Cashless Health Insurance

Cashless medical insurance is a facility where your insurer directly settles your hospital bills. According to the IRDAI guidelines for the cashless everywhere facility, individuals with health insurance plans can receive medical treatment at any authorised hospital without paying upfront medical fees. Earlier, the cashless claim was available only at the insurance provider’s empanelled hospitals.

This facility helps streamline access to quality healthcare for policyholders without the burden of arranging funds or completing extensive paperwork. The cashless treatment benefits help reduce the burden on individuals and families during critical times.

A cashless health insurance plan allows policyholders to deal with medical emergencies without worrying about the medical expenses. Here are some of the reasons why having cashless health insurance is important.

Immediate Access to Medical Treatment

With the cashless health insurance plans for families and individuals, you can get immediate medical treatment in an emergency and planned hospitalisation. You can receive timely medical care without having to wait to raise money.

No Upfront Medical Treatment Payment

Another reason to invest in a cashless health plan is the absence of upfront medical treatment payments. With this, the hospitalisation costs will be directly settled by the insurance provider, removing the need for large out-of-pocket expenses at the time of admission.

Quick and Easy Claim Settlement

The cashless health insurance benefits offer quick and easy claim settlement to the policyholder in critical times. The hospital and insurance provider coordinate directly, resulting in a simplified claim process with less paperwork for policyholders.

Access to Quality Medical Treatment

The health insurance plan with cashless benefits allows policyholders to access quality medical treatment. Policyholders can visit hospitals that have reputable and well-equipped staff with experience.

Cashless health insurance benefit is available with different types of health insurance plans, such as:

Individual Health Insurance Plan

Individual health insurance is a type of medical insurance plan which offers coverage to a single policyholder. A single policyholder utilises the entire sum insured of this health insurance plan.

Family Health Insurance Plan

This is another type of medical insurance plan designed for families. This medical insurance covers different family members such as spouses, children and parents under a single plan. The sum insured of this health insurance plan is distributed among the family members.

Also Read: Family Health Insurance

Senior Citizen Health Insurance

Senior citizen health insurance is a medical insurance plan designed for individuals aged 60 and above. This plan offers specialised health insurance coverage to elderly people based on their healthcare needs.

Critical Illness Health Insurance

This is a medical insurance policy that covers treatment for critical illnesses, including cancer, heart disease and kidney disease. The plan offers a lump-sum payment to policyholders or their families upon diagnosis of the illness.

TATA AIG offers a customised health insurance plan with cashless benefits at any authorised hospital. These plans include:

TATA AIG Medicare

TATA AIG Medicare is a health insurance plan that is available as an individual and family floater plan. The sum insured for this plan ranges from ₹3 lakhs to ₹20 lakhs. The plan allows policyholders to avail the cashless benefit. Furthermore, under this policy, the policyholder can avail of a cashless benefit of ₹10,000 per policy.

Also Read: Free Medical Check-Up in Health Insurance

TATA AIG Medicare Premier

TATA AIG Medicare Premiere is a wide-ranging health insurance plan available for both individuals and families with sum insured from ₹5 lakhs to ₹3 crores. The plan offers a wide range of benefits, including cashless hospitalisation at authorised hospitals.

TATA AIG Medicare Select

TATA AIG Medicare Premier is a health insurance plan available for individuals and family floaters with a sum insured ranging from ₹5 lakhs to ₹3 crores. The plan offers cashless benefits at over 12,000 network hospitals plus non-network hospitals across India, without any upfront medical fees.

TATA AIG Medicare Lite

It is a health insurance plan available as an individual and family floater plan. The sum insured options for this plan range from ₹5 lakhs to ₹20 lakhs. Under this plan, policyholders can avail the cashless benefit in any authorised hospital.

TATA AIG Eldercare

This is a type of health insurance plan designed for individuals aged 61 years and above, available as both individual and family floater options. Under this plan, policyholders can avail the cashless facility in network and authorised non-network hospitals in India.

TATA AIG Criti Medicare

It is a health insurance plan that provides coverage for 50 or 100 critical illnesses, such as cancer, heart conditions, kidney failure, stroke, and many more.

TATA AIG Health Supercharge

This is a health insurance plan that comes with a cashless facility. Under this health insurance plan, policyholders will have an additional layer of security when their base health insurance plan is exhausted.

Let us understand the workings of the cashless treatment benefit with an example. Pulkit, 32 years old, bought a TATA AIG individual health insurance plan with a sum insured of ₹10 lakhs. Later, he had to undergo an emergency appendicitis surgery that cost around ₹2 lakhs.

He was admitted to the TATA AIG empanelled network hospital and informed either the TATA AIG representative or the hospital’s TPA within 24 hours of admission. After checking his eligibility, the TPA approved the cashless treatment.

Pulkit did not have to pay any amount upfront as TATA AIG directly settled the eligible medical expenses of ₹2 lakhs with the hospital.

Filing a cashless claim with the TATA AIG is an easy process. Here is how you can avail of cashless claims for emergency and planned hospitalisation.

Cashless Claim Procedure for Planned Hospitalisation

• Step 1: For a planned medical treatment, inform us about your hospitalisation at least 48 hours in advance. You can do this by submitting a cashless claim form through the self-claim portal or by calling our customer support at 02264898282.
• Step 2: Once we receive your claim form, we’ll verify the documents. After approval, we’ll send you a confirmation letter and notify the hospital about your claim.
• Step 3: When you reach the hospital for treatment, present your health card, confirmation letter and any required supporting documents at the help desk.
• Step 4: The hospital will then start the cashless treatment process, and TATA AIG will directly settle all bills with the hospital.

Cashless Claim Procedure for Emergency Hospitalisation

• Step 1: In case of an emergency, visit a network hospital and inform us about your admission within 24 hours of being hospitalised. You can do this by submitting a claim form through the self-claim portal or by calling our customer support at 02264898282..
• Step 2: Submit the cashless claim form along with the required supporting documents. Once we receive and verify them, we will issue an authorisation letter to the hospital.
• Step 3: After the hospital receives the authorisation, it will proceed with your treatment, and Tata AIG will directly settle the bills with the hospital.

Also Read: Health Insurance Claims Process: Cashless & Reimbursement

Here is the list of documents policyholders need to submit at the time of filing the cashless hospitalisation.

• Health insurance card or policy document
• Government-issued ID such as Aadhaar card, PAN card, driving license, or voter ID
• Filled pre-authorisation form
• Doctor’s prescription and admission letter
• Discharge summary
• Any additional documents requested by the TATA AIG representative.

While filing a cashless health insurance claim, various factors need to be considered, such as:

Sum Insured

One thing to consider when choosing the best cashless health insurance plan is the sum insured. It is the maximum amount your insurance provider will cover for medical expenses during the policy period. Choosing the adequate sum insured is crucial for cashless health insurance claims for planned and emergency hospitalisation.

Network Hospital

Another crucial factor for cashless health insurance claims is the availability of network hospitals. The claim process at an empanelled network hospital is easy with minimal documentation compared to non-network hospitals. It is best to choose an insurance provider with a nationwide network of hospitals.

Waiting Period

The waiting period also plays a crucial role while availing the cashless claim benefit in network and non-network hospitals. It is a period during which policyholders cannot avail themselves of the health insurance benefit. While purchasing a health insurance policy, check the waiting period.

Inclusion and Exclusions

Before filing a cashless health insurance claim, check the inclusions and exclusions carefully. The inclusions list what your policy covers, such as hospitalisation expenses and treatments, while the exclusions list what is not covered, such as cosmetic procedures or pre-existing conditions during the waiting period.

Claim Process

The claim process is also crucial when filing a cashless health insurance claim. Lengthy, complicated claim procedures will create frustration among policyholders. It is best to go with the insurance provider that offers an easy claim process with less documentation.

Taking advantage of cashless hospitalisation is beneficial, but understanding the intricacies of the claim so that it is accepted is also essential. Some of the prominent reasons for cashless claim requests getting rejected are:

• If you have not informed the insurance provider about the hospitalisation within the decided timeframe.
• If you have availed of the treatment in a hospital that does not meet the requirements of the policy guidelines.
• If you failed to provide the correct information about a pre-existing disease at the time of authorisation.
• The personal information provided is incorrect or wrong at the time of pre-authorising for a cashless claim.
• There are specific exclusions listed under cashless health insurance that the insurance company won't cover.

Also Read: What Are The Challenges of a Cashless Mediclaim Policy?

Avoiding the cashless health insurance claim rejection is easy by simply following the tips mentioned below, which are:

• It is crucial to inform TATA AIG about the hospitalisation within the specified timeframe to avoid rejection.
• If you have any pre-existing conditions that could lead to a claim rejection, disclose them to TATA AIG in a timely manner.
• Ensure you provide accurate, factual information about the medical condition or disease on the pre-authorisation form to avoid rejection.
• Ensure the treatment you plan to take is covered under your health insurance policy.
• It is critical to renew the health insurance policy on time to avoid the cashless claim rejection.
• Lastly, check the waiting period before filing a cashless claim to avoid rejection.

Buying health insurance with cashless health insurance benefits is a straightforward process with TATA AIG. Here is how you can buy a plan in just a few steps.

• Step 1: Open the official TATA AIG website and head to the “Personal” section and choose a suitable plan under the “Health Insurance" section.
• Step 2: Choose “TATA AIG Health Plans” and then choose the individuals you want to cover. Click on the “Get Price” button.
• Step 3: Enter details such as date of birth, email address, phone number, etc. Also, answer the query "Does any of the insured member(s) have any pre-existing disease?" and then hit the “See Plan” options.
• Step 4: Various health insurance plans will appear; choose those that suit your health needs.
• Step 5: Complete the CKYC process, then make the health insurance plan premium payment using the preferred method.

Once done, the health insurance plan with cashless benefit will be sent to your registered email address.

Knowing all about the best health insurance policy with cashless benefits is important to save you and your family from hefty out-of-pocket expenses. With the cashless medical insurance, you can get quality medical treatment in any authorised hospital without worrying about the upfront medical fees.

If you are looking to buy health insurance online, TATA AIG offers customised health insurance plans with cashless benefits. For instance, our individual health insurance plans provide comprehensive coverage for medical expenses, including hospitalisation, surgeries, and day-care procedures, along with the convenience of cashless treatment at network and non-network hospitals across India.

Further, our low-premium health insurance starts at ₹15 per day and offers benefits such as easy cashless claims, coverage for medical emergencies and treatments, wellness perks, access to quality healthcare and more. With this in mind, get yourself and your family a tailored health insurance plan with a cashless benefit.