What is a Cashless Mediclaim?
A Cashless Mediclaim is one such advantage that is offered today by most insurers. It helps avoid the reimbursement formalities by taking care of the treatment cost. Yes, that’s right. Under a cashless Mediclaim, medical bills are directly settled by the insurance company, provided the total bill amount falls within the assured limit and the hospital is a network hospital. Cashless hospitalization is extremely beneficial especially in cases of emergency where the ailing patient or their family may not be able to make last moment monetary arrangements for the treatment. Furthermore, insurance companies have now started offering a higher amount of benefits on cashless mediclaim policies, to cater to the changing healthcare needs.
How Does This Work?
Health insurance companies, after checking their quality, rates, various procedures, etc. partner up with different hospitals, which are then called their ‘network hospitals’. Network hospitals are selected by an insurance company after thorough background vetting and efficiency and expertise of medical services they offer. Furthermore, these tie-ups are renewed on an annual basis, which means the hospitals where the quality of services is not as per the standards defined by the insurance company, the tie-up may not be renewed. This whole process ensures that only the most credible hospitals are brought on board to the list of network hospitals offered by an insurance company.
The cashless facility will be available only in these network hospitals. Therefore, if you get admitted, you will have the option to avail of this facility. A company representative or a TPA (third party administrator) will be responsible for coordinating with the hospital and settling all the claims (both cash and cashless claims) between the insurance company, the hospital and you. He is also in charge of accepting or denying your insurance claims.
How Do You Avail The Cashless Mediclaim Insurance?
To avail of medical treatment under the cashless Mediclaim policy, you or your family member will need to fill out a pre-authorization form that's available either on your TPA’s website or at the hospital’s insurance desk. The filled up form is then forwarded to the TPA for acceptance or rejection of your insurance claim. There can be two conditions wherein you can avail a cashless Medical policy:
1) Planned Hospitalization
When you are aware that you will have to be hospitalized in the next few days, you are required to fill the Pre-authorization form prior to your hospitalization date. Take your policy card along. Once the form is submitted, it will be checked and verified against the righteousness of the information furnished in the form. It is then sent to the TPA who will either accept or reject your claim with a valid reason.
2) Emergency Hospitalization
When one requires emergency care and doesn’t have time to re-apply for a cashless claim, he/she must remember to do it within 24 hours of admission. At the hospital, one of your relatives may need to fill out the pre-authorization form after which the form will be fast-tracked to the TPA, who typically has to process the claim request within 6 hours. However, in case there is no time to wait for the claim approval, the amount can be paid in cash and reimbursed later from the insurance company.
What Are The Policy Exclusions That Apply?
Although most cashless Mediclaim plans cover all emergencies and medical conditions, there may be certain specific exclusions listed in your policy that are not covered. For instance, pre-existing illnesses like HIV/AIDS, and injuries caused by terrorist acts, non-medical expenses or illegally caused damages. However, the best health insurance policies do cover ambulance charges, pre and post hospitalization expenses, critical illnesses and in-patient care.
**To understand exactly about the policy coverage, exclusions, etc. read the Policy Wordings carefully.**