What is Cashless Health Insurance and How Does it Work at Network Hospitals?

In India, approximately 400 million people lack access to health insurance. It leaves them vulnerable to the financial shock of unexpected medical expenses. For many families, a single hospital visit can wipe out years’ worth of savings.

In this scenario, one can benefit from getting cashless health insurance. It acts as a vital safeguard against financial stress and ensures timely, quality care.

What is Cashless Health Insurance?

Cashless health insurance enables policyholders to get medical treatment without paying upfront fees at the network hospitals. Instead, the insurance provider settles the bills directly with the hospital.

This reduces financial stress during emergencies and ensures timely care. It is a very convenient and hassle-free way to manage healthcare expenses.

How Does Cashless Health Insurance Work at Network Hospitals?

Step 1: Select a Network Hospital

Begin by ensuring the hospital you wish to be treated at is a part of your insurer’s network hospital list. The majority of insurers provide such information on their website. You can also obtain this information by contacting customer support.

Step 2: Get a Pre-Authorisation Request From Your Insurer

For planned hospitalisations, you need to submit a pre-authorisation form through the hospital’s insurance desk. This form will include basic details about you, the doctor’s diagnostic and treatment plan, and the estimated cost of the treatment procedure.

The hospital will forward this to your insurance company. The insurer then reviews and approves the claim if it falls within the policy coverage and settles bills directly with the hospital.

Step 3: Receive Approval of Claim and Treatment

After the insurer approves your claim, the treatment can begin without you having to pay anything upfront (except for exclusions, non-covered items, and personal expenses).

Why Choose Cashless Health Insurance?

There are many compelling reasons why cashless hospitalisation is growing in popularity across the globe:

• Speed and Convenience

During a medical emergency, the last thing that you would want to worry about is arranging finances. A cashless insurance removes that worry and enables swift treatment.

• No Out-Of-Pocket Expenses

With rising medical costs, even short hospital stays can be expensive. Cashless policies ensure that you do not have to dent your financial savings.

• Transparent Process

Insurance companies provide a detailed breakdown of inclusions and exclusions, which helps avoid any financial surprises.

What are the Inclusions of Cashless Hospitalisation?

The best health insurance in India for cashless treatment generally has these inclusions:

1. In-Patient Hospitalisation – Covers medical expenses for hospital stays exceeding 24 hours, including room charges, nursing, and prescribed treatments.
2. Pre- and Post-Hospitalisation – Medical expenses incurred up to 90 days before admission and 180 days after discharge are covered, if related to the same illness.
3. Daycare Procedures – Includes coverage for treatments that do not require 24-hour hospitalisation, such as cataract surgery, tonsillitis.
4. ICU Charges – Expenses that are related to Intensive Care Unit (ICU) stays are included under the policy.
5. Diagnostic Tests and Medications – Covers required diagnostics, doctor’s consultations, and medications administered during hospitalisation.
6. Ambulance Charges – Ambulance expenses for transporting patients to the hospital in emergencies are covered within specific limits.

What are Some of the Common Exclusions of Cashless Health Insurance?

When going for the best cashless health insurance, remember to be clear about the exclusions. This can be done by reading the policy terms carefully. Here are a few common exclusions of a cashless health plan:

1. Pre-Existing Conditions – There are many policies which do not cover pre-existing conditions immediately after issuing cashless health insurance. Generally, there is a waiting period for that.
2. Cosmetic Treatments – Procedures like weight loss treatments, cosmetic surgery, hair transplants, and dental treatments resulting from an accident are excluded.
3. Expenses of Non-Medical Nature – Items like toiletries, admission fees, and registration fees are not covered.
4. Self-Inflicted Injuries – Injuries resulting from suicide or self-harm are excluded.
5. Injuries Due to Alcohol or Drug Use – Injuries resulting from substance abuse are also not excluded.
6. Injuries Due to War and Acts of Terrorism – Injuries as a result of aggression in war or terrorism, civil unrest, are also excluded from most policies.
7. Treatments Related to Fertility – Fertility treatments like IVF are generally excluded from cashless health insurance plans.
8. Treatments of Experimental Nature – Treatments that are not yet accepted as standard medical practice are part of exclusions from such policies.

Conclusion

Cashless health insurance streamlines medical treatment by eliminating any upfront costs at the network hospitals. In a country where 40 crore people pay healthcare expenses out-of-pocket, cashless health insurance offers financial relief and swift access to care.