What Is Cashless Mediclaim and Its Benefits?

The aspect of cashless mediclaim is that medical/hospital bills are paid directly by the insurance company. As long as the total amount does not exceed the sum assured limit, the insurer maintains a list of network hospitals where cashless medical services can be availed.In the event of an emergency, where the family may not be able to make major financial arrangements for medical treatment, cashless mediclaim insurance facilities provide relief.

How Does Cashless Mediclaim Work?

To begin, each insurer maintains a list of hospitals that fall under its authorized service provider umbrella once they have completed their due diligence.

These hospitals are referred to as network or empaneled hospitals, and their affiliations are renewed annually. The entire hospital selection procedure is rigorous and focused on the hospital's greatest healthcare facilities.

If a hospital fails to meet the insurer's standard criteria, the hospital will be dropped from the network. This procedure ensures that only the top hospitals are included in an insurance company's network of hospitals. Only the list of network hospitals will have a cashless mediclaim facility.

You must submit the relevant paperwork to an insurance company representative or a Third Party Administrator (TPA) if you want to use this service. The TPA is in charge of communicating with the hospital and dealing with the insurance company for cashless claims.

How to Avail Cashless Mediclaim?

Only if you are admitted to a network hospital may you file a cashless mediclaim. You must fill out a pre-authorization form from the hospital's insurance desk and submit it to the TPA prior to admission. Your claim will be accepted or rejected by the insurer/TPA with a proper explanation. You can get cashless hospitalization if you meet the following criteria:

• Planned Hospitalization: You must fill out the pre-authorization form ahead of your hospitalization date if you know you will need to be hospitalized in the coming days. This form, along with your policy card, must be submitted to the insurer/TPA. The insurer/TPA will either accept or reject your claim with a good reason once the paperwork is filed.
• Emergency Hospitalization: If you are unable to fill out the cashless claim form due to an emergency, you should do it within the next 24 hours. The pre-authorization form can be filled out and submitted to the insurer/TPA by one of your family members. The claim will be processed within 6 hours by the insurer/TPA. If this is not possible, you can seek reimbursement from the insurance company afterward.

Exclusions under Cashless Mediclaim

Under cashless mediclaim policies, pre-existing diseases like HIV/AIDS, injuries caused by terrorist activities, non-medical expenses or illegally caused damages, dental operation, non-medical expenses, war, and so on are excluded.

Conclusion

Cashless claims are a better choice than reimbursement because you can receive hospital treatment even if you do not have the necessary funds for treatment. Furthermore, cashless mediclaim gives tax benefits. The policy can be renewed every year for the rest of the policyholder's life.