Cashless Health Insurance

Cashless health insurance allows direct bill settlement between the insurer and the network hospital, ensuring smooth medical treatment. It provides financial relief and quick access to quality healthcare without upfront payments.
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What is cashless treatment in health insurance policy?
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3 mins
3-March-2025

Cashless health insurance policies, as the name suggests, are those insurance plans wherein the policyholder has the option to avail of cashless treatment at an insurer’s network hospital. In case of cashless treatment, the insurer and the hospital settle all the medical bills among themselves. To avail of the cashless claim settlement facility, one only needs to inform the insurer at least two days before (in case of planned hospitalisation) and within 24 hours of hospitalisation in case of emergency. You can avail of this facility at any of the insurer’s network hospitals. The hospital admin will directly contact the insurer and send a pre-authorisation form to start the claim settlement process.

What is Cashless health insurance

Most insurance companies have tie-ups with leading hospitals pan India. They form a robust network of hospitals where their policyholders can avail of cashless treatment.

When choosing a plan, it makes sense to check the network hospitals of the insurer. Also, make it a point to go through your policy document and check the network hospital list. This will give you some idea about the more well-known or popular hospitals around you. This is important because in case of planned hospitalisation, you may have the chance to check network hospitals and choose one that suits. In case of an emergency, a network hospital may be difficult to zero in on if you haven’t checked the list previously.

In any case, cashless medical treatment is exclusively available at network hospitals. Following admission, it's crucial to notify your insurer promptly. Subsequently, your involvement will primarily entail providing any necessary documents. The hospital will then gather your insurance details and validate your policy. Once insurance information is verified, your cashless medical treatment can commence. In this scenario, your insurance company will directly settle expenses with the hospital upon completion of treatment, streamlining the process. This underscores the convenience and efficiency of cashless medical insurance.

Types of cashless health insurance in India

Cashless health insurance offers a convenient way to manage medical expenses by settling bills directly with the hospital. Here are the four main types:

  • Individual Health Insurance: Provides cashless coverage for a single person.
  • Family Health Insurance: Covers the entire family under a single policy, allowing all members to avail cashless treatment.
  • Senior Citizen Health Insurance: Specifically designed for individuals over 60, covering hospitalization, ambulance charges, and pre-existing conditions.
  • Maternity Health Insurance: Covers pregnancy and childbirth-related expenses for the insured woman and newborn, including vaccinations and treatments.

What is cashless facility in health insurance?

Cashless health insurance is a type of insurance plan where policyholders can avail of medical treatment without having to pay the hospital or medical facility directly. Instead, the insurance company settles the bill directly. This means that the policyholder does not need to worry about the cost of treatment or expenses incurred during hospitalisation.

Cashless health insurance makes the process simpler and easier for customers, ensuring they receive the best possible medical treatment without any stress or financial burden. It is an effective way to secure the financial well-being of individuals and families during a medical emergency.

Why should you opt for cashless health insurance?

Cashless health insurance comes in handy in times of a medical emergency when the policyholder might be cash-strapped or not have immediate access to funds. Besides, arranging money or dealing with the hassles of bill reimbursement should be last thing on their mind during an emergency. Thus, cashless health policies are designed to eliminate any financial roadblock that delays the insured from availing medical treatments on time.

Moreover, cashless health insurance plans also allow people to avail the best quality medical treatment without worrying about arranging money to pay the hospital bills.

Understanding the need for cashless mediclaim is essential. However, knowing how cashless health insurance works in India is equally important.

How does cashless health insurance work?

A cashless mediclaim policy simplifies healthcare expenses by directly settling bills with network hospitals. Here’s how it works:

Cashless health insurance offers significant advantages, making it a preferred choice for many. Here's why:

  • No upfront payment: Avoid the stress of hefty hospital bills during emergencies. Your insurer settles the costs directly with the hospital.
  • Wider hospital access: With cashless facilities expanding beyond network hospitals, you have more choices for treatment.
  • Simplified claim process: No need to submit bills and wait for reimbursement. The TPA handles the paperwork and coordinates with the hospital.
  • Faster access to treatment: Pre-authorization speeds up the admission process, ensuring you receive timely medical care.
  • Cashless OPD coverage: Many plans now offer cashless outpatient services, including consultations, tests, and medicines, enhancing convenience.

These benefits make cashless health insurance a valuable asset, providing financial security and peace of mind during medical emergencies.

What are benefits of cashless health insurance policy

  • Effortless hospitalization: Get admitted to any network hospital without upfront payment. Simply notify your insurer for a smooth and convenient process.
  • Quality healthcare: Network hospitals undergo stringent quality checks, ensuring you receive top-notch medical care from licensed professionals.
  • Stress-free recovery: Focus on healing without the financial burden of hospital bills, as the insurer settles expenses directly with the hospital.
  • Tax benefits: Enjoy tax exemptions on health insurance premiums under Section 80D of the Income Tax Act, reducing your tax obligations.
  • Comprehensive coverage: Get coverage for various medical expenses, including pre- and post-hospitalization, diagnosis, treatment, doctor visits, and specialized procedures like dialysis and chemotherapy.
  • Financial security: Protect your savings and avoid the need for loans to cover medical expenses, ensuring financial stability during emergencies.
  • Increased choice and flexibility: Many insurers now offer cashless OPD coverage and "cashless everywhere" facilities, expanding your options for treatment and convenience.
  • Faster claim settlement: Cashless claims are typically processed faster than reimbursement claims, reducing waiting times and providing quicker access to funds.
  • Reduced paperwork: Minimal documentation is required for cashless claims, simplifying the process and saving you time and effort.
  • Peace of Mind: Enjoy peace of mind knowing you have financial protection and support during unexpected medical events.

Also, read: Mediclaim Insurance Policy

Pro Tip

Avail hospitalisation and treatment benefits with health insurance plans starting at just Rs. 15*/day.

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What are Steps to File a Cashless Claim for Health Insurance

Here's how to file a cashless health insurance claim for both planned and emergency hospitalizations:

Planned hospitalization

  1. Inform insurer: Notify your insurance company at least 48 hours before hospitalization via their toll-free number.   
  2. Pre-authorization Form: Obtain a pre-authorization form from the hospital's insurance desk or download it from the insurer's website.
  3. Submit form: Submit the filled form and your health card to the hospital's insurance desk.
  4. Verification and approval: The insurer/TPA will verify the details and approve or reject the pre-authorization.   
  5. Authorization letter: If approved, you'll receive an authorization letter specifying the approved treatment amount.   
  6. Treatment and discharge: Receive treatment and sign all required documents upon discharge. The insurer will settle the bill directly with the hospital.

Emergency hospitalization

  1. Inform insurer: Inform the insurance company within 24 hours of emergency hospitalization.
  2. Health card: Present your health insurance card at the hospital.
  3. Pre-authorization form: Fill and submit the pre-authorization form at the insurance desk.   
  4. Hospital submission: The hospital submits the form to the insurer/TPA for approval.   
  5. Verification and approval: The insurer/TPA verifies the details and approves or rejects the request.   
  6. Treatment and discharge: If approved, receive treatment and sign documents upon discharge. The insurer will settle the bill.

What are the inclusions of cashless health policy?

Cashless health insurance provides coverage for a wide range of medical expenses, offering financial protection and peace of mind during times of need. Here's a breakdown of the typical inclusions:

· In-patient hospitalization: Covers expenses related to room rent, nursing care, doctor's fees, surgery costs, medicines, and other medical treatments during hospitalization.

· Pre- and post-hospitalization: Covers medical expenses incurred before and after hospitalization, such as doctor consultations, diagnostic tests, and medications.

· Day-care procedures: Covers expenses for procedures that don't require 24-hour hospitalization, such as chemotherapy, dialysis, and cataract surgery.

· Ambulance charges: Covers the cost of ambulance services for transporting the insured to the hospital in case of an emergency.

· Critical illnesses: Many policies offer coverage for specific critical illnesses like cancer, heart attack, and stroke, providing a lump sum benefit upon diagnosis.

· Maternity benefits: Some plans include maternity coverage, covering expenses related to pregnancy, childbirth, and newborn care.

· Alternative treatments: Certain policies may cover alternative treatments like Ayurveda, Unani, Siddha, and Homeopathy, subject to terms and conditions.

Wellness programs: Many insurers offer wellness benefits like health check-ups, preventive screenings, and discounts on fitness programs to promote healthy living.

What are the exclusions of cashless health policy?

Cashless medical insurance policies come with specific exclusions that are important to understand. These typically include:

  • Pre-existing conditions: Often excluded for a certain period after the policy begins.
  • Cosmetic procedures: Non-medical procedures like plastic surgery are usually not covered.
  • Experimental treatments: Treatments or drugs not yet approved or in clinical trials.
  • Self-inflicted injuries: Injuries caused intentionally are excluded.

Understanding these exclusions helps avoid surprises during claims.

The process to avail cashless health insurance

To raise a cashless claim request, you can follow these simple steps:

Step 1: Search for a partner hospital in your city and inform the insurance provider within 48 hours of hospitalisation (for emergency situations) or at least three days prior to admission (for planned hospitalisation).

Step 2: Make sure to carry the policy details or the patient's insurance cashless card provided with the policy document when you visit the network hospital.

Step 3: Produce a valid ID proof and insurance cashless card at the insurance desk of the hospital.

Step 4: Fill up all the details in the pre-authorisation form and submit it at the hospital.

Step 5: To expedite the procedure, fill up a request form on the official portal and inform your insurer about the same.

Step 6: Your insurance provider might take a few hours to review an application and inform you accordingly via SMS and e-mail.

Step 7: You can even check the status of the claim online.

The insurer will process the claim as per the terms and conditions after the completion of all the formalities.

Importance of having a cashless health insurance plan

Due to rising medical expenditures and emergencies, people are frequently in need of money and struggle to pay for medical expenses effectively. This sometimes results in compromising on the health care you receive. Cashless health insurance plans come in handy in such situations because they allow an individual to receive care without having immediate access to money. To receive the treatment, the policyholder needs to go to one of the network hospitals of the insurer and the procedures will be taken care of.

This facility allows the insured to feel less stressed and have peace of mind. Additionally, it will save time, effort, and energy while settling the claim with the insurance provider.

The points we have shared with you today are aimed at making sure that when you put your health insurance to the test during an emergency, it gives you the financial security you need without any hassles. To choose a health insurance plan that’s got you covered well in all these aspects, visit the Bajaj Finance website. Here, you can explore health insurance plans from our trusted partners, view product features, compare prices and purchase a plan that is best suited to your needs. All this in a matter of minutes and from the comfort of your home. It truly is becoming the new way to buy insurance.

Things to keep in mind before buying a cashless health insurance policy

Before purchasing a cashless medical insurance policy, consider these factors:

  • Network hospitals: Ensure the insurer has a wide network of hospitals.
  • Coverage details: Check what medical conditions and treatments are covered.
  • Exclusions: Be aware of what is not covered under the policy.
  • Claim process: Understand the process and documentation required for cashless claims.

These steps will help you select the most suitable policy for your needs.

What is the difference between cashless claims and reimbursement claims?

Categories

Cashless Claims

Reimbursement Claims

Payment Process

Insurer pays the hospital directly.

Policyholder pays the hospital and seeks reimbursement from the insurer.

Upfront Payment

Not required at discharge.

Required at the time of discharge.

Documentation

Simple: Health card and pre-authorization form.

Extensive: Doctor's notes, bills, payment receipts, claim form.

Pre-Approval

Mandatory pre-authorization.

No pre-authorization needed.

Convenience

Highly convenient during emergencies.

Less convenient during emergencies.

Processing Speed

Fast, typically within hours.

Slower processing time.

 

What are the main reasons for claim rejection in a cashless Mediclaim policy?

While cashless health insurance offers convenience, certain factors can lead to claim rejection. Here are some common reasons:

  • Policy exclusions: The claimed illness or procedure is not covered by the policy.
  • Sum insured exhausted: The policyholder has used up the entire sum insured for the policy period.
  • Waiting period: The claim is made during the waiting period specified in the policy.
  • Undisclosed pre-existing conditions: Pre-existing diseases were not disclosed during policy purchase.
  • Insufficient/incomplete information: Inadequate or incomplete information provided in the pre-authorization form.
  • Delayed intimation: Delay in informing the TPA about hospitalization.
  • Incorrect information: Providing inaccurate information to the insurer.
  • Expired policy: The policy has expired at the time of claim submission.

Tips to avoid cashless health insurance claim rejection?

Follow these tips to ensure your cashless health insurance claims are approved smoothly:

  • Disclose pre-existing conditions: Inform your insurer about any pre-existing diseases when purchasing the policy.
  • Timely intimation: Notify the insurer promptly about planned hospitalizations (at least 48 hours prior) or emergency hospitalizations (within 24 hours).
  • Accurate information: Provide complete and accurate details about your medical condition in the pre-authorization form.
  • Check waiting periods: Be aware of the waiting periods for specific treatments and ensure your claim falls outside these periods.
  • Understand policy terms: Read your policy documents carefully to know the inclusions and exclusions.
  • Renew policy on time: Renew your health insurance policy before it expires to maintain continuous coverage.

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Frequently asked questions

Which health insurance is best for getting cashless treatment?

There are various health insurance companies that provide cashless treatment facilities. However, the best company for you depends on your specific requirements and budget. It is advisable to compare the benefits, features, and premiums of different insurance providers before choosing the one that suits you the most.

What is the difference between cashless and reimbursement health insurance?

In cashless health insurance, the policyholder can avail of medical treatment without having to pay for the medical facility directly, as the insurance company settles the bill on their behalf. On the other hand, reimbursement health insurance requires the policyholder to pay for the medical treatment and then file a claim with the insurance company for reimbursement.

What is a cashless hospital?

A cashless hospital is a medical facility that has a tie-up with an insurance company to provide cashless health insurance benefits to policyholders. In other words, policyholders can avail of medical treatment at the hospital without having to pay the medical bills directly, as the insurance company settles the bill directly with the hospital. Cashless hospitals help policyholders to receive quality medical treatment without having to bear the financial burden.

Can I avail cashless treatment at any hospital?

No, cashless treatment is only available at hospitals within the insurer's network. Ensure the hospital where you seek treatment is part of the network to benefit from cashless facilities.

Does a cashless health insurance plan cover OPD treatment?

Typically, cashless health insurance plans do not cover OPD (Outpatient Department) treatments. They generally cover inpatient treatments and surgeries. Check your policy details for specific coverage options and exclusions.

Is cashless mediclaim taxable?

No, cashless mediclaim is not taxable. The reimbursement or cashless payment for medical expenses under the policy is tax-exempt, provided it meets the conditions laid out under tax laws.

Which is the best cashless medical insurance?

It's challenging to pinpoint the single "best" cashless medical insurance because individual needs and preferences vary greatly. However, some leading contenders often include plans from providers like Niva Bupa, Star Health Insurance, and Care Health Insurance, known for their extensive network hospitals, high claim settlement ratios, and comprehensive coverage. The "best" choice ultimately depends on factors like your budget, medical history, desired coverage, and preferred hospitals.

What is cashless medical insurance?

Cashless medical insurance is a type of health insurance that allows policyholders to receive medical treatment at network hospitals without having to pay for the expenses upfront. The insurance company settles the bill directly with the hospital, providing significant convenience and financial relief during medical emergencies. This eliminates the need for policyholders to pay out of pocket and then seek reimbursement later, making the process smoother and less stressful.

What is the new rule for cashless medical insurance?

While there isn't one specific "new rule," the cashless medical insurance landscape is constantly evolving. Recent trends include the expansion of cashless networks to include more hospitals, the introduction of cashless OPD coverage for outpatient services like consultations and tests, and the emergence of "cashless everywhere" features that allow claims even at non-network hospitals under certain conditions. Additionally, technology is playing a growing role, with TPAs using digital platforms and tools to expedite claim processing and enhance customer service.

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