Health insurance has become an essential part of financial planning, especially in today’s fast-paced world where medical emergencies can arise unexpectedly. Among the numerous benefits of health insurance, the cashless claim facility stands out as a significant advantage at times of medical emergencies.
This feature allows policyholders to receive medical treatment without the immediate need to pay out of pocket. Here’s an in-depth look at cashless claims, their benefits, and relevant statistics highlighting their importance in the healthcare sector.
According to a 2023 report by the Insurance Regulatory and Development Authority of India (IRDAI), the cashless claims facility is becoming increasingly popular, with over 70% of policyholders preferring cashless claims over reimbursement claims due to the convenience it offers.
Also Read: What are the different types of Health Insurance?
What is a Cashless Claim in Health Insurance?
A cashless claim in health insurance helps insured individuals to avail themselves of the best medical treatment at network hospitals without having to pay cash upfront. Instead, the hospital bills are settled directly with the insurance company. This facility is available for treatments covered under the policy, provided the hospital is part of the insurer’s network.
How do cashless claims work?
Network Hospitals
Always go to the hospital under the insurance provider’s network. You can find this list on the insurer’s website or through customer service. In the past few years, the number of network hospitals offering cashless claims has increased significantly, with over 15,000 hospitals across India being part of various health insurance networks, up from around 10,000 hospitals just five years ago. This expansion enhances policyholders' access to cashless facilities.
Pre-Authorization
Obtain pre-authorization from your insurer before treatment. This involves submitting necessary documents, such as your policy number, reason for hospitalization, and medical reports.
Hospital Admission
Upon receiving pre-authorization, you can be admitted to the network hospital without paying upfront. The hospital will manage all the paperwork and coordinate with the insurer.
Settlement of Bills
After treatment, the hospital submits the final bills and documents to the insurance company. The insurer reviews the claims and settles the bills directly with the hospital, minimizing your out-of-pocket expenses for covered treatments.
Also Read: How to File a Reimbursement Claim Under Health Insurance
Benefits of Cashless Mediclaim Insurance
- Hassle-Free Process – Cashless hospitalization offers a simple, convenient process where your insurance provider manages the paperwork and directly pays your medical bills.
- Reduces Financial Burden – It eliminates the stress of arranging funds during health emergencies, allowing you to focus entirely on your recovery.
- Access to Quality Healthcare – Cashless mediclaim insurance enables you to receive the best possible treatment, even at top-tier hospitals, without worrying about the immediate cost.
- Tax Savings – You can enjoy tax exemptions on premiums paid for cashless health insurance under Section 80D of the Income Tax Act, 1961.
Bottom Line
With the increasing cost of medical care in India, covering expensive hospital bills during a medical emergency can be challenging. Cashless mediclaim insurance ensures you receive top-quality treatment without the stress of paying upfront. To access cashless services, ensure you're admitted to a network hospital affiliated with your insurer and carefully review the policy's terms and conditions.
FAQs
What is a network hospital?
A network hospital is a healthcare provider that has an agreement with your insurance company to offer cashless treatment to policyholders.
How can I avail of a cashless claim?
To avail of a cashless claim, you must be admitted to a network hospital, submit your health insurance ID card, and inform your insurer or TPA (Third Party Administrator) to process the claim.
What happens if I get treated at a non-network hospital?
In this case, you can’t avail cashless benefits. However, you can pay the hospital bills and file a reimbursement claim with your insurer.
Is there a limit to how much can be covered under a cashless claim?
Yes, the coverage is limited to the sum insured under your health insurance policy and any sub-limits for specific treatments.