Cashless Health Insurance

Cashless Health Insurance

A medical emergency can seriously affect your finances. In addition to the emotional pain, you may have to fork out your savings for hospitalisation and medical care expenses. This is where the Health Insurance plan will come to your rescue during a medical emergency and comes in handy. 

What is cashless Health Insurance?

Cashless health insurance plans for family eliminates the need to pay cash at the hospital when you or your family member is hospitalised, and the claim is admissible/payable as per the policy terms. The Insurance company takes the onus to ease your burden of hospital bills and ensures the payment directly to the hospital.

Types of Cashless Health Insurance

Individual Health Insurance: This policy is designed to cover a single individual against medical expenses due to illness, injury, or hospitalisation. It includes benefits like hospitalisation, pre and post-hospitalisation expenses, and ambulance charges.

Family Floater Health Insurance: A single policy covers the entire family under this plan. It includes the policyholder, spouse, children, and sometimes dependent parents. The total sum insured is shared among all members.

Senior Citizen Health Insurance: Specifically designed for individuals aged 60 and above. This plan takes into account the unique healthcare needs of seniors, including coverage for pre-existing conditions, higher hospitalisation benefits, and critical illness cover.

Group Health Insurance: Usually provided by employers to their employees. This plan covers a group of people under one policy and offers benefits like hospitalisation, pre and post-hospitalisation expenses, and sometimes maternity coverage.
Critical Illness Insurance: This policy provides a lump sum payment if the insured is diagnosed with a specified critical illness like cancer, heart attack, or stroke. The payout can be used for treatment, recovery, or any other expenses.

Maternity Health Insurance: Covers maternity-related expenses, including delivery charges, prenatal and postnatal care, and newborn baby cover. Some plans also cover expenses related to complications during pregnancy.

How does Cashless Health Insurance work?

Mr Raj having a Health insurance policy, met with an accident and was admitted in a network hospital for the treatment of an accidental injury. Upon hospitalisation, he shares the policy details and valid ID proof with the Insurance desk in the hospital to avail Cashless facility. On the admissibility of the claim and approval given to the hospital, Mr Raj leaves the hospital peacefully without the burden of paying the hospital bill.

Network Hospitals

Network Hospitals are the major aspect of a cashless Insurance Policy. Insurance companies have a direct network with a particular set of hospitals. The policyholder is not eligible for cashless hospitalisation for that specific treatment if they receive medical care at a hospital that is not included in the list of Network Hospitals.

Hospitals empanelled with the Insurance company are called Network hospitals, and the insured can avail cashless facility for inpatient hospitalisation.

Key differences between cashless claims and reimbursement claims

Benefits of Cashless Health Insurance in India

1.Immediate Access to Healthcare: With cashless health insurance, you can get treated immediately without worrying about paying hospital bills upfront. This is crucial during emergencies when every second counts.

2.Financial Relief: Medical treatments can be expensive. Cashless insurance takes away the stress of arranging funds for hospital deposits or immediate payments, reducing the financial burden on you and your family.

3.Hassle-Free Process: Cashless insurance simplifies the entire process. The insurer directly settles the bill with the hospital, so you don't have to deal with paperwork, save for some minimal documentation.

4.Wide Network of Hospitals: Most insurers have a vast network of hospitals across India. This means you have multiple options to choose from, ensuring that you receive quality care wherever you are.

5.Cost-Effective: Cashless policies often cover more than just hospital bills, including pre and post-hospitalisation expenses, ambulance charges, and even check-ups, making it a comprehensive and cost-effective option.

6.Peace of Mind: Knowing that you have coverage that takes care of financial aspects allows you to concentrate on recovery and well-being without constant worry about expenses.

Ways to avail a cashless Health Insurance Policy

On submission of the valid policy copy and ID proof to the Insurance desk, the hospital will provide further information and the treatment details in the Pre-authorisation form and send the same to the Insurance for processing cashless. Policyholders can file cashless health insurance claims for planned and emergency hospitalisations.

1. Planned Hospitalisation

When the Insured has been advised for Surgery which is planned for a future date, the insured can go to the Network Hospital and share the policy details and the necessary documents with the Insurance desk. The hospital will further send the documents along with the duly filled Pre-authorisation form to the Insurance company, and cashless approval will be authorised subject to the claim is admissible, and the approval is valid for 7 days from the date of approval.

2. Emergency Hospitalisation

When the Insured person is admitted for any unforeseen or unexpected illness in the Network Hospital and shares the policy details and the necessary documents with the Insurance desk. The hospital will further send the documents along with a duly filled Pre-authorisation form to the Insurance Company, and cashless approval will be authorised subject to the claim is admissible.

Common Exclusions in Cashless Health Insurance

1.Pre-existing Conditions: Many policies do not cover pre-existing conditions immediately after issuance of the policy. Coverage usually starts after a waiting period.

2.Cosmetic Treatments: Procedures like cosmetic surgery, weight loss treatments, hair transplants, and dental treatments not resulting from an accident are generally excluded.

3.Non-Medical Expenses: Items like registration fees, admission fees, toiletries, and other non-medical expenses incurred during hospitalisation are not covered.

4.Self-Inflicted Injuries: Injuries resulting from self-harm or attempted suicide are excluded from coverage.

5.Injuries Due to Alcohol or Drug Use: Any medical expenses arising from injuries or illness due to substance abuse are typically not covered.

6.War and Acts of Terrorism: Injuries or illnesses arising out of wars, acts of terrorism, or civil unrest are excluded from most policies.

7.Participation in Dangerous Activities: Injuries sustained while participating in adventure sports or hazardous activities are not covered.

8.Fertility Treatments: Expenses related to fertility treatments, such as IVF, are usually excluded from cashless health insurance plans.

9.Pregnancy and Childbirth: Normal delivery and prenatal and postnatal expenses might not be covered unless specified in the policy. However, complications arising from pregnancy might be covered by some plans.

10.Experimental Treatments: Treatments that are considered experimental or not yet accepted as standard medical practice might be excluded.

11.Over-the-Counter Medications: Non-prescribed medicines and other over-the-counter medications are typically not covered.

12.Alternative Therapies: Treatments such as Ayurveda, Homeopathy, Naturopathy, and other alternative therapies are often excluded unless specifically mentioned in the policy.

Be aware of exclusions

All the Health Insurance policies are subject to waiting periods for specified diseases / Conditions, for 1 year / 2 years, of pre-existing illnesses 36 Months, 24 Months, 12 Months and 6 months according to the policy opted by the Insured. Pre and Post-hospitalisation expenses are covered for specific days as stated in the policy. 

Key considerations to keep in mind when filing a cashless health insurance

Know Your Network Hospitals: Always opt for treatment at hospitals that are part of your insurance provider's network to avail of cashless benefits.

Pre-Authorisation: Inform the insurance desk at the hospital and get a pre-authorisation form filled out. Submit this to your insurer at least 48 hours before a planned admission or within 24 hours of an emergency.

Keep Documents Ready: Ensure you have all necessary documents like your identity proof, policy card, pre-authorisation form, and any previous medical records ready for submission.

Check Coverage: Verify that the treatment you seek is covered under your policy. Some treatments and procedures may have waiting periods or need prior approval.

Coordinate with the TPA: Understand the role of the Third Party Administrator (TPA), and stay in touch with them for smooth processing and approvals.

Stay Within Policy Limits: Be aware of your sum insured and sub-limits for specific treatments to avoid out-of-pocket expenses.

Read Policy Terms: Thoroughly go through your policy's terms and conditions. Knowing inclusions, exclusions, and policy limits will save you from surprises later.

Follow-Up: Always follow up with both the hospital insurance desk and your insurer to ensure that there are no delays or issues with your claim processing.

Maintain Communication: Constant communication with your insurer and hospital can help resolve any unforeseen issues.
Expense Transparency: Keep a track of all expenses and ensure that they match what is billed to the insurer. In case of discrepancies, address them immediately.

Conclusion

Star Health Insurance has a huge network of 14,000+ hospitals across India. When you buy a Health Plan from Star Health Insurance company, you can avail cashless facility for admission in any network hospital across India. Over 97% cashless final approvals within 3 hours.

Enjoy peace of mind with health insurance cashless everywhere, ensuring coverage no matter where you are.

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