Things You Need To Know About Cashless Medical Insurance


Medical emergencies are unprecedented and bring along several hassles, especially during immediate hospitalisation. In such cases, a cashless medical insurance policy is the ideal financial support that you can have by your side.

What is a cashless medical policy?

A cashless medical policy or cashless hospitalisation is precisely what the name suggests – you don’t have to pay any cash during hospital admittance. It is a feature that comes with health insurance plans but not all of them.

How does cashless hospitalisation work?

Insurance providers are partnered with particular medical facilities known as network hospitals. You can avail cashless medical facility from the network hospitals who have partnered with the insurers.

Schemes like individual health insurance offered by Bajaj Finserv offers cashless facility in more than 5,700 hospitals across India.

A third-party administrator (TPA) acts as a coordinator between the insurance provider and a network hospital. It is up to the TPA to accept or reject claims and issue reimbursements.

Is cashless facility available with non-partnered hospitals?

A cashless hospital insurance policy is not available during admission in a hospital not empanelled with the insurance provider. Not only that but you also have to pay a co-payment fee. The co-payment fee is a certain percentage of your claims that you have to pay out of your own pocket during such admittance.

What is the process of availing cashless hospitalisation?

You start by filling a pre-authorisation form available either from your insurance provider’s website or the network hospital. The approval or rejection of your claim will depend on this form.

The process for availing cashless medical claim differs in the following situations:

  1. Emergency hospitalisation

Admitting the patient to a hospital as soon as possible is the first step during critical illness. In case of emergency hospitalisation, you have to fill the pre-authorisation form and get an approval for the cashless facility within 24 hours from the TPA. The TPA will approve or reject the form within 6 hours.

  1. Planned hospitalisation

Planned hospitalisation, as the name suggests, is when you have planned the hospitalisation process. It is advisable to conduct all the formalities and fill the pre-authorisation form beforehand. You must get approval from the TPA in such cases. The TPA will then send an authorisation letter to the network hospital.

Only after the above will you be able to receive the benefits of your cashless medical claim policy.

What are the benefits of cashless hospitalisation?

Two of the immaculate benefits that you receive with cashless facility include:

  1. Zero inconveniences for making claims

You have to pay for all the healthcare expenses in case of a standard health insurance. Next, you have to make a claim upon which the insurance company will reimburse the costs you have incurred. This process can take several days and involve considerable hassles. You may not even receive the full amount.

A cashless medical insurance policy eliminates precisely the above. You don’t have to go through any inconvenience of making a claim.

This facility is also available for health insurance schemes for senior citizens. The senior citizens health insurance policy offered by Bajaj Finserv also provides you income tax benefits under Section 80D.

  1. Beneficial during cash shortages

You have to arrange cash, especially during an emergency hospitalisation. And, doing the same can be difficult. Hence, cashless insurance policies are beneficial. They remove the necessity of paying cash when availing treatment.

The top-up health insurance policy from Bajaj Finserv offers additional coverage when the existing health insurance plan is not sufficient to meet the medical expenses. You can insure a sum ranging from Rs. 3 Lakh to Rs. 50 Lakh with this policy.

Availing a hospital cash cover plan thus ensures hassle-free hospital admissions at the time of emergency. Some policies also cover pre and post-hospitalisation expenses up to a specific period.