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How Does Cashless Mediclaim Work?
Most of us take care to select a good insurance policy that will sufficiently safeguard our family’s medical requirements. However, we often tend to overlook the nuances involved in opting for a conventional reimbursement facility, where the insurer reimburses the policyholder for medical expenses incurred after treatment has been completed.
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- How Does Cashless Mediclaim Work?
This means that the policyholder not only pays out of their pocket during the treatment, but that if they do not provide the necessary paperwork or formalities as per the requirements of the insurer, they might not even be reimbursed by the insurance provider. This is why cashless mediclaim policies are a better choice. Under this facility, the policyholder does not have to pay for the medical expenses out of their pocket. Instead, they have to notify the insurer that they would be availing of medical care, who would then manage the expenses directly with the medical centre during the course of the treatment. In other words, even if the policyholder does not have the money for medical treatment during emergencies or when medical attention is required, cashless mediclaim covers their medical and hospitalization needs.
Cashless mediclaim is a type of benefit within medical insurance and can be availed of within an individual or family floater policy. Here is how the cashless mediclaim facility works –
Network of Hospitals
The most important aspect to cashless mediclaim is the network of hospitals, failing which, it cannot be availed. Insurance companies tend to have a direct network with a certain list of hospitals. If the policyholder avails of medical care in a facility that is not listed under the network of hospitals, then they cannot avail of cashless mediclaim for that particular round of treatment.
Planned Claims
When the policyholder is aware that they would be undergoing treatment, they have to inform the insurer in advance, as per the stipulations of the policy. The insurer will then bear the pre and post hospitalization expenses in due course. The policyholder thus needn’t have to bear any expenses up to the number of days that are mentioned in the policy. The pre-authorization form would require information and history about the illness, the line of treatment and the approximate duration of hospitalization and expected expenses.
Emergency Claims
There are often situations where unplanned expenses crop up, in the case of a medical emergency, accident or grave illness. The insurer can avail of cashless mediclaim under such circumstances as well by informing the insurer accordingly. The insurer should read the terms and conditions mentioned in the policy and provide the necessary documentation under both cases, so that they can enjoy the maximum benefit of cashless mediclaim. Most emergency claims usually have an intimation deadline mentioned in the policy application documents.
Don’t miss out on: Different Health Insurance Plans.
Exclusions
While most cashless plans cover most medical conditions and emergencies, there are some temporary and permanent exclusions that are listed in the plan that the policy will never cover. They could be pre-existing illnesses, HIV/AIDS, routine medical check-ups, dental procedure, experimental treatments, non-medical expenses or injuries caused by terrorist acts, wars or during illegal activities.
However, cashless mediclaims do cover benefits like ambulance charges, critical illnesses, pre and post hospitalization medical expenses and in-patient care, to name a few.
Between the reimbursement and cashless route, the latter is generally the more favourable option, given that the policyholder can avail of medical treatment even if they do not have the funds for the same. This is particularly beneficial in the case of those do not have a fixed income. Apart from that, various policies offer a myriad of advantages like transfer of policy from one policyholder to another, cashless mediclaim that is valid outside India. Cashless mediclaim also provides tax benefits and can be renewed every year throughout the lifetime of the policyholder.
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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
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**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
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*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
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*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
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