Cashless Health Policy: How Does it Work During Planned & Emergency Hospitalization?

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A cashless health insurance is a policy wherein the insurance company directly settles your medical bills, whether, a nursing home or a hospital. A huge relief to the insured individual, whatever bill is raised by the health provider is cleared by the insurance company through a Third-Party Administrator without you running from pillar to post to arrange funds during hospitalisation.

The good thing is that you can avail cashless health policy both during an emergency as well as planned hospitalization i.e. during planned surgeries.

How Does Cashless Health Policy Work during Emergency Hospitalization?

In case of an accident or any other medical emergency, the individual or a family member insured under the policy can claim health insurance. This is how it works:

  • The insured has to give out the details of his/her insurance card – the policy number along with its validity to the hospital.
  • A pre-authorization cashless treatment form available at the hospital has to be filled and submitted.
  • This filled form will then be sent to the Third-Party Administrator by the hospital.
  • The Third-Party Administrator will then approve the insured’s plea for cashless treatment.

Going by the protocol, they should process the application within 6 hours.

How Does Insurance Health Cashless Facility Work during Planned Hospitalization?

When the policyholder plans his/her surgery and is aware of his/her hospitalization dates, he/she can claim cashless health insurance in advance. How does this work? Well, the insured has to follow certain steps:

  • The insured has to fill and submit the pre-authorization form at the hospital desk that he/she has finalized for his hospitalization.
  • This form will then go to the Third-Party Administrator via the hospital desk. They will then scrutinize the application form.
  • The policy holder will receive an approval letter that will mention the sanction amount as well as the treatment details.

Few things to Remember While Availing Cashless Health Insurance Policy:

You can approach only those hospitals that fall under the Preferred Provider Network (PPN) of your health insurance provider.

While you purchase a cashless policy, you need to check if the insurance companies have tie-ups with your preferred group of hospitals so that you don’t have to compromise with your choice of health provider.

Most policies would not cover pregnancy and dental related issues, so make sure you know the policy terms and insurance guidelines of the company before you take the health insurance for you and your family.

How to Choose the Best Cashless Health Cover?

Here are a few important features that you need to focus while selecting the policy to cover you and your family:

Sum Insured: Check out the policy that gives you the maximum coverage in your budget.

Co-payment: Check for the percentage share of the claim amount amongst you and the insurance provider beforehand.

Renewable Age: It is better to go with a health policy that has a higher renewable age. So, before you zero in your choice of insurance, make sure you check for the maximum renewable age.

Limitations on Specific Treatments: Often you will see that certain treatments have limits set by the insurance provider. Make sure that you know these limits beforehand.

Waiting Period: You need to have a clear picture of the waiting period, not just on your overall health insurance policy but also for some specific conditions.

Upper Limits of Hospital Room Rent: Check the upper limits of the hospital room rent and whether it covers the charges of the hospital of your preference. Also, check for sub-limits in the policy terms and conditions.

OPD Treatments: Along with the hospitalization charges, also check and compare the list of day care treatments that are covered in the medical policy.

Cashless health insurance policy is one of the best options today to get fast cash during medical emergencies or during the treatment of sudden emergence of unexpected conditions. However, before one claim a policy, one has to be clear on not just his/her requirements but also what his/her expectations are from the health insurance provider.

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About Deepti Verma 249 Articles
Deepti Verma is a Political/Social Writer with an opinion on almost everything! Follow @universal_rover