Cashless Hospitalisation in Health Insurance: What You Need to Know

Cashless Hospitalisation in Health Insurance

Your insurer is offering cashless hospitalisation. Does that mean you don’t need to pay anything at the hospital?

Your health insurance provider is offering you cashless hospitalisation, and you are sceptical if it's an offer that’s too good to be true. You are wondering if cashless hospitalisation really means that you don’t need to pay anything at the hospital. If you are looking for answers to these assumptions, then you are at the right place.

What is Cashless Hospitalisation?

Cashless treatment or cashless hospitalisation is a big boon when you are surrounded by a medical emergency. Key to a smooth and hassle-free claim settlement process, cashless hospitalisation means that you can get medical treatment without having to pay the bills upfront at the time of discharge. Your health insurance company would take this load off your back and make the payment directly to the hospital, thus saving you from paying hefty medical bills.

Understanding How Cashless Hospitalisation Works

A health insurance company collaborates with hospitals and healthcare centres all over the country. When you seek admission to any of these hospitals, your medical bills are paid directly by the insurer. Therefore, in a network hospital, you can save yourself from the trouble of paying hefty bills and simply concentrate on the treatment of the patient.

For a planned hospitalisation as well as an emergency hospitalisation, you need to fill up the pre-authorisation claim form and submit it to the hospital help desk, your insurance company executives, or the appointed TPA officials to present at the hospital. They will then process the formalities allowing you a hassle-free settlement process.

Benefits of Cashless Hospitalisation

1. Financial Relief: The absence of liquid cash in hand does not mean compromising on the treatment. As the insurer would settle your bill, there is no need to worry about arranging funds.
2. Minimal Documentation: Compared to a reimbursement process, cashless hospitalisation requires hardly any paperwork to be submitted. Your health card/ policy papers and the doctor’s prescription are mostly the only documents required.
3. Great Help in an Emergency: If a medical urgency hits you when you are away from home, you can seek admission in any of the network hospitals, that are typically available all across the country. Cashless hospitalisation can, thus, come to your rescue.
4. Convenient and Hassle-Free: With cashless hospitalisation, the process of claim settlement becomes very smooth as most of the formalities are taken care of by the insurer.

Points to Keep in Mind for Cashless Hospitalisation

1. Be Prepared: A medical emergency can strike anytime, and being prepared for such a situation can make things much simpler. Try keeping all your policy papers, health cards, medical documents, list of network hospitals etc., safe in one place, which can be accessed by your family members in a time of need.
2. At the Time of Hospitalisation: Most insurers request you to notify them about a planned hospitalisation at least 3-4 days in advance so that all the paperwork and other formalities can be completed. You would have to seek a pre-authorisation from either the insurance company (if they have an in-house claim settlement team) or the Third Party Agent, TPA, before you seek admission. Doing so timely would ensure that the claim is settled smoothly. For emergency hospitalisation, you should inform the insurer within the first 24 hours of admission. You can complete the pre-authorisation formalities post-admission.
3. At the Time of Discharge: The insurance company/ the TPA would settle the medical bill at the time of discharge. In case your medical bill has exceeded the sum insured or if there are any uncovered expenses, you would have to pay them yourself.

Key Takeaways

1. Cashless hospitalisation is a feature that makes seeking medical treatment all the more accessible and affordable.
2. Without having to run around arranging funds, one can concentrate on the treatment.
3. A larger number of network hospitals allows quicker access to good quality treatment even in an emergency.
4. Cashless hospitalisation does not mean there would be no out-of-pocket expenses. Uncovered expenses would be borne by the policyholder.
5. Also, keep in mind that cashless hospitalisation is a feature only available at network hospitals/ healthcare centres.
6. Exclusions of your health insurance plan would not be covered under cashless hospitalisation.
7. Updating the insurer about the hospitalisation timely can make the procedure of cashless hospitalisation easier and quicker.