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 the best treatment in a good hospital can be a big hassle if it involves your loved ones. Hence rather than regret later, it is better to opt for the best cashless health 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.
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What is Cashless Mediclaim Policy??
The best cashless Mediclaim policy for a family in India helps us during emergency and critical situations. It comes in handy where the patient or family member may not be prepared to organize money for the treatment. If you hold a cashless Mediclaim policy, you can be certain that the insurance company will pay the hospital expenses. All you need to do is select a plan wisely and according to your requirements.
In case of a cashless Mediclaim policy, 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 hospitalisation and claim the cashless insurance.
In this case, the hospital should be informed that the patient needs to be treated under cashless Mediclaim policy before admission. The insurance card should be with the patient.
The insurance policyholder should fill a form known as the pre-authorization form, and it should be sent to the third-party administrator who the hospital further controls.
The third-party administrator accepts or rejects the cashless health insurance depending upon the terms and conditions the insurance company has set. 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 the 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 organization owner (sponsor) owns the policy. The individuals under the policy are called members. The individual can get the policy for their entire family, and the policy is named a family health plan.
Cashless health Insurance policy for older people (senior citizens):
This cashless health insurance is for older people or the senior citizens of the country. This policy covers expenses, ambulance charges, and pre-existing diseases and subjects to terms and policy.
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How Cashless Mediclaim Policy Works?
The hospitals have a link up with various 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 the Claim Procedure of the 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 the insurance policy scheme) before getting admission to the hospital.
For getting the admission to the desired hospital, the individual needs to:
Emergency Hospitalisation:
- Call the insurance company's toll-free number to know the hospital that is listed with the insurance company.
- Finalize the hospital and carry the health insurance policy's policy card and fill the pre-authorization 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 approval and rejection.
- The TPA will send the approval letter (authorization letter) of the sanctioned amount for the medical treatment.
- 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, show the company's policy number, name, and type of health insurance policy availed.
- Fill in the pre-authorization form accurately and submit it to the TPA.
- Emergency hospitalisation should be claimed within 6 hours.
What are the Inclusions and Exclusions in Cashless Mediclaim Policy in India?
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 hospitalization are:
- Attendant or visitor charges
- Ambulance charges
- Service charges, Toiletries
- Oxygen mask charges
- Diapers, nebulizers, and the documentation charges
What Should You Know About Cashless Mediclaim Policy?
Listed below are a few reasons where the mediclaim policy can be rejected:
- The disease or type of illness must 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.
- The pre-authorization form information is insufficient to approve the mediclaim policy.
- Delay in the information to the third-party authorization about the hospital or mediclaim.
Important Points to Remember:
The medical policy is available in nearby or network hospitals.
The hospital should justify the treatment and the procedure of the patient.
The individual should keep a photocopy, medical bills, form, reports, and other essential documents ready.
The individual should read the terms and 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 of Cashless Mediclaim Policy:
- Suppose the individual or his family is on a family vacation and there is a need for an emergency. In that case, an insurance mediclaim policy is the best way to deal with emergency service. The individual must carry a health insurance card in terms of any crisis.
- Few companies offer medical insurance policies in different countries, whereas many insurance companies offer medical insurance in the same country. This is advantageous in both cases.
- The primary reason for buying health insurance is the treatment at an affordable cost and no pressure.
- Don’t wait for an unforeseen medical emergency to strike. Make a smart move and buy a cashless mediclaim policy for yourself and your family to get financial protection in your time of need.
