Understanding the Basics of Cashless Health Insurance

Health emergencies often come unannounced. In such stressful times, the last thing you want to worry about is arranging a large sum of money for hospital bills. This is where cashless health insurance comes to the rescue. It is a useful feature that makes healthcare more accessible and stress-free. But what exactly is it? How does it work? By understanding the basics of cashless health insurance in simple terms, you might be able to use your health policy to its full potential. 

What is Cashless Health Insurance?

Imagine someone in your family needs to be hospitalised. With a cashless health insurance plan, you can get them treated at a good hospital without paying the bills from your pocket. The insurance company settles the bills directly with the hospital. This is a huge relief for you and your family. 

It lets you focus on the patient's recovery instead of financial worries. This facility is available at 'network hospitals'. These are hospitals that have a tie-up with your insurance provider. You just need to show your health insurance card, and the rest is taken care of. 

How Does the Cashless Process Work?

The process for using cashless health insurance is quite simple. It can be divided into two main scenarios: planned hospitalisation and emergency hospitalisation. 

For a Planned Hospitalisation

A planned hospitalisation is a medical treatment that you know about in advance. For example, a planned surgery like a cataract operation or a knee replacement. Here is how the process works:

1. Choose a Network Hospital: First, you need to choose a hospital from your insurer's network for the treatment. You can find this list on your insurer's website. 
2. Inform the Insurer: You must inform your insurance company a few days before the hospitalisation (usually 3-4 days in advance).
3. Fill the Pre-authorisation Form: The hospital's insurance desk will give you a pre-authorisation form to fill out with your details and the doctor's report. 
4. Approval from Insurer: The insurance company reviews the form and the documents. If everything is in order, they send an approval letter to the hospital. 
5. Get Treated: Once approved, you can get admitted and undergo the treatment without paying for the covered expenses. The insurer will handle the bills directly. 

For an Emergency Hospitalisation

A medical emergency, like an accident or a heart attack, is unplanned. The process for cashless health insurance in such cases is slightly different:

1. Get Admitted to a Network Hospital: The first priority is to get the patient to the nearest network hospital. 
2. Inform the Insurer: You or a family member must inform the insurance company within 24 hours of admission. 
3. Show Your Health Card: At the hospital, you need to present the patient's health insurance card and an ID proof. 
4. Fill the Pre-authorisation Form: The hospital's insurance desk will help you fill the pre-authorisation form, which is then sent to the insurer. 
5. Treatment Begins: The hospital starts the treatment on time, as it is an emergency situation. The verification process happens while the patient is receiving care. 
6. Bill Settlement: Once the insurer approves the claim, they will settle the bills with the hospital as per your policy's terms. 

Key Things to Remember About Cashless Health Insurance

To make the best use of your cashless health insurance policy, keep these points in mind:



• Network Hospitals are Key: The cashless facility is only available at network hospitals. Always keep a list of these hospitals handy.
• Know Your Policy: Be aware of what your policy covers and what it does not. Some expenses, like registration fees, toiletries, and food for visitors, are usually not covered. 
• Inform in Time: Whether it is a planned or emergency admission, informing the insurer within the specified time is very important. A delay can lead to claim rejection.
• Keep Documents Ready: Always have your health card and a valid ID proof ready. This will make the process smoother at the hospital. 



Difference Between Cashless vs. Reimbursement Claims

The main alternative to a cashless claim is a reimbursement claim. In a reimbursement claim, you first pay all the hospital bills yourself. Then, you submit all the original bills, receipts, and medical reports to the insurance company. The insurer then verifies the documents and transfers the approved amount to your bank account. 

While you get your money back, the process involves arranging a large sum of money upfront and a lot of paperwork. Cashless health insurance is much more convenient and is the preferred option for most people. 

Conclusion

Cashless health insurance is a powerful tool that provides immense financial support during tough times. Understanding how it works helps you use it effectively when you need it the most. Before buying a policy, always compare the network hospitals and features on a reliable financial marketplace like Bajaj Markets. A well-chosen plan with a strong cashless facility can be a true asset for your family's health and financial security.