All You Need to Know About Cashless Mediclaim


Jul 27 2020


Medical costs are on a continuous rise where medical emergencies can present financial difficulty to many of us. Getting the desired treatment at high-end hospitals may become difficult due to high costs. This is where a reliable and rewarding health insurance policy comes to aid. Having a cashless mediclaim policy for a family is probably the best financial safety net.

However, before purchasing a cashless mediclaim policy for the family, it is essential to analyze a few points and even look at the existing loopholes, if any. It is important to take note of the associated factors for evading unwanted situations emanating out of cashless mediclaim policies in due course of time.

The Reality of a Cashless Arrangement

To avail the benefits of a cashless claim, the insured must raise a request to the concerned insurer. If things go according to plan, the insurer approves the claim and offers coverage for an amount comparable to the overall sum assured. There is an impanelled network of hospitals associated with the insurance company, and the insured is entitled to avail health insurance benefits only at these network hospitals.

What are the Essential Steps?

For a planned treatment, you must inform the insurer at least two days in advance, before getting admitted. However, if there is an emergency and the person needs to be admitted immediately, informing the insurer within a timeframe of 24 hours is still a good option. Moreover, it is crucial to inform the hospital authorities as well, regarding the mode of payment and the cashless mediclaim policy, before taking admission into the hospital.

It is vital to keep the insurance card handy throughout the process as it is a ready reference for all your details and is asked for by the hospital to identify you and your policy. This card contains the details regarding the existing policy, policy number, and name of the policyholder and any family members if also added.

When it comes to putting the claim forward, you must duly fill-up the pre-authorization form and send it over to the insurer. The insurer receives the application based on furnished details, thereby arranging for cashless coverage.

Are there any Loopholes?

You must fill the application form carefully. It is also important to note that the insurer has the authority to reject the claims based on certain factors.

  • Firstly, while purchasing the insurance, the insured must carefully look at the ailments which are covered under the plan as anything else wouldn’t be covered for.
  • Moreover, making correct declarations when it comes to filling up the application form is also crucial as furnishing incomplete details can invariably reject insurance claims.
  • Other factors that can interfere with the coverage include faulty documentation process and exhaustion of the assured limit.

Cashless Mediclaim has simplified the availability of high-end medical treatments and other facilities. However, in most cases, the insured still needs to pay for diet changes, oxygen masks, nebulizers, and other add-ons. There is also a list of items that the insurance company, as per regulations, is not allowed to cover. These expenses will have to be paid by the policyholder from his pocket. The best advice would, therefore, be only to raise the amount that is acceptable by the insurance company, to avoid unnecessary hassles, while putting across the claim.