Understanding the value of health insurance in easing financial strain is crucial, given India’s rising medical care costs. People can reduce last-minute complications and make wise decisions for their financial well-being by becoming familiar with the claim process, various types of claims, and network hospitals
Cashless Claims: Simple & Convenient
A cashless claim is a type of health insurance claim in which the insurance provider pays the network hospital directly, obviating the need for policyholders to make an upfront payment. Both scheduled hospitalisations and unplanned ones are covered by this kind of health insurance claim. But it’s important to remember that cashless claims are only available at network hospitals with agreements with the insurance provider. Claims are subject to terms and conditions set forth under health insurance policy.*
Making Sense Of Cashless Claims
Hospitals In The Network: Each health insurance provider has a list of network hospitals that accept cashless claims. These network hospitals are typically accessible through intermediaries or insurance agents, as well as from the insurance provider’s official website. Claims are subject to terms and conditions set forth under health insurance policy.*
Planned Hospitalization: If policyholders plan to be hospitalised, they must notify the insurer 48 to 72 hours in advance.*
Emergency Hospitalization: In an emergency hospitalisation, the insurer need not be informed in advance; however, notice must be given 24 hours after admission.*
Selecting The Ideal Insurer: Choosing a health insurance policy from an insurer with a vast network of hospitals is recommended. This guarantees seamless cashless treatment and simple access to network hospitals. It’s also important to note that group health insurance policies support cashless hospitalisation. *
Payment Claims: Hospitals Outside Of The Network Are Covered
Policyholders can still file claims through reimbursement in cases where treatment is received at non-network hospitals due to particular circumstances or a lack of knowledge. In reimbursement claims, people pay their non-network hospital bills upfront before submitting the required paperwork to the insurer for reimbursement, which may include a copy of their non-network hospital bills as proof. Claims are subject to terms and conditions set forth under health insurance policy.*
Smooth Reimbursement Claim Processing:
Non-Network Hospitals: It is essential to know that non-network hospitals do not offer cashless treatment options. Policyholders should check the network hospitals in and around their area before admission to avoid any last-minute issues or claim denials. *
Required Documentation: To ensure that a reimbursement claim is approved, policyholders must provide the insurer with all the necessary documents required for mediclaim reimbursement, including proof of network hospital bills and any other requirements outlined in the policy.*
Effective medical expense management requires understanding the types of health insurance claims and how they are processed. While reimbursement claims provide coverage for care received at non-network hospitals, cashless claims provide a convenient and hassle-free experience when receiving care at network hospitals. People can confidently navigate the health insurance claim process, protecting their financial stability during medical emergencies or planned treatments by remaining knowledgeable about the network hospitals, notifying the insurer promptly, and providing accurate documentation.
A health insurance calculator is a convenient tool you can utilise online to check the coverage needed based on your requirements.
*Standard T&C apply
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.