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Cashless Health Insurance Policy

Cashless Health Insurance

Cashless Health Insurance :

In the times, we are living today, living a completely healthy life is surely a luxury. Most of us spend our lives earning a livelihood to meet the necessities of everyday life. However, life is unpredictable, anything can happen at any point in time. Considering the rising medical inflation, any uncalled medical emergency can easily take a toll not only on our savings but also on our mental health.

There are times people do not understand the health condition until it gets severe. The situations at times are critical leading to immediate hospitalization. Under any such condition, paying medical bills can affect financial stability. To deal with and avoid any such hassles, having cashless health insurance is going to be much helpful.

8000+ cashless hospitals across country

98%* Claim Settlement ratio

In-House Health Administration Team

What is Cashless Health Insurance?

Cashless health insurance is the policy where the hospital bills/ medical expenses are directly settled between the insurance company and the network hospital. It means that the insured need not pay anything in cash.

In recent times, the surge in medical expenses has made it a nightmare to meet it and avail the best of the medical facility. The best cashless mediclaim policy helps the common man to access quality health care and other related facilities without worrying about expenses.

Over time, the demand for it has also significantly increased. In case of emergencies such as falling ill, or in case of an accident, there are times when the family may not be able to arrange for funds. Cashless insurance is the solution wherein the incurred expenses will be directly settled by the insurer in any of the network hospitals. Buying a cashless mediclaim policy will help you to deal with any such emergencies efficiently. While buying health insurance, choose a plan that offers cashless hospitalization and treatment benefit.

What is Covered in Cashless Health Insurance?

There are various features and benefits that health insurance offers. Amongst them is the benefit of having a cashless insurance facility. Generally, the health insurance companies in India, offer various coverages under the plans. These coverages may vary from insurer to insurer. Besides, there are certain standard coverages listed below that are a part of the cashless health insurance plans.

Cover for pre and post-hospitalization expenses for up to 60 and 90 days

Cover for pre and post-hospitalization expenses for up to 60 and 90 days

In-patient expenses cover

In-patient expenses cover

Ambulance service

Ambulance service

Daycare treatment expenses

Daycare treatment expenses

Medical check-ups/ physician fees/ doctors consultation fees

Medical check-ups/ physician fees/ doctors consultation fees

Room rent and boarding expenses cover

Room rent and boarding expenses cover

How Does Cashless Health Insurance Work?

The health insurance companies in India partner with various hospitals. These partnered hospitals are referred to as network hospitals.

The insurance company selects a network hospital after an extensive background check that includes its efficiency and the medical services offered. The tie-ups are mostly on an annual basis and are renewed each year or as per the due date of renewal. So, in case the hospital doesn’t meet the standards like before, there is a high chance that the renewal may not be extended. This process of selecting a network hospital is important as it shows its credibility of it. The list of network hospitals is shared by the insurance company with the policyholder during the buying of the health insurance plan. These are finalized after checking the quality, different procedures, rates, etc. At Bajaj Allianz General Insurance, we have 8000+ network hospitals and an in-house HAT team.

At the same time, it's important to remember that a cashless facility can only be availed at a network hospital. So, if the insured gets admitted, then as per the plan the benefit can be availed. A third-party administrator who is also referred to as the TPA is the company’s representative and is responsible to take care of the formalities. The TPA is the point of contact who is responsible to coordinate between the insurer and you. The TPA ensures that the health insurance cashless claims are settled seamlessly. A TPA also plays a pivotal role in accepting or denying health insurance claims. 

 

Complete List of Documents Required for Cashless Hospitalization

At Bajaj Allianz General Insurance, we are at the forefront of taking care of your health needs and offer an array of health insurance plans. Listed below are the documents that will be required to avail the benefit of cashless treatment at any of the network hospitals:

·         Cashless hospitalization claim form duly filed and signed by the insured

·         Original hospital bill with a detailed break-up of cost

·         Original paid receipts

·         Original discharge summary document

·         The lab and test reports

·         Copy of invoice/stickers/barcode in case of implants

·         A first consultation letter from the doctor

·         Know Your Customer form

·         Filled and signed NEFT form by policyholder/ proposer

Note: For the complete list of documents, check with the insurer

Importance of Having a Cashless Health Insurance

The importance of having medical insurance is understood more than ever in the past. We are in a pandemic and with the medical inflation, people are somewhere caught struggling with medical expenses. In a condition like this, having a cashless medical insurance policy is not less than a boon. Having the right plan in place will enable to access the healthcare facility and not stress about arranging cash on an urgent basis.

While buying a health insurance plan, the insurer offers the option to opt for a cashless insurance plan. It means that costs will directly be handled by the insurance company. To avail the maximum benefit of the best cashless health insurance, ensure to undergo treatment in any network hospital only. Having the right plan in place also gives you peace of mind as you need not get into the process of settling the bills directly with the hospital. 

 

Tips to Keep in Mind Before Making a Cashless Claim

Are you worried about making a cashless claim? Do you think it’s a tedious process? Well, do not worry. We have enlisted some handy tips that you should keep in mind before making a cashless claim: 

· Inform at the Earliest: Whether it’s a planned or an unplanned hospitalization, inform the insurance company at the earliest. Doing so will help the insurer review the policy and authorize the claim request. An exception is made in case of emergency treatment. 

· Keep Details Handy: Keep all the information related to the plan handy. In case of emergency hospitalization, you can get in touch with an insurer and get seamless assistance.

·  Give Correct Information: The pre-authorization requires important details such as the medical history of the patient, pre-existing conditions, costs, etc. Ensure to provide all correct information so that the claims are processed easily and smoothly.

· Know the Inclusions and Exclusions: It’s always important to understand both the policy inclusions and exclusions. This will always help to understand the expenses that may incur and you are prepared for them in advance. Being up to date with the plan will avoid any confusion later on. 

 

Tips to Select the Right Cashless Health Insurance Plan

While choosing the mediclaim policy choose an insurer that has an extensive network of hospitals and offers cashless health treatment benefits. We have jotted below some important tips that will help to select the right cashless medical insurance plan:

 

Research

The key tip is to conduct extensive research, and compare the features and benefits offered within the plan. Certain features remain common and most insurance companies offer cover for it. However, it is always recommended to customize the plan as per the necessity. Before you zero down a plan, analyze the needs and accordingly make an informed decision.

 

• A Large Number of Network Hospitals:

While buying a plan ensure that you go through the list of network hospitals. The benefit of a cashless insurance policy can only be availed at any of the network hospitals. Ensure that the network hospital is widely spread out PAN India. So, if in case any emergency strikes you are rushed to the hospital immediately.

 

• Credibility

When it comes to choosing cashless mediclaim insurance, go with the insurance company that is established and has a good claim settlement ratio. The claim settlement ratio of a company plays an extremely crucial role. It gives you a bigger picture of the efficiency of paying health insurance claims.

 

• Read the Policy Document:

This is a common mistake that most of us commit of not reading the health insurance policy documents carefully. Before you make the final payment towards buying the plan, it's important to understand every term and condition offered within the plan. You could either directly visit the website of the insurance company or simply get in touch with customer support. A little work beforehand is helpful in the long run. Understanding the inclusions and exclusions offered within the plan will never leave you disappointed in times of distress.

 

• Identify the Needs

A wise way of making the right insurance plan is to simply identify the varying healthcare needs. It is also recommended to see the limitations of the cashless benefits. It's important to chalk out the priorities and choose the one that best fulfills the needs.

 

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All About Cashless Health Insurance

Important Things to Know About the Cashless Facility

Owing to the lifestyle that we are leading, undoubtedly we are all prone to various lifestyle diseases. Over these years, medical costs have also increased significantly. On one hand, it's important to avail of the medical facility yet we cannot overlook the other side of the coin.

To deal with any such scenarios, it’s imperative to have the best cashless health insurance policy. Presently, cashless claims are gaining momentum. These days’ people buying health insurance do consider availing cashless befit options. We have listed some key important things that you should know about the cashless facility in India:

 

·         The cashless facility can only be availed if the treatment is availed at any of the network hospitals.

·         The network hospital will explain to the policyholder or the insurer the treatment and condition of the policy.

·         Regardless of whether it’s a cashless facility or not, ensure to keep all health-related documents and medical bills safe and handy.

·         Before you zero down a plan, read and re-read the terms and conditions offered by the insurer for the mediclaim cashless facility.

·         In case the treatment amount exceeds the sum insured then the remaining balance will be borne by the insured. The health insurance company is nowhere liable to pay the complete amount in any such scenario.

 

When it comes to buying a cashless mediclaim policy for family, ensure that you are sufficiently covered.

 

 

Comparison of Cashless and Reimbursement Claims

In the times we are living today, having mediclaim insurance in place is extremely crucial. In India, there are generally two types of claim settlements in health insurance. These are namely cashless and reimbursement settlements. 

When it comes to cashless treatment health insurance, the insurer bears the bills during discharge. For reimbursement, the medical bills primarily are borne by the individual. Later, the insured can claim the same to the health insurance company by providing all the required important documents.

The tables below show the comparison of cashless and reimbursement claims on various parameters: 

 

Parameters

Cashless Process

Reimbursement Process

Liability of an Individual

The insured need not pay the medical bills or expenses themselves. The insurance company will settle the bills with the network hospital directly

Initially, the medical expenses need to be borne by the insured. After the discharge, the insured need to submit the bills and file a claim with the insurer

Network Hospital

The benefit of cashless treatment can only be availed at the network hospitals empaneled with the insurance company

The medical treatment can be availed at any network or non-network hospitals

Claim Process

In case of planned or emergency hospitalization, the insurance company needs to be informed at the earliest

Upon discharge, the insured needs to pay the bills directly and file for reimbursement

Claim Settlement Turnaround

The bills are immediately settled while the insured is undergoing the treatment process or is hospitalized

Compared to the cashless benefit, reimbursement takes a little longer

 

At Bajaj Allianz General Insurance, we also offer an exclusive feature Health CDC (Claim by Direct Settlement). Under it health insurance claims up to Rs 20,000 is settled instantly using our Caringly Yours mobile app.

The cashless mediclaim policy is designed with the prime objective of offering financial relief to the insured/policyholder in crucial times. The cashless medical insurance for family will be helpful and ensure that nothing is to be paid in the cash up to the sum insured. 

Important points to note before buying Health Insurance Policy for Your Parents

  • Inclusions
  • Exclusions

Medical Emergency:

Read more

Medical emergency of any unkind can be stressful if the finances are not well-planned. The cashless claims tend to be more beneficial as the family does not have to run and look around arranging for funds. The insured can immediately start availing of the medical treatment by showing the health card to the network hospital.

Peace of Mind

Read more

In case a need arises, having a cashless mediclaim insurance policy assures that finances may not be a concern for you. The insured can easily get admitted into any of the network hospitals and start availing of the treatment in a hassle-free way. The insured can focus on the recovery and recuperate faster by not worrying in terms of money. 

An Array of Cover

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A cashless mediclaim policy offers a wide range of cover options including the OPD cover, pre and post-hospitalization expenses, and so on. It is also recommended to check with the insurer from time to time in regards to features and benefits offered within the plan. 

Tax Benefit

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The premium made towards a cashless health insurance plan is entitled to tax benefits within Section 80D of the Income Tax Act Individuals below 60 years of age can benefit from up to Rs 50,000 and senior citizens may avail of up to Rs 50,000. 

Note: The tax benefit is subject to change, as per the prevailing laws. 

Ambulance Cover

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A cover is provided for the expenses incurred towards transferring to the hospital or between hospitals. This implies both the hospital's ambulance and the ambulance provided by the ambulance service provider up to a certain limit. 

Modern Treatment Method

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Modern treatment methods and advancements in technologies are restricted to 50% of the sum insured or up to Rs 5 lakh. It includes oral chemotherapy, intravitreal injections, bronchial thermoplasty, etc.*

*This is not an exhaustive list. For more information, please refer to the product brochure. 

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War: No cashless treatment is offered if the treatment is required due to war. 

    Internal Self Injury: In case, you tried to harm yourself intentionally, the expenses incurred towards treating the same also remain uncovered. 

Dental Treatment: Any expenses incurred towards detailed treatment remain uncovered unless it is necessitated by cancer or acute traumatic injury. 

External Devices: Any cost that involves dentures, hearing aids, contact lenses, crutches, etc. also is excluded from the cashless medical policy. 

Plastic Surgery: Any cosmetic surgery until it’s required for treating cancer or any burn or accidental body injury too remains uncovered. 

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FAQs about Cashless Health Insurance Policy

1. Is COVID-19 covered under Cashless Health Insurance?

The IRDAI has directed the insurance companies that the reimbursement claim within the health insurance plan needs to be settled as per the terms and conditions expeditiously.  The insurance regulator has fixed a turnaround time for granting both the cashless preauthorization as well as the final discharge of the patient insured. It is recommended to get in touch with the insurer in case of anything. 

2. Is it possible for a cashless health insurance claim to be denied?

Yes, a cashless health insurance claim may be denied under the following circumstances:

·         If the medical condition/ treatment is not covered under the plan.

·         If the treatment is availed at a non-network hospital that is not empaneled with the insurance company.

·         When the information provided by the network hospital is incomplete or does not meet the criteria mentioned in the policy document.

·         If the pre-authorization form is not sent timely. 

3. What is the tenure of the cashless medical insurance plan?

The tenure of the cashless medical insurance plan may differ from insurer to insurer. It is highly suggested to get in touch with the insurance company and get all policy-related details. 

4. In a cashless health insurance coverage, how many claims are allowed each year?

The insured can claim multiple times during the policy term subject to the sum insured amount. Henceforth, it is recommended to opt for a higher sum insured while buying a plan and remain secured. 

5. Is cashless claim settlement better than the reimbursement process?

The cashless claim process when compared to a reimbursement claim process is always better. The cashless claim process is easy, convenient, and saves time. Anything leading to hospitalization or medical treatment takes a toll not only on the insured but also on the dependents too. The cashless benefit is also better as the insured need not worry about the expenses and can focus more on recovery. 

6. Is there a waiting period for filing a claim under an insurance policy?

When a health insurance policy is availed, the insurance companies offer a 30-day waiting period. This starts from the inception date of the policy. It means that during this tenure, no claims will be accepted apart from the accidental cases. However, it is also to be noted that the waiting period may differ from insurer to insurer and medical condition/ illness as well. The waiting period is not applicable for the subsequent plan under renewal.

7. What is the procedure for applying for cashless health insurance?

At Bajaj Allianz General Insurance, the process to apply for cashless treatment is simple. Listed below are the steps to avail the benefit of cashless health insurance:

1.      Intimate the insurer at the earliest.

2.      Visit the network hospital where the treatment is to be taken

3.      The third part administrator desk of the network hospital will connect with the insurance company for cashless treatment.

With us you do not have to worry, the hospital will verify the details and send the duly filled pre-authorization form. We verify all the details with the policy benefits. We intimate our decision within a day or so. Once the cashless claim is approved, a first response is sent to the healthcare provider within 60 minutes. The treatment expenses at the network hospital will be settled swiftly.

*Standard T&C apply

8. What factors affect the premium of a cashless health insurance policy?

Various factors affect cashless health insurance premiums. It is important to note that the wider the health insurance coverage, the steeper is going to be the premium. Some of the factors that directly affect the health insurance premium are gender, age, tobacco consumption, lifestyle habit, pre-existing disease, body mass index, and so forth. 

9. What is the ‘free-look period’ under the cashless health insurance coverage?

In the case of the health insurance plan, the policyholder can easily act upon the free look period benefit in a time stimulated. The health insurance companies offer a free look period of 15 days. During this tenure, the policyholder can make a final decision on whether or not the plan fulfills the requirements.

In case the policyholder feels that the plan doesn’t meet the requirements, the individual can cancel the policy within 15 days. There will be no cancelation charges if the plan is canceled within 15 days. Yet, a premium will be charged for the days that the individual makes the final decision.

 Written By : Bajaj Allianz - Updated : 05th October 2022

Disclaimer

I hereby authorize Bajaj Allianz General Insurance Co. Ltd. to call me on the contact number made available by me on the website with a specific request to call back at a convenient time. I further declare that, irrespective of my contact number being registered on National Customer Preference Register (NCPR) under either Fully or Partially Blocked category, any call made or SMS sent in response to my request shall not be construed as an Unsolicited Commercial Communication even though the content of the call may be for the purposes of explaining various insurance products and services or solicitation and procurement of insurance business. Furthermore, I understand that these calls will be recorded & monitored for quality & training purposes, and may be made available to me if required.

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