Health Insurance

Things You Should Know About Cashless Mediclaim Policy

Medical emergencies can show up anytime! You might have to admit a relative, family member, or a friend even at odd hours or in the middle of the night. While admitting the ailing person to a reputed…

Medical emergencies can show up anytime! You might have to admit a relative, family member, or a friend even at odd hours or in the middle of the night. While admitting the ailing person to a reputed hospital is one part of your job, keeping the finances ready for such unforeseen circumstances happens to be another significant task as well. Emergency hospitalisations can occur at any hour. It’s imperative to stay prepared and be ready for such situations. Investing in a comprehensive cashless mediclaim policy will be the best thing to do to prepare yourself for such a scenario. Rather than accumulating cash during those crucial hours, you must concentrate on the patient’s treatment. That’s exactly where cashless health policies come to your rescue. Here’s a crisp guide to the crucial factors worth knowing about cashless mediclaim policies.

Why Cashless Mediclaim Policies?

When it comes to admitting a closed one to the hospital, mental unrest and tension will get the better of you. It’s during this time that cashless policies will help you out! You have to gather profound information on these policies, look for them online, and compare some of the related options. That will surely help you choose the best cashless mediclaim policy for family or individuals. Before anything else, you should know the type of plans. Here’s a short overview of the various types of cashless health plans:

Insurance for senior citizens

If you have an elderly member in the family, make sure you get a cashless health policy for them. From hospitalisation charges and ambulance costs to associated medical expenses, these particular policies will cover almost all of the expenses associated with an emergency hospitalisation. Even senior citizens with pre-existing diseases will also receive coverage depending on the waiting period and policy terms.

Health coverage for the entire family

You can also opt for a family health plan, where the policy owner along with all the other family members will receive complete coverage.

These are the basic plans for cashless mediclaim coverage. You can compare innumerable options in the market and receive best cashless mediclaim policy for family in India. However, before finalising the choice, you must have a clear idea of the inclusions, exclusions and cashless network hospitals near your area. Take a look at the following points before making your first move!

Knowing the details

Do you know how a standard cashless hospitalisation plan works? If the answer is ‘yes’, you are perfectly on the right track. In case you don’t know, here’s a quick reference for you:

You can avail the policy and raise a claim under two conditions. Either it has to be a planned hospitalisation or an emergency admittance to the hospital.

Unplanned or emergency hospitalization

At times, you might need to act promptly and admit your loved ones immediately. Ensuring perfect medical care for the patient will be imperative. Make sure you initiate the claim within a day, i.e., within 24 hours of hospital admission. Here are some steps to follow:

  • Produce the policy card at the hospital or nursing center. It will have important information such as policy number, the name of the company, and type of health insurance plan.
  • You have to fill in the pre-authorisation form. The concerned authority will initiate the process right after that.
  • If you opt for TPA, protocol states that the claim should be processed within 6 hours of initiation. If it’s a planned hospitalization, processes will be different.

Planned hospitalization

  • Since you are planning it beforehand, you know how to go about the process. Check out these tips, and they will give you an idea of what to do:
  • Go through your policy and develop an idea of the hospitals listed under the plan. You can also call up the toll-free number of your insurance company to know about the networked hospitals.
  • Decide which hospital you wish to get admitted to. A pre-authorisation form has to be taken from the place and filled in by the patient. It’s the physician’s responsibility to fill in the second part.
  • The insurance desk at the hospital will assess and scrutinise the form. Once the authenticity of the filled details are verified, the hospital staff will fax it to TPA.
  • TPA can accept or reject the claim based on its credibility.
  • If the form gets approval from TPA, you will receive an authorisation from them along with the sanctioned amount for treatment.

These are the comprehensive approaches followed by medical institutions and insurance companies when it comes to processing a claim. Other than these factors, you should also have certain crucial aspects in mind. That will help you decode the details of a cashless medical insurance policy.

Inclusions and Exclusions

Your cashless policy will pay for hospitalisation charges, ambulance costs, and other associated expenses. However, you will come across certain charges that won’t be covered by them. Knowing about these exclusions is important while raising a claim. Here we go!

  • Visitor and Attendant fees
  • Service charges
  • Ambulance charges
  • Expenses included in the diet
  • Toiletry expenses
  • Documentation charges
  • Expenses for nebulizers, oxygen masks, diapers, etc.

If you are opting for a cashless health insurance, these are some of the exclusions you should keep in mind. However, senior citizens can have the benefit of getting ambulance charges too.

Things to remember

Whether it’s a planned or an emergency hospitalisation, it is imperative to keep these important factors in mind. Breeze through these points before opting for a cashless mediclaim policy:

  • You can only get the benefit at network hospitals. If it’s a planned hospitalisation, make sure you admit the patient to one of the hospitals covered under the cashless network list of your insurer.
  • The hospital has to give proper justifications for all the treatments the patient is undergoing. The patient has every right to ask for it.
  • Read the policy documents carefully. It’s imperative to keep the crucial factors in mind and learn about the clauses. Your eligibility might get affected because of certain clauses.
  • Make sure you have copies of crucial medical bills, lab reports, discharge papers, and claim form. These papers will be useful while raising a claim.
  • Informing the TPA or Third Party Administrators is crucial. Since they are responsible for approving and processing the claim, it will be imperative to inform the TPA.
  • Take a look at the list of network hospitals before every hospitalisation. You might face difficulties to raise your health claim if you admit the patient in any other hospital, apart from the names included in the cashless network list.

What are the rejections?

Rejections are an integral part of these policies. If you wish to develop comprehensive ideas of every aspect, it will be imperative to know about the rejections too. Here’s a quick look at the conditions for rejections:

  • If the plan doesn't cover your illness and you have been admitted to the hospital for that, your claim might get rejected. You might have used up the entire sum assured. In that case, it’s unlikely that you will get cashless coverage.
  • Insufficient information can also lead to problems in raising a claim.
  • If you have a pre-existing ailment, make sure the information provided by you at the time of purchasing the policy is sufficient, precise, and correct. Or else, there’s a high possibility of the claim getting rejected.
  • You have to inform the TPA within 24 hours of hospitalisation. Delays in this regard can lead to serious issues in raising a successful claim.

With these pointers and crucial aspects in mind, you will surely get the opportunity to process a claim successfully. If you are thinking about investing in a cashless mediclaim policy, it’s the right time to do it.

Factors to consider before investing

The best cashless mediclaim plan can be beneficial in ways more than one. Once you decide to invest in these plans, here are some factors you should consider:

Efficiency of claim processing

Make sure you know the ratio and efficiency of claim processing while choosing an insurance company. That will determine the speed of your claims getting approved as well as the probability of your claim being accepted or rejected.

No-claim bonus

Some of the insurance providers offer a no-claim bonus to their customers. Check whether your chosen insurance company offers any such bonus for not raising claims during the policy period.

Network hospitals

Keeping a list of network hospitals is important in this regard. Even if you shift to another place, it won’t be difficult to plan hospitalisations in case you are familiar with the list of cashless hospitals in your area.

Pre-and-Post hospitalization charges

There are insurance providers who offer pre & post-hospitalisation benefits. Some of them also cover charges incurred during that time. You should know about these details and find out whether your chosen insurance company can offer these advantages.

Assessing the benefits

So, now you are through with all the crucial aspects involved in a cashless mediclaim policy. However, in-depth information about the benefits will help you to a great extent. Check them out before investing in a cashless health policy:

  • Instant solutions for hospitalisation
  • Patients won’t have to shell out money from their pockets
  • Comprehensive claim-settlement by TPA
  • Emergency hospitalisations covered
  • Complete peace of mind

Final take

Investing in a cashless mediclaim policy will be beneficial in ways more than one. However, you have to be judicious and wise while making the final move. You might come across a host of insurance companies offering unique benefits. Read, learn, research, and compare cashless mediclaim policy before finalising the decision. That’s your key to safe hospitalisations and good health!

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