Medical treatments can be very expensive. Paying a huge amount of money up front during a health emergency can cause a lot of stress. This is where cashless hospitalisation in a health insurance policy comes in as a saviour. With this facility, you do not have to pay for hospital bills out of your pocket at the time of admission or discharge. Instead, your insurance company settles the bill directly with the hospital, as per your policy terms.
Let’s explore how cashless hospitalisation works, the inclusions and exclusions, who should get it and some important things to remember if you choose this facility.
How does cashless hospitalisation work?
A cashless hospitalisation facility can be availed without any hassle if you follow these steps:
- Choose a network hospital: Your insurance company will have a list of partner or network hospitals. You must go to one of these hospitals to enjoy the cashless facility.
- Show your health card: When you arrive at the hospital, show your health insurance policy card along with an identity proof.
- Pre-authorisation request: The hospital will send a request to your insurer or their third-party administrator to approve the treatment cost. This step can happen in advance for planned treatments or shortly after admission in emergencies.
- Get treatment without paying cash: After the approval, you can go ahead with the treatment without worrying about paying the bills yourself (except for exclusions or co-payments under your policy).
- Insurer pays the bill: Once you are discharged, the insurer directly pays the hospital as per the policy terms, so you do not need to arrange huge sums of money on the spot.
If you are admitted to a hospital outside the insurer’s network, you will need to pay first and then apply for reimbursement later, which is not considered cashless hospitalisation.
Who should buy cashless medical insurance?
Cashless health insurance is useful for practically everyone, but it is especially helpful for:
- Families with children or elderly parents: Since hospital visits can happen anytime, cashless insurance removes the stress of arranging funds quickly.
- People with limited savings: If you don’t have big savings for emergencies, this facility helps you get treatment without delay.
- Busy professionals: If you travel a lot or work long hours, you may not have time to handle complex claims paperwork. Cashless treatment saves you time.
- Anyone who values peace of mind: Knowing that you can walk into a hospital and focus on getting better, rather than on arranging money, is a huge relief.
In short, cashless medical insurance is a smart choice for most people.
Key features of cashless health insurance
Cashless health insurance policies usually come with these beneficial features:
- Network of hospitals: Insurers tie up with many hospitals, giving you lots of options across the country.
- No upfront payments: The biggest advantage is that you do not have to pay from your pocket at the time of treatment (other than deductibles, if any).
- Emergency cover: Even sudden hospitalisation can be handled cashless with a pre-authorisation request after admission.
- Family floater options: One policy can cover your whole family for cashless treatment.
What is not covered?
It is important to know that cashless insurance does not cover everything. Some common exclusions are:
- Pre-existing illnesses (if not declared and covered after the waiting period)
- Cosmetic or plastic surgery (unless medically necessary after an accident)
- Dental or eye treatments, unless specified
- Treatment for self-inflicted injuries
- Non-medical expenses like toiletries, phone charges, or food for visitors
- Experimental treatments or unapproved drugs
You should always read your policy terms carefully to understand what is excluded, so there are no surprises later.
Benefits of a cashless facility in health insurance
Let’s break down why the cashless facility with individual health insurance is so valuable:
- Financial relief: You avoid paying huge amounts of cash at once, which is a big relief in emergencies.
- No paperwork stress: Since the hospital and insurer manage most of the paperwork directly, you have fewer documents to worry about.
- Quick treatment: You do not waste time arranging money, which is very important in critical illnesses or accidents.
- Wider choice of good hospitals: Insurance companies usually have a good network of reputable hospitals.
Things to keep in mind while opting for cashless hospitalisation
While cashless hospitalisation is a great benefit, you should pay attention to a few points:
- Check the network list: Always check the list of network hospitals before you buy a policy or before you get admitted.
- Inform the insurer quickly: For planned surgeries, inform your insurance company in advance. In an emergency, inform them as soon as possible after admission.
- Understand co-payments: Some policies require you to pay a small share of the bill, called a co-payment. Know this amount beforehand.
- Know the limits: There might be sub-limits on room rent, doctor’s fees or specific treatments. Read these terms clearly.
- Keep documents ready: Carry your insurance card, identity proof and relevant documents to speed up the process.
- Check exclusions: Always read what is not covered, so you do not get stuck with bills later.
By keeping these points in mind, you can make the most of the cashless hospitalisation facility.
Conclusion
Cashless hospitalisation in a health insurance policy is a practical and valuable facility that protects you from the stress of paying large medical bills during a health emergency. It offers quick access to quality healthcare without worrying about arranging funds. By choosing a good policy, knowing its network hospitals, and understanding the terms, you can ensure your family and yourself get timely treatment and peace of mind.
If you’d like guidance in choosing the right health insurance plan with cashless hospitalisation benefits, simply fill in the form on this page. Our experts will help you make a confident and well-informed decision for you and your loved ones.
FAQs
1. Is cashless hospitalisation available in all hospitals?
No, it is available only in the network hospitals of your insurance company. Always check the list before hospital admission.
2. Does cashless insurance cover all types of treatments?
It covers treatments as per your policy. Cosmetic treatments, dental care, and experimental procedures are usually not covered unless specified.
3. Can I get a cashless facility in an emergency?
Yes, you can. Just inform the insurer or their third-party administrator quickly, and the hospital will help you with the approval process.
4. Is there any paperwork I must do for cashless hospitalisation?
You need to fill out a pre-authorisation form and show your insurance documents, but you do not need to handle most of the billing paperwork yourself.
5. Do I still have to pay anything even with cashless insurance?
You might need to pay for things not covered by the policy, like consumables, registration charges or co-payments, if any.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.