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Things to Know About Cashless Health Insurance in India

Have you ever feared the danger of a medical emergency? Were you ever afraid that you will not need enough time to arrange money and your financial condition’s backbone will be broken? If the answer to such questions is a “Yes,” then do not worry. These are practical and sensible lines of thought where cashless insurance can help you out. 

However, one needs to get his safety needs ready as if, by any chance, such tough situations arise, finance should be the last thing one should care about. To solve this problem is the value that Health Insurance provides. The following article walks through the cashless Health insurance provisions in India and imparts a clear idea of medical insurance.

What is health insurance?

A cashless Health insurance Policy is provided by insurance companies where they bear the expenses of medical treatment of the insurance holder. They solve the problem of clearing off the headache by arranging the huge costs of medical treatment during emergencies.

As mentioned earlier, the financial aspect of treatment should ideally be the last thing that the injured, diseased, or their kin must worry about. To efficiently solve the problem, the venture of cashless health insurance is the best thing one can invest in. The system is a boon for persons who cannot arrange immediate cash. 

The insurance firms take care of the expenses so that the family members can take care of the one who needs the most. The cashless mode keeps the process hassle-free and smooth. The transaction is carried out by the insurer and the relevant hospital and takes care of negotiations. The injured or the ill person does not have to take any burden of getting the hospital expenses.

In India, there are mostly two basic types of cashless health insurance which cover the best cashless insurance in India

  1. Planned Insurance Claim
  2. Emergency Insurance Claim

Planned Insurance claim:

This insurance claim comes into the picture when the treatment and medical procedure are known and prepared beforehand. The insurance holder or their family members must fill out forms for pre-authorization from the insurance provider who reviews the application, and the insurance claim is provided

Emergency Insurance Claim:

In situations of a medical emergency where medical treatment is required immediately without any prior knowledge. To avail this, claim the insurer is made aware of the emergency as soon as possible, and the insurance firm usually replies within 6 hours of the claim.

Cashless Health Insurance is based on the types of people they provide insurance to:

  1. Cashless Family Health Insurance: This insurance claim covers the whole family of the insurance holders. Therefore, it can be availed during the requirement of any of the members of the family.
  2. Cashless Senior Citizen Health Insurance: This is usually focussed on senior citizens for treatment of their old age diseases and long-term diseases. Therefore, it is important to read carefully before taking insurance of this type to make sure what type of diseases are covered by the insurance.
  3. Cashless Critical Illness Health Insurance: This is aimed at serious life-threatening disease treatment and covers the same expenses. The diseases covered under this insurance scheme are cancer, heart attack, etc.

How Cashless Health Insurance Works?

The two basic values a Cashless Health Insurance policy provides are the safety net that medical insurance provides and mitigates the danger of any financial catastrophe for the family. And the hassle-free nature of availing the insurance at the time of requirement. In most cases, the insurance companies have prior tie-ups with the group of hospitals where the insurance can be availed. As the insurance holder gets admitted into these groups of hospitals, the insurance firm settles the finances separately.

These days insurance companies have removed the criteria of minimum 1-day hospitalization and are offering insurance claims for outpatient departments cases. 

How to avail of cashless hospitalization?

In planned Claim

As the hospitalization details are known beforehand, choosing a network hospital that has an alliance with one’s health insurance firm is well advised. Even the firm’s customer support can be asked for more information regarding the allied hospital nearest to one’s locality.

The steps to avail of cashless hospitalization are as follows:

  • The customer support of the insurance company should be called to know about the details of the nearest hospital to the place of one is residing. 
  • Usually, cashless insurance providers have a form called the pre-authorization form available on their official website. This form must be filled out and submitted at the network hospital.
  • The hospital administration usually reviews the same form to ensure a genuine case.
  • The insurer provides an authorization letter once the pre-authorization form gets approved. The letter comprises the detailed financial titbits for the required treatment.

In Emergency Claim

As in this case, immediate medical care is required, and cashless health insurance needs to be sought immediately within 24 hours of hospitalization. 

  • The health insurance card is submitted before the network hospital (i.e., hospital allied with the insurance firm) along with the policy number and the type of policy one is holding.
  • The pre-authorization form can be filled out, and the later processes will be as above.
  • Also, one can pay from pocket and later get the finances reimbursed by the insurer.

So, cashless medical claims are a big help for common people. However, it is helpful to remember that they work in network hospitals only and to store all the documents properly. Moreover, some of the in-hospital expenses are usually not covered in the cashless mediclaim policy, so it should be kept in mind. Also, the regulations and terms are very particular to a company. Hence, one should read and understand them before taking any form of cashless insurance to get the value that it aims to provide.

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