Cashless Claim in Health Insurance – Why should you know about it?
Kabir (30 years old) works in the manufacturing industry and lives in Pune with Seema (25 years old). After 3 years of marriage, the couple plans to start their family as Kabir has purchased a small apartment. The cost of living and medical inflation is rising exponentially in Pune. So, Kabir is planning to invest in a comprehensive healthcare policy to protect his savings and also safeguard his family’s health. Though his friends and acquaintances have advised him to go for a cashless claim health insurance policy, Kabir still wants to acquire some more knowledge regarding this so that he can wisely select the best cashless claim settlement policy for a scintillating future.
Here we are going to discuss more details about a cashless insurance claim and why you should prefer it over the mediclaim reimbursement process.
These days, the role of health insurance is indubitable in everyone’s life. Because of a sedentary lifestyle, people are prone to various menacing diseases. Moreover, over the past few years, the cost of medical expenses has increased meaningfully. Without a prominent health insurance policy, it would be very difficult for mediocre people to manage all healthcare expenses. Here enters the cashless health insurance process that saves people from their financial worries without compromising the quality of treatment.
Health Insurance Claim
Two processes can settle all health insurance claims: medical claim reimbursement and cashless mediclaim procedure. The reimbursement process in health insurance is tedious and time-consuming as a lot of paperwork is involved. On the other hand, cashless claim in health insurance is a breeze and convenient. These days, people prefer the cashless claim process as it doesn’t involve carrying cash around with you.
What is a Cashless Mediclaim process?
Under a cashless claim in health insurance, your insurer will pay the bills directly to your selected network hospital for your treatment. The claim settlement happens instantly here. Since people have understood the importance of cashless claims, the popularity of cashless claims is getting high. Many people are inclined to a cashless mediclaim process to avail of this feature for their treatment.
Some imperative things to remember for the cashless facilities:
- The cashless mediclaim process is only applicable if you seek treatment from any of the network hospitals of your insurance company.
- Before admission, the hospital explains all the terms and conditions to the insured policyholder for his/her treatment.
- Though the process is cashless, you still collect and keep all the bills and receipts of other healthcare expenses of the hospital.
- Go through the policy details carefully of the insurance company for the cashless facility.
- If your treatment amount surpasses the assured sum, you need to pay the remaining balance from your pocket. In this scenario, the insurance company is not responsible for the full payment of your treatment.
How to make a claim with the cashless settlement?
There are two types of cashless claim settlement processes.
Planned Hospitalization:
You should inform your insurer at least 3-4 days before admission. In this case, you need to fill up the pre-authorization form and need to carry your health card. After receiving your form, the insurer will scrutinize your claim. If the company is satisfied, you can enjoy the cashless facility.
Emergency Hospitalization
In case of emergency hospitalization, by showing your health insurance card, you can get admitted to a hospital. You need to fulfill the pre-authorization form and forward the request. If you didn’t get approval on time, then you can go for the health insurance reimbursement process. In this case of a reimbursement process in health insurance, you first need to pay the bills from your pocket and then, you can initiate a claim.
What are the exclusions for the Mediclaim facility?
Some exclusions are,
- Attendant fees
- Hygiene products of the patient
- Documentation charges
- Service charges
10 Things you should know about before buying a cashless health policy
Don’t compromise with certain things if you want to purchase a cashless claim for a bright future as mentioned below:-
- Coverage
- Exclusions
- Claim Settlement Ratio
- Co-Payment
- Network Hospitals
- No Claim Benefits
- Lifetime Renewal
- Waiting Period
- Additional Benefits
- Cost
1. Coverage
Give the utmost importance to coverage before purchasing a cashless claim health policy. Apart from the sum assured, the coverage should come with a plethora of features and benefits. Choose a coverage policy that can cover almost every medical situation. Some policies offer restoration features where the sum assured amount gets restored when it’s exhausted. It is better to prefer those policies the most.
2. Exclusions
Before making the final decision, take a look at the exclusions of the policy. If you don’t have adequate ideas about limitations, then your cashless claims can also get rejected. Being aware of exclusions will help you to make your decisions wisely.
3. Claim Settlement Ratio
You should consider the claim settlement ratio of the health insurance company while purchasing a cashless health insurance policy. This ratio implies how trustworthy your insurer is and how efficiently it settles all the claims of the customers. Therefore, choose a cashless health plan of an insurer that has a high claim settlement ratio.
4. Co-Payment
Co-payment implies the portion of healthcare expenses that needs to be compensated by you as an insured before initiating the claims with the insurance provider. So, choose health policies that have no co-pay clause.
5. Network Hospitals
Cashless facilities are only acceptable at the network hospitals of the insurers. So, choose a health insurance company that has a wider hospital network.
6. No Claim Benefits
This is the common feature for most cashless health insurance policies. As a result, benefits for each claim-free year can be accumulated up to a maximum of 50% by most of the policies.
7. Lifetime Renewal
Always prefer policies that are renewable for a lifetime. In this way, you can get rid of coverage hassles and high premiums.
8. Waiting Period
The waiting period is common for all cashless health insurance plans. So, choose policies that have a lesser waiting period so that you can get financial support for your treatment.
9. Additional Benefits
Some health insurance policies also offer additional coverage benefits like critical illness cover and accidental cover etc. While purchasing the best cashless health insurance plan, consider these features.
10. Cost
The cost is another deciding factor. So, compare the quotes of various cashless health plans online thoroughly and then make your decision.
Documents required for purchasing cashless health insurance plans
The list of documents that you need to submit,
- PAN card
- Age proof (Birth certificate/SSLC mark sheet/Voter ID/Passport, etc.)
- Identity proof (PAN card/ driving license/voter’s ID/ passport/aadhaar card, etc.)
- Address proof (Driving license/passport/latest electricity bill/ telephone bill etc.)
- Photographs
The importance of cashless claim facilities is rising day by day. That’s why many leading insurers are incorporating intriguing features into their cashless health insurance policies to make them more convenient. So while purchasing a health insurance policy, ensure you can avail of the cashless facility in a hassle-free way for your healthcare needs.
