy is covered.
4. Ambulance services for reaching the hospital is also included.
5. Domiciliary treatment expenses are covered as per the policy document.
6. Medical check-ups are included.
Cashless Hospitalisation Claim Process
Generally, the below steps are followed to raise a claim for the hospitalisation of the admitted person:
Step 1
Doctor advises hospitalisation or you or your family might be hospitalised due to an emergency.
Step 2
Intimate your insurer about the hospitalisation.
Step 3
If it’s a cashless claim, then you need to avail the cashless facility at any of the network hospitals. And, if it’s a non-network hospital, then you will have to raise a reimbursement claim after paying the hospital bill.
Step 4
If it’s not a cashless claim, you will have to pay off the hospital bill in full and then raise a claim with your insurance company to reimburse the expenses.
Benefits of Cashless Health Insurance by ACKO
Wide Network of Hospitals
ACKO has partnered with more than 6,500 network hospitals across the country to help you get access to quality healthcare facilities.
Hassle-free Claim Experience
Owing to the robust digital infrastructure, the entire claims experience is quick, hassle-free and simple.
How does a Cashless Health Insurance Work?
When you or your family members (beneficiaries) of the health insurance policy get admitted to one of the network hospitals, ACKO and the hospital will work together to settle medical expenses arising out of the hospitalisation. You can claim up to the sum insured for the medical expenses. You can raise a claim for the expenses incurred through two methods: cashless and reimbursement. Read on to find out the difference between the two.
Cashless Claim
To avail the cashless hospitalisation benefits, you need to get admitted at one of the network hospitals listed by ACKO. In this case, you don’t have to pay anything, except for the minor portion i.e. deductibles as per the terms and conditions of the policy.
Reimbursement Claim
While ACKO offers the benefit of cashless hospitalisation at one of their network hospitals, there may be a situation where you might have to get yourself admitted at a non-network hospital. In this situation, you need to pay the hospital bill in full and then raise a claim with us to reimburse the expenses.
Documents Required for Cashless Hospitalisation
To avail or to initiate the cashless hospitalisation, the below documents are required.
1. Filled health insurance claim form
2. Patients discharge summary
3. Copy of your health insurance card
4. Cancelled cheque in case of reimbursement
5. Original medical bills and receipts
6. Prescription and cash invoice
7. In case of accident, Medico-Legal Certificate (MLC) or FIR
8. Investigation reports (X-ray/ECG/Laboratory)
How to Avail Cashless Insurance?
Hospitalisation can be planned, however, there are circumstances when there can be an unplanned or emergency hospitalisation. Let’s look at different situations of hospitalisation and how cashless insurance works in each of these situations.
Cashless Insurance During Planned Hospitalisation
Follow the steps below to avail cashless insurance in case of a planned hospitalisation.
Step 1:
Doctor advises hospitalisation.
Step 2:
Inform ACKO about the planned hospitalisation.
Step 3:
Ensure the hospitalisation is at one of the network hospitals listed by ACKO.
Step 4:
Get yourself admitted to the hospital and inform the hospital authorities about the cashless insurance facility.
Step 5:
Present your health insurance card or provide the insurance policy number to the hospital authorities.
Step 6:
Fill the pre-authorization form with relevant details.
Step 7:
The hospital will coordinate with ACKO or the Third-Party Administration (TPA) about your hospitalisation under the cashless facility.
Step 8:
After ACKO authorizes your claim, your cashless hospitalisation will be initiated by the hospital.
Step 9:
Upon discharge, ensure you verify and sign all the medical bills.
Cashless Insurance During Emergency Hospitalisation
Medical emergencies come unannounced. To avail cashless hospitalisation during such circumstances, follow the steps below.
Step 1:
Get admitted to the hospital.
Step 2:
Duly fill the pre-authorisation form and provide the policy number or the health insurance card.
Step 3:
The hospital will coordinate with the Third-Party Administrator (TPA) or ACKO to authorise your hospitalisation.
Step 4:
Upon authorisation, your cashless hospitalisation will be initiated.
Step 5:
Upon discharge, verify the medical bills and sign it.
Step 6:
Obtain a copy of the medical bills and the discharge summary for future reference.
Difference Between Cashless Claim and Reimbursement Claim
Both these types of claim are offered by most of insurance companies. However, they differ in features and how they work, let’s look at the difference between the two claim process.
| Cashless Claim | Reimbursement Claim |
|---|---|
| Don’t have to pay medical costs yourself. | Have to pay medical costs first. |
| Insurance company settles the bill directly with the hospital. | Insurance company settles the costs with you after you pay for hospitalisation. |
| Treatments only in a network hospital. | Treatments in any hospital. |
| The claim is settled immediately. | Reimbursement claims take time. |
| Hassle-free process. | Process of claim request is tedious. |
Things to Consider Before Buying Cashless Health Insurance Policy
Before you go ahead and purchase a cashless health insurance plan, consider the below points to make the right decision.
Network Hospitals
Ensure you check cashless network hospitals with the insurer. A high number of network hospitals offers you several choices.
Inclusions and Exclusions
Your insurance company will bear all costs which include hospitalisation, ambulance, and other related expenses. However, there are exclusions which you should be aware of as well.
The Efficiency of Servicing a Claim
Ensure you know the Claim Settlement Ratio (CSR) of the insurance company. CSR tells a lot about the reliability of the insurance company. The higher the CSR, the higher the possibility of your claim getting settled.
No Claim Bonus
Check if the insurance policy offers a no-claim bonus (NCB) for not raising any claim during the policy period as this could be a discount while renewing the policy.
Pre and Post-Hospitalisation Coverage
Insurance companies offer pre- and post-hospitalisation costs; however, some do not. Hence, check if the insurance policy covers both pre- and post-hospitalisation expenses.
Maternity Benefits
With medical costs escalating every day, maternity costs have increased accordingly. Hence, you need to choose medical insurance which offers to cover costs related to maternity.
Medical Check-ups
Several insurers offer to cover medical check-ups. Choose an insurance company which offers medical check-ups as a part of their policy.
Selecting the Insured Declared Value (IDV)
Select the sum insured wisely as it covers expenses arising out of hospitalisation for the policy period. Ensure you do not choose an IDV which does not cover you extensively especially during an emergency.
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FAQs about Cashless Health Insurance Policy
Here are some frequently asked questions about cashless medical insurance policies.
What are the types of cashless health insurance policies in India?
Typically, there are three types of cashless medical insurance policies: individual, family floater and senior citizen.
Can cashless health insurance claim be denied?
Yes, it could be denied under the following situations: 1. If the medical condition is not covered by the policy. 2. If the hospital is not part of the network of hospitals listed by the insurance company. 3. If the information provided by the network hospital lacks the required information. 4. If you do not send the pre-authorisation form on time.
What is the tenure of the cashless health insurance plan?
Similar to other insurance products, cashless health insurance plans come with a one-year policy; however, some insurers do offer tenures of two years.
How many claims are allowed in a year in a cashless health insurance policy?
You can claim several times during the policy period subject to a maximum of the sum insured amount.
Do cashless health insurance plans cover pre-existing diseases?
Some insurance providers offer to cover pre-existing diseases subject to terms and conditions set by the insurance company.
Can I receive cashless treatment at any hospital?
No, you can only avail cashless treatment at hospitals that are part of the network associated with your health insurance company.
Is cashless mediclaim taxable?
No, cashless mediclaim is not taxable. The amount received through a cashless mediclaim policy is exempt from income tax under Section 10(10D) of the Income Tax Act, 1961.
Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
