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Essentials of Cashless Health Insurance


Jan 07 2020


A medical emergency is one that happens without warning, and you can’t put off. This means that you don’t have the luxury of time to sit and plan out your finances. During such times, the benefits of cashless health insurance can be like a gift from heaven. Here in this article, we aim to explain all that you need to know about cashless insurance.

What is cashless medical insurance?

When you choose cashless insurance, you don’t need to worry about arranging cash for medical expenses. The insurance company will directly pay your hospital expenses.

Each insurance company has a certain number of hospitals in its network. Example- Insurance Company ABC has a tie-up with around 1000 hospitals across India. If you come across some medical emergency and seek to avail the cashless facility, you need to get treatment from a hospital that is enlisted with ABC’s hospital network. In short, you must avail treatment from a hospital which is in the insurance company’s network.

Types of claims that can be made in a cashless policy

  • Planned claim- This can be used when you know about impending hospitalization at least 2-3 days in advance. In such a case, you must fill out the pre-authorization form before hospitalization. These are sent to the insurer which will then approve or dismiss the claim.
  • Emergency Claim- In case of a medical emergency like an accident or grave illness, you can still claim insurance. In case of an emergency, the insurer must be notified about the on-going treatment at the earliest. As per the protocol, the insurer is expected to process the claim within 6 hours.

Points to keep in mind while availing of cashless medical insurance

  • Ask your family members to contact or inform the insurer at the earliest in-case of emergency hospitalization.
  • Carry original ID proof at the time of hospitalization.
  • Submit the required investigation and medical reports to the insurer.
  • Give complete information about your insurance provider in the prescribed format.

Other types of cashless health insurance in India

Apart from cashless policies for individuals, the following plans are available for you.

  • Cashless Family Health Insurance- In this, you own the policy, and your family members are also covered under it. You can get your whole family insured with a single premium under the family health plan.
  • Cashless Health Insurance for Senior Citizens- Under this plan, the policy covers various charges or expenses like hospitalization, ambulance, and pre-existing diseases towards senior citizens.

Rejection of cashless insurance claims

Even after submitting proper documents and after choosing a network hospital, your claim could be rejected. Here is the list of a few causes for claim rejection -

  • A specific illness is not covered by insurance.
  • You have exhausted the sum insured for that period.
  • The information provided in the form is inadequate.
  • Delay in informing the insurer about hospitalization.

One of the main benefits of health insurance with a cashless facility is clear- you are freed from the hassle of arranging cash at the already stressful time of medical trouble.