Cashless Health Insurance

These days, many people can’t afford proper healthcare treatment costs due to rising medical inflation. But health emergencies can happen to anyone without any notice. Most people don’t realize that they are suffering from diseases unless they need hospitalization. In this scenario, paying outstanding medical bills will certainly increase their financial responsibilities. But with cashless health insurance, you don’t need to face this kind of situation.  

What is Cashless Health Insurance?

Cashless insurance policies are designed specially to meet the much-needed financial relief to policyholders at the difficult time of hospitalization. A cashless Mediclaim agreement is signed between insurance companies and their network hospitals. Under a cashless Mediclaim policy, all the claims are settled by the insurance company directly without involving the insured policyholder. Here, a Third-Party Administrator (TPA) acts as a bridge between the hospitals and the health insurance company.  This third-party administrator settles all claims. TPAs have a desk at a network hospital where they process all the claim requests of customers.

Types of Cashless Medical Insurance Policies

  • Cashless Individual Health Insurance: This type of policy offers cashless claims to individuals against hospital expenses and other benefits, according to the terms and conditions of the policy.
  • Cashless Family Health Insurance: Under this type of policy plan, all members of the family will get cashless facilities if they need hospitalization.
  • Cashless Health Insurance for Senior Citizens: This type of policy is specially designed for senior citizens. The policy offers coverage for ambulance costs, hospitalization expenditures, pre-existing diseases, etc.

Benefits of Buying Cashless Health Insurance Plans

  • Provides a Robust Corpus for Medical Emergencies: Medical emergencies will certainly create turmoil in your savings. With cashless claim facilities, families don’t need to arrange funds for hospital expenses. By just showing their cashless health insurance policy card to the relevant hospital, the patients can get the best treatments for their illnesses.
  • Gives You Relief: With a cashless facility, you don’t need to worry about your finances in case of medical emergencies. You can get admitted to a hospital and start the necessary treatment without any delay if you have cashless claim health insurance.
  • A Plethora of Coverage: Cashless health insurance policies offer an array of health coverage, including pre-and post-hospitalization expenses, ambulance expenses, inpatient care, domiciliary treatment, etc.
  • Safeguards your Health During Travels: cashless policies will also support if there is a healthcare emergency when you are traveling. Since you have cashless insurance, you can get healthcare services at a network hospital without spending a single penny.
  • Tax Benefits: You may enjoy tax benefits for all your paid premiums under Section 80D of the Income Tax Act 1961, up to Rs.25,000 for individuals below 60 years of age and up to Rs.50,000 for senior citizens.


Let’s take a look at the 4 best cashless health insurance plans in India as mentioned below:-

1. Apollo Munich Optima Restore health insurance

Some features are:

  • The minimum sum insured amount is Rs. 3 lakh
  • Eligibility: between 5 years to 65 years
  • 3 years waiting period for pre-existing diseases
  • Offers coverage for pre-and post-hospitalization expenses, in-patient costs, daycare expenses, critical illness cover, and cashless facilities
  • The plan includes Restore Benefit and Multiplier Benefit
  • Offers tax benefits under Section 80D of the Income Tax Act, 1961


2. Reliance Health Gain Plan

Some prominent features and benefits are:

  • The plan has two variants (Plan A and Plan B)
  • The range of sum insured is between Rs.3 lakh to Rs. 18 lakh
  • The plan offers coverage for in-patient treatment, pre-and post-hospitalization expenses, domiciliary treatment, daycare procedures, organ transplant treatment, ambulance coverage, emergency ambulance services, etc.
  • To avail yourself of the cashless facility, you need to collect the pre-authorization form from the TPA and then, submit it along with the required details


3. ICICI Lombard Health Care Plus

This policy reimburses the excess payment that may arise due to an illness or injury.

Some features and benefits are:

  • Individual coverage for each family member
  • Flexible sum insured
  • Entry age for members is from 5 years to 65 years
  • No sub-limits on room rent, diagnostic tests/ doctor’s fees, hospitalization expenses, etc.
  • After renewal, any of the family members will get a free health check-up


4. Future Generali Health Suraksha – Family Floater

Some features and benefits are:

  • The policy comes up with four variants (Gold, Platinum, Topaz, and Ruby)
  • The range of the sum insured is between Rs. 50000 to Rs. 10 lakh
  • Pre-and post-hospitalization expenses (60 days and 90 days respectively)
  • The policy covers ambulance costs up to Rs. 2000
  • 409 daycare benefits
  • Hospital cash allowance for the Platinum plan
  • Free medical check-ups after every 4 claim-free years


FAQs Related to Cashless Health Insurance

What is not covered under cashless health insurance?

Though a cashless health policy takes care of most of your hospitalization expenses, certain items could not be covered under the part of your medical expense. Some of them are mentioned below:
· Admission or registration fees
· Toiletries
· Service Charges
· Attendant's fees
· Expenses related to diapers, oxygen masks, syringes, etc.

How Does Cashless Hospitalization Work?

Health insurance companies are tied up with various hospitals in India to prepare a list of network hospitals. Policyholders are eligible for cashless facilities if they are hospitalized in empanelled (network) hospitals for their illnesses. All expenses up to the sum insured will be paid by the health insurance company directly to the hospital.

Do cashless health insurance policies offer OPD coverage?

Many health insurance companies offer OPD coverage in their cashless policies, but you should take services from a network hospital.

Do I need to inform my cashless health insurance provider regarding my planned hospitalization?

Yes, you must inform your health insurance provider of your planned hospitalization at least before 48 hrs of getting admitted to a network hospital.

What are the reasons for claim rejection under a cashless mediclaim policy?

· If your disease for hospitalization is not covered by the policy
· If your sum insured amount is already exhausted
· If the information in the pre-authorization form is insufficient
· Delay in informing TPA about hospitalization

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