Which Policies of Health Insurance Covers Cashless Hospitalization?

A cashless health insurance policy is a kind of medical insurance where the insurer pays the medical bills directly to a network hospital, thereby saving the insured from any upfront cash payments. These policies of health insurance do not require the policyholder to pay the entire amount up-front and then file a claim to get reimbursed. Instead, they let the policyholder focus on their medical emergencies and care while the insurer handles the hospitalisation costs.

With cashless claims, the insured person has to just make a call to the TPA desk of the hospital. If approved, the insurer pays the amount directly.

6 Different Types of Policies of Health Insurance That Offer Cashless Benefits 

• Cashless Individual Health Plan: As the name implies, this is an individual health plan that is tailored to your specific medical needs.
• Cashless Senior Health Plan: If you are over 60, this option caters to your needs by providing you with immediate, out-of-pocket coverage for serious illnesses as well as long-term, pre-existing conditions that frequently affect your group. 
• Cashless Maternity Health Plan: In case you are an insured woman, the insurer will directly clear your expenses for pregnancy and childbirth. It also covers treatments and vaccinations for your newborn baby.
• Cashless Group Health Plan: If you are an employee in an organisation, this plan provides you with health cover that covers expenses like pre and post-hospitalisation and sometimes even maternity benefits.
• Cashless Critical Illness Health Plan: With this plan, you get coverage for critical illnesses like stroke, cancer, kidney failure, etc. You get coverage for your treatment costs without having to pay up front.

How Does Cashless Health Insurance Work?

Policies of health insurance with cashless benefits make it easy for you to get healthcare without any hassles. This is helpful if you are in a financial squeeze or if you do not have access to funds immediately. In cashless mediclaim policy, the insurer directly coordinates with the hospital to cover the treatment during the stay.

The process starts with choosing an insurance provider that can partner with you and offer critical support during health crises. Following this, choose a suitable health plan within your price range, settle the premium, and verify which medical centres are covered under the policy. 

Simply present your insurance card to the network hospital. The insurer will speak with the hospital directly to complete the settlement after you have received treatment.

Today, cashless benefits have come a long way, and most of the insurers have extended the same beyond hospitalisation to OPD services as well. Policyholders can now avail themselves of these cashless benefits, from doctor consultations and diagnostic tests to medicines, without having to get admitted for 24 hours.

Advantages of Cashless Health Insurance 

• Seamless Experience: No need to carry emergency funds or fill out reimbursement forms for peace of mind. The insurer works directly with the network hospital and manages the entire payment process. 
• Get Immediate Care: In case of emergencies, you get the treatment without wasting time on financial formalities when you raise a cashless claim. 
• Choice of Hospitals: With cashless health insurance, you can get quality care in many hospitals across India.
• Financial Security: Medical expenses can be costly; this health insurance plan offers you financial protection and stability in case of an emergency.
• No Documentation Needed: Cashless health insurance does not involve you submitting a long list of documents to get your money back, unlike a reimbursement claim process.
• Stress-free: Cashless insurance lets you focus solely on your recovery, without having to worry about hospital bills. 

How to File For a Cashless Claim

For Planned Hospitalisation.

Planned hospitalisation occurs when you are aware of your impending visit/admission to the hospital for treatment. Here is a step-by-step guide to help you file your claim successfully. 

• Step 1: Dial your insurance company’s toll-free number and notify them of your procedure at least 48 hours before your appointment.
• Step 2: Take your health insurance card and request a pre-authorisation form, or download it from the company’s website
• Step 3: Complete the pre-authorisation form at the insurance desk and submit it, which will be sent to the insurer by the hospital. 
• Step 4: The insurer will verify your details and either approve or decline your claim.
• Step 5: Once approved, the insurance provider issues the authorisation letter specifying the exact amount cleared for your medical care.
• Step 6: Proceed with your medical treatment and finalise the standard hospital paperwork. The insurance company will manage the final billing directly with the facility. 

For Emergency Hospitalisation

Emergency hospitalisation occurs in the case of a sudden hospitalisation that cannot be avoided. Follow the steps mentioned below in such conditions:

• Step 1: Inform the insurance company within 24 hours of your emergency procedure by calling the toll-free number they have provided.
• Step 2: Carry your insurance card with all the necessary information like policy number, plan details, etc.
• Step 3: Complete the pre-authorisation form and hand it over at the insurance desk for submission to the insurance company.
• Step 4: The insurer verifies your details and approves or denies your claim.
• Step 5: Once approved, procure treatment and finish all paperwork at discharge, and the hospital and insurer will take care of the bill settlement on your behalf.

Cashless Health Insurance: What’s Covered 

• Hospitalisation Expenses: Policies of health insurance with cashless benefits fully cover all your costs related to intensive care treatments, daily room rent, and professional nursing care during admission. 
• Surgery and Procedures: Every expense associated with clinical treatments and operations is fully covered.
• Doctor Fees: Your treating physicians' and loop-in specialists' daily consultation fees are paid.
• Diagnostic Tests: Necessary lab work and scans like MRIs, blood panels and X-rays are taken care of on the spot.
• Before & After Care Expenses: Your insurance takes care of the diagnostic tests, treatments, and check-ups that happen right before you enter the hospital and during your recovery period after discharge. 
• Emergency Ambulances: All expenses of emergency hospital transportation are covered.
• Nursery Treatments: These include quick, contemporary procedures (such as cataract surgery) that allow you to come in and go out the same day.

Cashless Health Insurance: What’s Excluded

• Pre-Existing Conditions: If you have a disease or condition before you buy the policy, that disease or condition may not be covered until a waiting period has been met.
• Cosmetic Procedures: Surgery and treatments performed solely for aesthetic or appearance reasons are 100 per cent out of pocket.
• Routine Dental Work: Routine dental exams and procedures are not covered unless they are required because of an accident
• Non-Medical Extras: You cannot claim for personal comfort items such as toiletries, special hospital gowns or guest meals.
• Self-Inflicted Injuries: Medical expenses for deliberately self-inflicted injuries are not covered.

Cashless vs Reimbursement Claims 

Final Word

Well-being is the foundation of true prosperity, and maintaining your health shouldn't be a burden. Niva Bupa stands out as one of India's most reputable and popular insurance partners when your objective is to safeguard the health of your loved ones. We make sure that when life gets tough, getting the right treatment is the easiest thing you do. 

Frequently Asked Question

Q1. Does every hospital offer cashless care?

Yes, the benefit of cashless everywhere is that you get cashless treatment at any hospital in India, whether it is on your insurer’s network list or not.

Q2. How to choose the best cashless health insurance plan? 

Every person has his or her own perfect health plan. To make the right choice, you need to compare different policies of health insurance by matching the features of a policy to your medical needs and financial ability. 

Q3. Is OPD covered under cashless health insurance? 

Usually not. Most cashless plans cover hospitalisation, surgeries and emergencies. If OPD coverage is not specifically mentioned in your policy, then it is not covered.

Q4. What is the timeframe for cashless health insurance?

In case of emergency hospitalisation, you need to start a cashless health insurance claim within 24 hours and at least 48 hours before planned hospitalisation.

Q5. Do I get tax benefits if I have cashless health insurance?

 Yes, the amount you pay for cashless health insurance is eligible for tax deduction under Section 80D of the Income Tax Act.