Cashless Health Insurance Policy

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.

What is Cashless Health Insurance?

With a cashless health insurance policy, the insured can receive medical treatment at pre-approved hospitals where no advance payment is needed. Instead, the insurer directly settles the bills with the hospital, helping get healthcare smoothly. To use this facility, the insured must present their cashless health card, including essential insurance details, at the time of hospitalisation. This feature offers fast and easy healthcare, especially during critical emergencies or scheduled medical procedures.

Unlike traditional reimbursement-based insurance, cashless health insurance removes the need to manually submit claims after treatment. This modern approach has changed how healthcare is available and accessible, making it more straightforward for individuals and families to manage unexpected medical costs. With a cashless health insurance policy, you gain the confidence to prioritise health over finances, knowing that your medical expenses are covered.

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 18,400 + 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.

Types of Cashless Health Insurance Plans

The best cashless health insurance in India caters to diverse needs, offering a range of options to policyholders.

Individual Health Insurance Plans: 

  ✓ Tailored for single-person coverage.

  ✓ Ensures comprehensive medical care for the individual.

Family Floater Plans: 

  ✓ Covers multiple family members under a single policy.

  ✓ Provides a shared sum insured for all insured members.

Critical Illness Plans: 

  ✓ Specifically designed to cover severe illnesses like cancer or heart disease.

  ✓ Offers financial protection during critical health events.

Top-Up Plans: 

  ✓Enhances existing coverage by offering additional financial support.

  ✓ Kicks in after the initial sum insured is exhausted.

Super Top-Up Plans: 

  ✓ Provides extensive coverage beyond what is offered by top-up plans.

  ✓ Offers more substantial financial protection for high medical expenses.

Choosing the Right Plan: 

✓ Ensure adequate protection by selecting a plan that fits your specific healthcare needs.

Features of Cashless Health Insurance

Cashless health insurance benefits from fast claim processing, direct billing at hospitals, a vast healthcare provider network and eases financial strain.

Network Hospitals

Policyholders can avail of cashless services only at hospitals empanelled with the insurer. These hospitals are carefully selected for their quality and services.

Pre-Authorisation

 A pre-approval process ensures smooth and quick cashless claim settlements. This step verifies that the treatment falls within the policy’s scope.

Comprehensive Coverage

Coverage for hospitalisation, surgeries, ambulance charges, and other medical needs depends on the specific policy chosen.

Daycare Procedures

Daycare procedures, such as cataract surgery or dialysis, are generally covered under Bajaj Allianz General Insurance Company’s policies.

Digital Documentation

Minimal paperwork enhances convenience for policyholders, making the process faster and more efficient.

Emergency Coverage

Cashless health insurance ensures you are prepared for unforeseen circumstances without financial worries.

Benefits of Cashless Health Insurance

Cashless health insurance eases the burden of medical expenses by offering care without complications of advance payments and providing comfort and monetary protection.

Immediate Access to Treatment

In medical emergencies, timely care can save lives. With a cashless health insurance policy, you can focus on health without worrying about arranging funds.

No Upfront Payments

Policyholders don’t need to make initial payments; the insurer covers eligible expenses directly with the hospital.

Financial Security 

It preserves your savings by covering hefty medical bills, reducing the economic burden during emergencies.

Wide Network of Hospitals 

Bajaj Allianz General Insurance Company partners with 18,400 hospitals across India, providing accessibility to quality healthcare.

Streamlined Process

The process is paperless, reducing the hassle of filing reimbursement claims and managing bills manually.

Comprehensive Coverage

These policies ensure end-to-end financial protection for medical needs from pre-hospitalisation to post-hospitalisation expenses.
The convenience offered by cashless insurance goes beyond financial relief. It eliminates delays in treatment caused by economic concerns, enabling faster access to healthcare services. This benefit is especially critical during emergencies where every second counts.

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

-  In-patient expenses cover

-  Ambulance service

-  Daycare treatment expenses

-  Medical check-ups/ physician fees/ doctors consultation fee

-  Room rent and boarding expenses cover

What is Not Covered in Cashless Health Insurance?

While cashless health insurance policies provide extensive coverage, they also have exclusions:

-  Cosmetic Procedures: Surgeries like Botox or plastic surgery for aesthetic purposes are not covered.

-  Self-Inflicted Injuries: Injuries resulting from intentional self-harm are excluded.

-  Lifestyle-Related Conditions: Issues caused by alcohol or drug abuse are not covered.

-  Non-Medical Expenses: Items like toiletries or extra room charges are excluded.

-  Experimental Treatments: Innovative procedures or treatments not widely recognised as standard medical practices are excluded.

Understanding these exclusions helps avoid surprises during critical times. Always review your policy document to clarify what’s included and excluded.

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

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.

Cashless Insurance During Planned Hospitalisation

Planned hospitalisation allows you to inform the insurer in advance:

-  Pre-Authorisation: Submit the pre-authorisation form at least 72 hours before admission.

-  Document Submission: Provide ID proof, health insurance card, and medical reports.

-  Approval Process: The insurer verifies the documents and approves the treatment.

-  Cashless Treatment: Receive treatment without paying upfront; the insurer settles the bills directly with the hospital.

-  Post-Treatment Follow-Up: Ensure all documents are processed correctly to avoid discrepancies.

Planning ensures a hassle-free experience, giving you more time to focus on your health.

Cashless Insurance During Emergency Hospitalisation

For emergencies, the process is expedited:

-  Immediate Admission: Visit a network hospital and notify the insurance desk.

-  Inform the Insurer: Share emergency details within 24-48 hours.

-  Document Submission: Provide the insurance card, ID proof, and initial medical reports.

-  Approval and Treatment: The insurer approves treatment, ensuring cashless settlement of bills.

-  Settlement of Uncovered Costs: Settle any non-covered expenses directly with the hospital.

This feature is invaluable in critical situations, ensuring that treatment is not delayed due to financial concerns.

All About Cashless Mediclaim Policy

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:

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.

Reasons For Rejection of Cashless Health Insurance Policy

Understanding why a cashless health insurance policy might be rejected can help policyholders avoid common pitfalls.

-  One major reason for rejection is providing incorrect or incomplete information during the application process. This includes inaccuracies in personal details, medical history, or failing to disclose pre-existing conditions.

-  Additionally, cashless claims can be denied if the treatment is sought at a hospital not listed in the insurer's network.

-  Policyholders must also adhere to the waiting periods specified in their policy, as claims made within these periods for certain conditions might not be honoured. Familiarising yourself with the policy's terms and exclusions is crucial to avoid rejections.

Cashless Hospitalisation Claim Process

The process of filing a cashless claim is straightforward:

-  Choose a Network Hospital: Visit any hospital within the insurer’s network.

-  Inform the Insurer: Notify your insurer about the planned or emergency hospitalisation.

-  Submit Documents: Provide necessary documentation, including a filled claim form and ID proof.

-  Pre-Authorisation Approval: The hospital’s insurance desk coordinates with the insurer for approval.

-  Receive Treatment: Once approved, the treatment begins without upfront payments.

-  Settle Bills: The insurer directly pays the hospital for all covered expenses.

This efficient process ensures that you can focus on recovery without financial distractions.