Cashless Health Insurance

Before purchasing a cashless insurance plan, consider the points below to make the right decision:

• It would be best if you bought a policy that offers adequate coverage without compromising on the benefits and at an affordable premium. The best practice is to look for the causes behind a reduced premium. It should not be at the cost of insurance coverage. Check if there is any clause of co-payment, deductibles, and sub-limits; if there is, you would actually end up paying more at the time of claim.
• This waiting period shall apply to pre-existing illnesses like blood pressure, diabetes, thyroid, etc., that one may have before buying the policy. Additionally, it applies to specific treatments and illnesses like arthritis, varicose veins, cataracts, etc. So, you can compare and choose a plan with a minimum waiting period to claim the benefits in case of a health emergency.
• No-Claim Bonus (NCB) refers to the discount offered by the insurance company for all the years that you have not filed a claim. Basically, your coverage amount is increased during subsequent policy renewals for all claim-free years. However, most health insurance providers specify the NCB limit. And the increase in the sum insured would depend on the limit specified by the insurer.
• It will be helpful to check with your insurer for the list of hospitals and know which network hospitals are in your vicinity. It saves you from the tiresome paperwork that is required at the time of admission and claim. Moreover, the insurance company pays the sum insured directly to the hospital. 

Cashless health insurance is necessary during unforeseen health emergencies when you might be cash-strapped or not have immediate access to cash. It is designed to eliminate the need to worry about documents and cash in hand when genuinely being with the family. It also allows people to avail the best quality medical treatment without stressing about arranging money to pay the bills.

Health insurance policies have a wide array of features covering every aspect of healthcare emergencies. In addition, almost every insurer today is offering cashless health insurance policies. Let's take a look at some of the features offered by cashless health insurance plans:

• Domiciliary treatments
• Daily hospital cash allowance
• Emergency ambulance cost cover
• Value added services
• Pre-existing illness cover
• Free health check-ups
• No claim bonus
• Organ donor cover

Cashless insurance removes the hassles of having to pay cash at the hospitals at the time of need. For cashless medical insurance, insurance providers enter into direct negotiations with hospitals in their network to pay for the treatment availed by the insured person. They tie up with some specific hospitals, known as the network hospitals of the insurance company. 

When the insured gets hospitalised in a network hospital, they do not have to settle the bill with the hospital at the time of discharge. Instead, the TPA (third party administrator) or the insurance company will coordinate and settle the bill directly at the hospital.

Medical emergencies come unannounced. To avail of cashless hospitalisation during such circumstances, follow the steps below:

• Once the insured is admitted to the hospital, they must show a health card issued by the insurance company. The Health card will have all the vital details such as the insurer's name, policy number, plan type, etc.
• Insured needs to contact the TPA/insurance desk and initiate the cashless claim by filling up a pre-authorisation request, usually within 24 hours of hospitalisation.
• A third-party administrator/insurance company will review all the initial documents submitted.
• Once the insurance company approves the cashless request, further documents are to be produced by the hospital to expedite the claim process.
• Once the final set of documents submitted by the hospital is verified, the claim amount will be directly settled with the network hospital.
• If admission to the specified list of network hospitals is not feasible, there is an option of a reimbursement claim. In this case, the insured would pay the bill in full, and they can file a claim with relevant documents and medical bills later on with the insurance provider.

The requirement of documents may vary on a claim-to-claim basis. However, certain standard documents are needed for cashless health claims. Following are the documents required:

• Claim form duly filled and signed
• Doctor's advice for hospitalisation
• Discharge summary of the hospital
• Doctors' prescriptions, treatment details along with original medical bills and receipts given by hospitals, diagnostic centres, doctors, and pharmacies
• Diagnosis reports (ECG/Scan/X-ray, Lab test reports, etc.)
• Health card copy

Niva Bupa provides the best cashless health insurance. We have truly understood what makes health insurance ideal for the people and created products that cater to all those needs and much more.