Cashless Health Insurance

Cashless health insurance refers to a type of claim settlement in health insurance that allows you to receive medical treatment at an authorised hospital without paying the hospital bills yourself. Your insurer settles the bill directly with the hospital, as per your policy terms and conditions.

For example, you are admitted to a hospital for a surgery that costs around ₹2 lakh. If you have a health insurance policy with TATA AIG, instead of arranging funds for yourself, you can file a claim with us for the treatment. Once the request is authorised, TATA AIG settles the admissible amount directly with the hospital.

This differs from reimbursement claims, where you'd pay the hospital out of pocket first and then submit bills to the insurer for repayment later. Cashless treatment removes that upfront financial burden altogether.

How the Cashless Process Works: A Quick Glance

• Select Hospital: Visit a TATA AIG network hospital or any authorised hospital of your choice in your city or area that allows cashless claim settlements.
• Show Insurance Card: Show the health card and a valid government ID at the hospital insurance desk.
• Pre-authorisation: You can contact TATA AIG through any available channel, including WhatsApp, for cashless claim settlement, or ask your hospital to raise a request with us.
• Approval: Once approved, the hospital sends your treatment and cost estimate to us. We review the claim and the settlement process with the hospital.
• Direct Settlement: Upon discharge, TATA AIG pays the admissible amount directly to the hospital.

Cashless Everywhere is an initiative launched by the General Insurance Council (GIC) in January 2024 to broaden cashless healthcare access across India. It allows policyholders to avail cashless treatment at hospitals beyond the insurer’s conventional network, subject to the applicable process and authorisation. Traditionally, cashless treatment was mainly available at network hospitals where the insurer had an existing arrangement for direct claim settlement.

With the introduction of the cashless everywhere facility, policyholders can also request cashless treatment at an eligible non-network hospital. This can be useful if you need treatment at a nearby or preferred hospital that is not listed among your insurer’s regular network hospitals.

Can You Get Cashless Treatment at a Non-Network Hospital?

Yes, with a TATA AIG cashless everywhere facility, you can avail medical treatment in both network and non-network hospitals. A network hospital is a hospital that has an existing arrangement with TATA AIG for providing cashless treatment.

Non-network hospitals are hospitals which are not part of TATA AIG's empanelled hospital network. However, under the Cashless Everywhere facility, policyholders may receive cashless treatment at authorised non-network hospitals that offer this facility, subject to TATA AIG’s policy terms and conditions.

To confirm whether a hospital offers cashless treatment, you can contact TATA AIG directly.

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No Upfront Medical Treatment Payment

With a cashless mediclaim policy, you don't have to pay medical bills out of pocket. TATA AIG settles the hefty medical bills directly.

Quick and Easy Claim Settlement

It eases the whole claim settlement process. The hospital and insurance provider coordinate directly, simplifying the claim process and reducing paperwork for policyholders.

Immediate Access to Quality Medical Treatment

Whether it is an emergency or planned hospitalisation, you can access quality medical treatment in any authorised hospital in India.

Wider Rural Healthcare Access

Cashless facilities can make quality healthcare more accessible in rural areas, especially when people need treatment at an authorised hospital closer to home.

Streamlined Coordination

With cashless health insurance, the hospital and insurer coordinate directly for pre-authorisation, billing and discharge. This makes the process smoother for policyholders.

Adaptation to Post-COVID Healthcare Needs

COVID-19 showed how expensive long hospital stays can be. Cashless health insurance can help you manage such expenses without arranging the full bill upfront.

Whether it is an emergency or planned hospitalisation, filing a cashless mediclaim policy with TATA AIG is a straightforward process. Along with direct access to over 15,000+ network hospitals, TATA AIG also allows you to opt for cashless treatment at any authorised hospital outside the network.

How Does Cashless Treatment Work During Planned Hospitalisation?

• Inform TATA AIG: Notify TATA AIG at least 48 hours before the planned admission. You can call us at 022-6489-8282 or reach us through any of our available contact options.
• Request for Pre-authorisation: Present your TATA AIG health card and a valid government photo ID, usually your Aadhaar Card, at the hospital. KYC information is required for claims above ₹1 Lakh. The diagnosis, doctor’s treatment plan, and estimated amount are required for pre-authorisation.
• Receive authorisation: Our claims team reviews the hospital’s pre-authorisation request and sends the approval to the hospital within a few minutes or the same day. You also receive status updates via SMS, WhatsApp, and email.
• Get admitted and treated: With the cashless approval in place, proceed with your scheduled admission and medical care without arranging any funds for the payment upfront.
• Discharge and Claim Settlement: At discharge, the hospital submits the final itemised bill, discharge summary and the test reports to TATA AIG. Our claims team reviews the documents and confirms the amount payable under your policy within 3 hours. If the entire bill is covered, you can leave the hospital without making any payment. We will settle the bill directly with the hospital.

How Does Cashless Treatment Work During an Emergency?

• Go to the hospital of your choice: Visit the hospital and receive the required treatment. Notify TATA AIG within 24 hours of the hospitalisation by calling us at 022-6489-8282 or reaching us through any of our available contact options.
• Hospital raises the request: Show your health card and a valid photo ID, usually your Aadhaar card, at the hospital desk. You need to complete mandatory KYC for bills of ₹1,00,000 and above. The hospital's TPA desk sends the cashless request to TATA AIG.
• Review and authorisation: Our team reviews the doctor's initial medical notes and sends the approval to the hospital within a few minutes.
• Continue treatment: Treatment continues while the cashless request is processed. Once approved, the authorisation is communicated to you and the hospital.
• Discharge and Claim Settlement: The hospital submits the final bill and required documents to TATA AIG. Within 3 hours, our team confirms the amount covered under your policy. If it covers the entire bill, you can leave without making any payment.

Please note: This is the general process for cashless claims. The process may vary depending on the specific case and hospital requirements.

TATA AIG processes pre-authorisation requests within a few minutes or the same day and final authorisation within 3 hours of receiving the discharge request from the hospital.

If your cashless claim request is rejected, you may need to pay the hospital bills yourself at the time of discharge. However, a cashless claim rejection does not automatically mean that your treatment is not covered under your policy.

Here are some possible reasons why a cashless mediclaim may be rejected:

• Incomplete Documents: Missing or incorrect documents may prevent the insurer from processing the cashless request.
• Hospital-Related Requirements: The hospital may not meet the requirements for processing the cashless request.
• Intimation Delay: The request may not follow the applicable hospitalisation intimation process or timeline.
• Policy Terms: The proposed treatment may not meet the applicable terms for cashless authorisation.

Does Cashless Claim Rejection Mean the Treatment Is Not Covered?

Not necessarily. Check the reason for rejection and contact us for clarification. If the treatment is eligible for coverage, you can pay for the hospital expenses yourself and later submit a reimbursement claim to TATA AIG.

Sum Insured

Check your available sum insured before hospitalisation. If the payable medical expenses exceed the available sum insured, you will have to pay the excess amount yourself.

Waiting Period

Before availing cashless treatment, check whether the treatment has a waiting period. Make sure you complete the applicable waiting period before claiming the benefit.

Pre-existing Conditions

If you have a pre-existing medical condition, check whether the applicable waiting period has been completed before seeking cashless treatment for it. Share accurate medical information in the pre-authorisation form.

Add-ons and Riders

Check the add-ons and riders included in your TATA AIG health insurance policy before hospitalisation. This helps you know whether any additional benefits apply to the treatment you are seeking.

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TATA AIG offers various health insurance plans which come with different coverage limits and benefits. The exact expenses and limits will depend on the type of plan you have.

What Medical Expenses Are Covered?

• In-patient hospitalisation: Covers the hospitalisation expenses due to disease, illness or injury during the policy period .
• Daycare procedures: Covers medical treatment that does not require 24-hour hospitalisation .
• Pre-hospitalisation expenses: Covers pre-hospitalisation expenses before admission for a specified number of days, as mentioned in the policy.
• Post-hospitalisation expenses: Covers the medical treatment costs after discharge from the hospital up to a specified number of days .
• Ambulance expenses: Covers expenses incurred on transportation of insured persons to a hospital, up to a specified limit .
• Organ donor expenses: Covers medical costs of harvesting an organ from a donor for transplantation into the insured person .
• Domiciliary treatment: Covers treatment taken at home that would otherwise have required hospitalisation, subject to conditions .
• AYUSH treatment: Covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy .
• Other plan-specific benefits: Depending on the plan, this can include OPD consultations , high-end diagnostics and more.

Please Note: TATA AIG also offers unique add-ons or riders, such as Consumables Benefit, Maternity Care and OPD Care under different TATA AIG health insurance plans. Depending on your needs, you can opt for these add-ons while buying a plan.

What Medical Expenses May Not Be Covered?

• Medical treatments such as cosmetic surgery , obesity or weight control , etc are specifically excluded under the policy.
• Medical expenses for pre-existing diseases or specific diseases like tumours or cysts are non-payable until their waiting period ends .
• Charges for non-medical hospital items, such as telephone calls, internet, cosmetics, hygiene articles and body care products, are excluded from the plan .
• Medical costs related to optional benefits, such as daily cash allowances or OPD cover, are payable only if selected during policy purchase.

Disclaimer: The base covers, coverage limits and product features described above depend on the specific TATA AIG policy you choose and are subject to change. Please refer to your policy document for accurate, up-to-date details.

Affordable Premium

Get comprehensive medical coverage based on your healthcare needs at an affordable premium starting from ₹15/day.

Wide Range of Sum Insured Options

Our health insurance plans offer a sum insured option from ₹5 lakhs to ₹5 crores.

Discounts to Save on Premiums

Get up to 9% off on long-term policies and up to 32% savings with family floater plans. We also offer a 7.5% professional discount to salaried customers.

Comprehensive Coverage

Covers hospitalisation, pre- and post-hospitalisation expenses, daycare procedures, and AYUSH treatments.

Enhanced Coverage Options

Get coverage for maternity care, OPD care, consumables benefit, and more as in-built or optional benefits, depending on your policy.

Cashless Network Hospitals

We have a wide network of over 15,000 empanelled hospitals across the country for our policyholders.

Automatic Restoration Benefits

With our medical insurance plan, you get the automatic restoration of sum insured benefits.

Cumulative Bonus

Increase your sum insured by 50% for every claim-free year, up to 100% of the base sum insured.

Annual Preventive Health Checkups

Avail free annual health check-ups at network hospitals under your policy.

Tax Benefits

Enjoy tax benefits on health insurance premiums paid for self and family, including spouse, children and parents.

Hassle free Claim Process

File and track your medical insurance claim online using the TATA AIG app or claim portal with minimal paperwork.

24/7 Customer Assistance

Round-the-clock support via 022-6489-8282 for queries, claims and emergencies.

• Head to the TATA AIG Website: Open the TATA AIG website, navigate to the “Personal” section and choose the “Health Insurance” plan.
• Select Members to Cover: Choose whether you're insuring yourself or others, indicate the number of members, and click "Get Plan."
• Provide Necessary Details: Enter your date of birth, mobile number, email address and pincode, then click "See Plan."
• Compare and Choose a Plan: Browse the available health insurance plans and customise it by choosing the right sum insured, policy tenure and add-ons.
• Pay and Get Covered: Review the premium breakup and pay online to activate your policy.

Documents Required to Buy Health Insurance

• Identity proof: Aadhaar Card, Passport, Driving Licence, etc.
• Address proof: Aadhaar Card, Passport, Voter ID, etc.
• Age proof: Birth Certificate, Aadhaar Card, Passport, etc.
• Income proof: Bank statements, salary slips, ITR forms, etc.
• Medical documents: Past medical records, prescriptions, etc.
• Previous health insurance documents, if applicable

With steps laid out and documents ready, buying the right cover is just a few clicks away. Explore TATA AIG's cashless health insurance plans for families and individuals now!

• Individual Health Insurance: A standalone or individual health insurance plan designed for a single person or sole earners with a sum insured up to ₹5 crores.
• Family Health Insurance: A medical insurance plan for a family that covers up to 7 family members, including parents, spouse and children.
• Critical Illness Health Insurance: This health insurance plan is designed to safeguard you against critical illnesses like cancer, heart disease, etc. Covers up to 100 critical illnesses .
• Senior Citizen Health Insurance: This health insurance plan is designed with the needs of senior citizens over 61 years of age in mind.
• Women Health Insurance: This coverage addresses women’s healthcare needs at different life stages, including Gynaecologist consultation and Polycystic Ovarian Cover .

Cashless Health insurance Plans We Offer

TATA AIG MediCare Premier

• Who it is designed for: Policyholders looking for high-value, comprehensive coverage packed with features like lifestyle benefits, global access, and maternity benefits.
• Available Sum Insured: ₹5 Lakhs up to ₹3 Crores .
• Cashless Proposition: Comprehensive benefits without any sub-limit unless otherwise mentioned, built-in maternity cover , high-end diagnostics on an OPD basis and emergency air ambulance .

TATA AIG MediCare Select

• Who it is designed for: Value-focused buyers and families seeking flexible, modular health coverage that can be customised with unique optional benefits.
• Available Sum Insured: ₹5 Lakhs up to ₹3 Crores .
• Cashless Proposition: Seamless cashless in-patient and day care settlements with built-in unlimited sum insured restorations , 90 days pre and post-hospitalisation coverage , and customisable optional add-ons like Early Access .

TATA AIG MediCare Reserve

• Who It Is Designed For: Anyone looking for an affordable top-up plan to increase their existing health insurance cover.
• Available Sum Insured: ₹5 Lakhs to ₹5 Crores
• Cashless Proposition: Delivers direct cashless settlement across network hospitals for in-patient care , all day care procedures , 90 days pre and post-hospitalisation expenses , AYUSH treatments , and organ donor expenses .

TATA AIG Criti Medicare

• Who it is designed for: Individuals looking for targeted financial protection against major severe conditions, with dedicated multi-pay critical illness options and cancer care.
• Available Sum Insured: ₹5 Lakhs up to ₹2 Crores (in multiples of ₹5 Lakh)
• Cashless Proposition: In addition to lump-sum critical illness payouts, the built-in Cancer 360 Degree Indemnity Cover enables direct cashless hospitalisation , chemotherapy , radiotherapy , day care , and home care treatments at network hospitals .

TATA AIG Eldercare

• Who it is designed for: Senior citizens needing dedicated healthcare management and support.
• Available Sum Insured: ₹5 Lakhs, ₹10 Lakhs, and ₹25 Lakhs .
• Cashless Proposition: Delivers hassle-free cashless admission for in-patient care , day care treatments , and home care . It also provides cashless post-operative recovery benefits such as home physiotherapy through empanelled providers.