Cashless Claims Explained: A Comprehensive Guide

Health cover starting at Rs. 15/day*
4w_m_landing_page.svg
Who Would You Like To Insure?
Self
Spouse
Son
Daughter
Father
Mother

Cashless Claims Explained: A Comprehensive Guide

Medical treatments are getting more and more expensive with every passing year, and rising inflation rates, taxes and other costs make it crucial to have a health insurance policy in today’s time. Usually, there are various types of insurance; however, buying a cashless claim insurance is quite beneficial in emergencies.

Here, you will get to know what a cashless claim is in health insurance, its benefits and how you can initiate your claim procedure.

What is a Cashless Claim in Health Insurance

A cashless claim in health insurance is the process in which the medical and hospitalisation bills of the policy taker are settled directly between the insurance company and the networked hospital. However, it must be noted that the expense amount should not exceed the sum of the policy coverage of the bought health insurance plan.

A cashless insurance claim has several benefits, which will be discussed further. However, its most prominent benefit is that it gives you a piece of mind and saves you from out-of-pocket expenses in case of any medical emergencies.

Types of Cashless Health Insurance in India

Individual Cashless Health Insurance- In this type of health insurance, the insurance company provides cashless medical expense settlement to the individuals. The individual is the policyholder and is provided with hassle-free cashless settlement on hospitalisation bills.

Family Cashless Health Insurance- Under the family cashless insurance claim, all the registered family members under the policy are insured, including the policyholder. All the family members are eligible to avail cashless medical and hospitalisation services provided. Usually, the insurance amount of such policies is high, as it is done for multiple members.

Senior Citizen Cashless Health Insurance- This type of policy is specifically for elderly people, and it provides them with cashless medical and hospitalisation benefits like ambulance service, treatment of pre-mentioned diseases in policy, etc.

What are the Benefits of a Cashless Insurance Claim?

Immediate Treatment Accessibility- Having cashless claims in health insurance helps you get immediate access to medical treatment in emergencies. If you have planned medical treatment, you have to inform the hospital, and all your medical bills will be taken care of by the insurance company.

Convenience of Cashless- Under the cashless mediclaim process, you do not need to worry about arranging cash for hospital bills and treatments. The policy will cover all your expenses and will make payments without you getting involved in any way.

Great Hospital Network- The insurance companies have connections with several reputed hospitals from where you can choose to get treated. Such a vast network of hospitals helps in getting the best and most expert treatment as per your medical requirements.

Minimal Paperwork- The cashless health insurance policy saves you from the hassle of arranging and signing several physical documents and keeping insurance papers safe. With cashless insurance, the insurance company takes care of all the complicated paperwork so that you can get treated without disturbance.

Tax Benefits- Buying a cashless claim policy for individual, family or senior citizens helps you avail of several tax benefits under Section 80D of Income Tax.

Peace of Mind- Having cashless critical illness insurance provides peace of mind in distressed situations. It gives you peace of mind to focus on your treatment and getting better; rather than being worried about medical bills.

How to Initiate a Cashless Health Insurance Claim Procedure with Tata

Step 1: Search for your nearest network hospitals under your insurance policy and inform your Third-party Administrator (TPA) about your hospitalisation. However, if the hospitalisation is for planned treatment, then you need to inform the TPA at least 2 days in advance. In case of emergencies, this timeline is within 48 hours of hospitalisation.

Step 2: Once you are at the hospital, present your policy documents and patient insurance cashless card.

Step 3: The hospital will then give you the cashless claim form to initiate the cashless claim process. You can also download the form from the TPA website.

Step 4: Once you get the form, fill the form carefully and submit it at the hospital reception.

Step 5: The hospital will then share your filled cashless claim form with the designated TPA for authorisation of your documents.

Step 6: After the authorisation is done, the TPA will release the approval document, and the hospital will move forward with your treatment immediately. The medical expense then will be settled between the insurance company and hospital, without you getting involved.

Documents Required for Cashless Claim Process

  • Government Identification Proof (AADHAR, PAN Card)

  • Your Filled and Signed Cashless Claim Form

  • Hospital Admission Form

  • Summary of Discharge

  • Medical Reports and Other Records

  • Main Hospital Bill

  • Main Hospital Bill with Breakup

  • Hospital Pre-Authorisation Form

  • Pharmacy Bills and Prescriptions (excluding hospital supplies)

  • Emergency Contact Details

  • Bank Statements

Reasons Why Cashless Mediclaim Process Gets Rejected

There are various reasons why your cashless medic-claim process might get rejected. It is important to know these reasons to avoid rejection or to reapply after rejection.

Incomplete Documentation: The health insurance policy terms and conditions are exacting and in order to get your claim settlement swiftly, you need to submit all the necessary documents. With proper documentation, the insurance company will reject your claim immediately. Make sure to cross-check the document requirements with your TPA before applying.

Lack of Communication: The policyholder must inform the TPA within the set period regarding their hospitalisation. The failure of clear and timely communication can result in your cashless claim insurance rejection.

Non-Disclosure of Information: If the policyholder fails to mention any crucial information regarding their health or any disease while buying the health insurance policy, then the insurance company is in a position to reject the medical claims related to the issue. It is advisable to be transparent and honest while filling out your insurance documents.

Policy Exclusions: Certain diseases, treatments and medical conditions are not covered under the cashless insurance claim. If you make claims for any of the excluded conditions of policy then your claim settlement will get rejected.

Lapsed Policy: Your cashless claim insurance can also get rejected because of a lapse in policy. If you have failed to pay policy premiums on time or it expired because of inactivity. Then, any claims made during this period will be rejected.

How to Avoid Your Cashless Insurance Claim From Being Rejected

Be Transparent: You must mention every possible detail regarding your health or any ongoing diseases while buying the health insurance policy. It will prevent you from facing any trouble during the claim settlement.

Inform in Advance: If you are getting hospitalised for any planned treatment, then it is crucial to inform your TPA. Informing at least 2 days before your hospitalisation is necessary so that the authorisation and claim settlement process can be started on time.

Read Documents Carefully: Every policy buyer must read all the insurance documents carefully before agreeing and signing them. Read all the terms and conditions mentioned to clear every doubt regarding any terms and conditions. Make sure to read the list of inclusions and exclusions for medical treatment.

Get Treatment at Network Hospitals: The cashless health insurance claim procedure will only move forward if you go to any network hospital for treatment. The insurance company approves network hospitals and provides you with cashless treatment facilities, which other hospitals might not do.

Conclusion

Medical emergencies are unforeseeable and can occur anytime, what you can do is be prepared for it. Buying a health insurance policy with cashless claim settlement helps you stay relaxed and focus on your treatment.

Tata AIG health insurance has over 10 thousand network hospitals across India, providing cashless hospitalisation facilities. Along with this, our policy provides you with COVID-19 coverage, includes pre-existing diseases, and covers your ambulance cost, too.

Moreover, you can always compare health insurance plans to buy the best cashless claim insurance that covers all your needs and is economical for you.

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

Related Articles

Can I claim both cashless and reimbursement?

Can I claim both cashless and reimbursement?

iconDown

You can, but you should follow the insurer’s claim filing procedure for the particular claim type.

What treatments are excluded from the cashless claim insurance?

iconDown

Treatments like cosmetic surgeries, self-inflicted injuries, illegal treatments and dental and hearing treatments are excluded from cashless claim insurance.

scrollToTop