Understanding Cashless Medical Insurance Policies: How to Know if Yours is Cashless

When you purchase health insurance, the primary goal is to ensure financial support in times of medical emergencies. After experiencing a stressful hospital stay, one of the insured's key expectations is seamless resolution of medical bills, with no hassle in hospital bill settlements. This is where cashless medical insurance policies come into play. These policies provide the convenience of immediate access to healthcare without the need to worry about payment of hospital bills and treatment costs.

What Do You Mean By Cashless Health Insurance?

Cashless health insurance, in simple terms, refers to a policy where all medical bills are settled directly by the insurance provider, rather than by the insured. Under this policy, the total medical expenses or hospitalization costs should not exceed the sum assured, and the hospital chosen must be a network hospital. This type of insurance is particularly beneficial during planned or sudden medical emergencies, as the insurance company covers all hospitalization and treatment expenses upfront, giving you more time to focus on other critical aspects like treatment arrangements or hospital admission formalities.

Key Features of Cashless Health Insurance

Direct handling of medical expenditures by the insurance company. Availability of the facility only in networked hospitals. TPAs (Third Party Administrators) handle coordination with hospitals and claim settlements. Insured must retain copies of required documentation such as diagnostics reports, medical bills, discharge summaries, and claim forms. The insurance company pays for expenses within the sum insured limit. Any amount exceeding this limit is the policyholder's responsibility. Expenses beyond predefined sub-limits or items not covered under the policy are the insured's responsibility.

How Does Cashless Health Insurance Work?

Health insurance providers establish partnerships with various hospitals across the country, after evaluating their quality, reputation, and procedure coverage. These hospitals known as networked hospitals, are carefully vetted and accredited by the insurance companies. Cashless insurance is exclusively available in networked hospitals. When you are admitted to a networked hospital, you have the option to avail the cashless facility. A TPA, or third-party administrator, is assigned to handle the coordination between the hospital and the insurance company, ensuring smooth claim settlements.

In the event of treatment in a non-networked hospital, the policyholder is responsible for settling the bills first and then seeking reimbursement from the insurance company. For detailed information, please contact the customer service numbers provided: 91 8961473988 or 91 9007255104.

Understanding your policy and knowing if it is cashless or not can significantly ease the burden during a medical emergency. Always ensure you have access to networked hospitals and familiarize yourself with the requirements for cashless claims. This will allow you to make prompt arrangements for treatment and minimize potential stress involved in paperwork and financial matters.