What is Cashless Hospitalization?

According to data from the National Health Policy 2017, India has the highest rate of out-of-pocket expenditure in the world, which stands at about 65%. Low penetration of health insurance, followed by the increase in treatment costs of chronic diseases such as Cancer, Diabetes, cardiac problems, etc as well as low public spending on healthcare are some of the reasons behind it.

In case of a medical emergency, not only does a patient have to deal with physical and mental agony but also the financial pressure of assembling adequate cash to fund the hospitalization expenses at the earliest. A cashless mediclaim policy can help you avoid standing in long ATM queues for cash disbursal or depending on relatives to assist you, during such a time. Cashless treatment offers you the convenience of settlement of claims directly between the health insurance company and the concerned hospital so that you don’t have to run around from pillar to post to arrange cash in an urgent situation.

What is Cashless Hospitalization?

The Insurance Regulatory Authority of India (IRDA) launched the cashless hospitalization process in 2002. This facility allows cashless treatment to those buying health insurance plans through a third-party administrator. It can be availed only at the designated hospitals part of the network of facilities as listed in the policy document of the insurer subject to certain terms and conditions.

A cashless mediclaim policy saves you the trouble of making payment upfront to the hospital at the time of admission. At the same time, you can be assured of getting the best medical treatment at the choicest hospitals with cashless hospitalization along with an adequate sum insured

How Does Cashless Hospitalization Work?

Now that you know what is cashless hospitalization, let us understand how you can take advantage of this cashless mediclaim facility. Here are two scenarios:

1. Planned Hospital Admission

Suppose you or your family member is to be admitted to a hospital for minor surgery.  You will be required to inform your insurance company in advance by either filling the pre-authorization form downloaded from the TPA website or at the hospital insurance desk for cashless treatment. The concerned physician is also required to fill the form.  This form is then submitted to the insurance helpdesk at the hospital where it is verified and further sent over to the TPA who again authenticates the details. Once this is over, the amount is sanctioned and an authorization for the same is sent over to the hospital towards cashless mediclaim.

2. Emergency Hospital Admission

If you are rushed to a hospital due to a medical emergency, you can settle the hospital bills yourself and file the claim for reimbursement later, if you do not have time to wait for TPA approval. Alternatively, you can show your health insurance card at the insurance helpdesk of the hospital. You will be given an authorization form after noting down your policy number and coverage details. Fill the form and submit it to expedite the cashless mediclaim process.

In both the cases above, depending on the policy terms, a certain part or full expense will be borne by the insurance company.

Things to Remember When Opting for Cashless Mediclaim Policy

1. Your insurance company should have a tie-up with the hospital that you are admitted to, for you to avail cashless insurance

2. Cashless hospitalization comes with certain exclusions that may differ from one insurance provider to another such as hospital admission fee, ambulance charges, service charges, etc. check your pouch documents carefully to know all exclusions.

3. Read the policy document of your insurance company carefully to understand what illnesses are covered by cashless insurance

4. Your policy might have co-pay charges that you are required to pay to the hospital for every claim

5. If you are admitted to a room that is not covered by the policy you are entitled to, your cashless treatment request might be reduced subject to the eligible ward charges.

Conclusion:

This is all the information on what is cashless hospitalization and how you can avail it. Compare policies from different insurers to zero upon the best health insurance plan for yourself. Do read the terms and conditions of your policy clearly to understand what is included and excluded by your insurance company before you file a claim. Remember to keep all copies of medical bills, reports, claim forms, and discharge papers at hand as they may be required in the future to file for claim. Enjoy the benefits of health insurance and stay financially prepared with cashless insurance.