Mediclaim - Understand the need, process, and worth!
Hospitalisation can come with its own share of financial troubles. The skyrocketing costs of medicines and hefty treatment expenses can leave you drained financially and emotionally. In order to avoid such unfortunate situations, it is best to opt for a cashless mediclaim policy. It allows for cashless treatment of the patient at the hospitals that have partnered with the insurance company.
The thought of not being able to afford quality care of treatment at a good hospital can be a big hassle if it involves your loved ones. Hence rather than repent later, it is better to opt for a cashless medical insurance. With this, you can be sure that money won’t be a barrier to great healthcare that can save lives and ensure a better degree of recovery.
What is Cashless Mediclaim policy??
The best cashless mediclaim policy for family in India helps us during emergency and critical situations. It comes in handy where the patient or his family member may not be prepared to organise money for the treatment. If you hold a cashless mediclaim policy, you can be certain that the hospital expenses will be paid by the insurance company. All you need to do is select a plan wisely and according to your requirements.
In case of cashless mediclaim policy for family, the hospital should be listed with the insurance company. This policy helps the patient as the hospital directly settles the bill with the third party administrator. There is no burden on the individual to make any payment or worry about it. All you need to do is look at the partnered hospital list in your area and take your ailing family member to the same for hospitalisation and claim the cashless insurance.
In this case, the hospital should be informed prior to admission that the patient needs to be treated under cashless mediclaim policy. The insurance card should be with the patient.
A form known as pre-authorisation form should be filled by the insurance policyholder and it should be sent to the third party administrator which is further controlled by the hospital.
The third-party administrator accepts or rejects the cashless mediclaim policy depending upon the terms and conditions which have been set by the insurance company. The hospital is further informed about the third party administrator decision and the limit of the expenses.
Types of Cashless Health Insurance Plans:
There are many types of best cashless mediclaim policies for family in India. They can be majorly classified into the below categories:
- Cashless Family Health Insurance: This policy is the cashless health insurance scheme where the person or the owner of the organisation (sponsor) owns the policy and the individuals under the policy are called as members. The individual can get the policy for their entire family and the policy is named as a family health plan.
- Cashless health Insurance policy for the older people (senior citizens): This cashless health insurance is for the older people or the senior citizens of the country. This policy covers expenses, ambulance charges, and the diseases that are pre-existing and subject to terms and policy.
How Cashless Mediclaim Policy Works?
The hospitals have a link up with different health insurance policy companies. These companies tend to check the quality, medical services and the rates (negotiable) for the different medical procedures and treatment. The company has a tie-up with various hospitals and these hospitals are known as network hospitals.
Once the individual is hospitalized, he does not have the pressure to settle down the bill with the hospital as a third-party administrator has to coordinate with the hospital for the bills. The third party coordinator is the insurance company representative.
What is claim procedure of Cashless mediclaim policy?
There are two ways for the claim and cashless hospitalisation:
- Planned Hospitalisation for Individuals: This type of hospitalisation works for patients having a disease and the treatment is a prolonged one. The individual can decide the hospital and the facilities and services (as per insurance policy scheme) before getting admission to the hospital.
For getting the admission in the desired hospital the individual needs to:
- Call the toll-free number of the insurance company to know the hospital that is listed with the insurance company.
- Finalise the hospital and carry the policy card of the health insurance policy and fill the pre-authorisation form, which the individual can get from the desk or download online.
- Submit the filled form and scrutinise it thoroughly for authenticity.
- The form will further be given to the TPA for the approval and the rejection.
- The TPA will send the approval letter (authorisation letter) of the sanctioned amount for the medical treatment.
- Emergency Hospitalisation
- There are times when you need expert medical care or immediate care. There should be a cashless mediclaim policy which should be available within 24 hours.
- The individual or insured person should carry the policy card to the hospital, and show the policy number, name of the company, and the type of health insurance policy availed.
- Fill in the pre-authorisation form accurately and submit to the TPA.
- Emergency hospitalisation should be claimed within 6 hours.
What are the Inclusions and Exclusions in cashless mediclaim policy?
Inclusions for cashless mediclaim are –
- In-patient hospitalisation costs
- Doctor’s fees
- Medical consultation fees
- Medicines and devices (e.g. ventilator rent, syringes etc.)
- Room charges
- The things or expenses which are not included in cashless hospitalisation are:
- Attendant or visitor charges
- Ambulance charges
- Service charges, Toiletries
- Oxygen mask charges
- Diapers, nebulizers, and the documentation charges
What You Should Know About Cashless Mediclaim Policy?
Listed below are a few reasons where the mediclaim policy is rejected:
- The disease or type of illness has to be under the insurance policy scheme. In case the illness is not mentioned then the mediclaim will be rejected.
- The policy period is expired or exhausted.
- If the pre-authorisation form information is insufficient to approve the mediclaim policy.
- Delay in the information to the third party authorisation about the hospital or mediclaim.
Important points to remember:
- The medical policy is available in the nearby or network hospitals.
- The justification should be provided by the hospital for the treatment and the procedure of the patient.
- The individual should keep a photocopy, medical bills, form, reports and other important documents ready.
- The individual should read the terms and the conditions of the cashless policy.
- The insurance company accepts to pay a part of the amount. In case the treatment procedure exceeds the amount then the policyholder has to pay the remaining amount.
Advantages or merits of Cashless mediclaim policy:
- If the individual or his family is on a family vacation and there is need of an emergency, then insurance mediclaim policy is the best way to deal with an emergency service. The individual must carry a health insurance card in terms of any crisis.
- There are few companies that offer medical insurance policy in different countries whereas there are many insurance companies that offer medical insurance in the same country. This is advantageous in both cases.
- The basic reason for buying the health insurance is the treatment at an affordable cost and no pressure of expenses.
Don’t wait for unforeseen medical emergency to strike. Make a smart move and purchase cashless mediclaim for yourself and your family to get financial protection in your time of need.