What is a Cashless Mediclaim Policy?

Paying the medical expenses and completing lengthy paperwork is one of the biggest challenges during medical emergencies. With a cashless policy, you can leave behind the worries of reimbursement and funds arrangement to pay your hospital bills.

In a cashless mediclaim policy, the insurance company settles the medical bills directly to the hospital. To avail this benefit, you can claim the sum insured, and the hospitalisation should be at any of your insurer's network hospitals.

Features and advantages of a Cashless Mediclaim Policy

The following are some of the features and advantages of cashless insurance policies

Features

  • Pre/post/emergency hospitalisation expenses.
  • Planned/unplanned hospitalisation
  • An extensive network of hospitals.
  • No-Claim Bonus (NCB).
  • In-patient treatment cost.
  • Preventive health check-ups.
  • Day-care expenses.
  • Ambulance expenses coverage.
  • Domiciliary treatment coverage.
  • Income tax benefits
  • Free-look period.
  • Critical illnesses coverage.

Benefits

  • Relieves You From Financial Burden:A cheap medical insurance policy acts as a financial cover during hospitalisation wherein you don’t have to pay anything from your pocket.
  • Offers a Wide Coverage: Most of the insurers provide coverage for pre/post-hospitalisation expenses, domiciliary treatment charges, in-patient care, and ambulance costs. However, the cover might differ among insurance providers.
  • Relaxed Mind: The cheapest mediclaim policy benefits you by paying your hospital expenses. Hence, it provides you with peace of mind by taking care of your financial concerns.
  • Tax Benefits: The premium of cashless policies is eligible for tax benefits as per ITA's Section 80D.
  • Travel Coverage: In the event of medical urgency, while you are at an unknown location, you can visit any of your insurer's network hospitals to avail emergency treatment without worrying about medical costs.

Types of Cashless Mediclaim Policies in India

Cashless medical policies in India are majorly classified into the following three types:

  • Individual: provides cashless hospitalisation for individuals.
  • Family Floater: provides cashless facilities for all the family members, who are the policy's beneficiaries.
  • Senior Citizen: offers coverage to senior citizens.

How to Claim Cashless Mediclaim Policy?

Process

The following are the steps involved in claiming cashless facilities:

  • Step 1: Firstly, the doctor advises hospitalisation in the event of an emergency.
  • Step 2: Inform your insurer about the hospitalisation.
  • Step 3: You need to be hospitalised at any of the insurer's network hospitals if you are eligible for a cashless claim. If it is a non-network hospital, you need to claim reimbursement from your insurer after clearing the hospitalisation dues from your pocket.
  • Step 4: In the case of a non-cashless claim, you have to first pay the hospital dues in full and then request reimbursement from your insurer.

Documents Required

  • Filled & duly signed claim form along with the patient’s discharge summary.
  • Policy's copy.
  • Cancelled cheque in the case of reimbursement
  • Original hospital bills
  • Cash invoices and prescriptions
  • MLC/FIR, in case of an accident.
  • X-ray, ECG, and other reports

What are thechances of Claim Rejection in a CashlessMediclaim Policy?

  • Not knowing the claim process: Being unaware of the claim process and not properlyfollowing the process can cause claim rejection. Adhering to the claim process and taking assistance from the insurer's customer care team can decrease the chances of claim rejections.
  • Pre-existing ailments: One of the top reasons for cashless claim rejections is if you have pre-existing illnesses assome of them are not covered under the cashless policies for a certain period(2-4 years). During this duration, you are required to pay for your treatment of pre-existing illnesses. Hence, if you request the claim for pre-existing diseases during the waiting period, the chances are that the claim would get rejected.
  • Not disclosing the information: Another primary reason for claim rejection is not giving your insurer complete information about your medical history.
  • Exclusions: Treatment expenses due to hospitalisation relating to HIV/AIDS and STD's, are not covered under cashless policies. Hence, raising the claims for illnesses that are permanently exempted from the policy will lead to rejection.
  • Policy Duration: Like other insurance policies, cashless policies are active for a specific period. Any claim that is raised after the policy's expiration and before the renewal is rejected.

Crucial Points to Consider Before Buying Cashless Mediclaim Policies in India

Considering the extensive range of cheap medical insurance plans available, buying an ideal cashless policy is a challenging task. Hence, we have prepared some crucial points for you that you should consider while buying cashless policies:

  • Adequate coverage: While buying a cashless policy, it is advised toconsider the inflation factor and then choose the right amount of coverage.
  • Network hospitals: Another essential point is to ensure that your preferred hospitals are there in the insurer's list of network hospitals for a seamless cashless treatment.
  • Waiting period: Every cashlesspolicy comes with a specific waiting period for treatment of some illnesses. During this duration, you cannot claim reimbursement from your insurer for these illnesses. Hence, it would be best to choose the policies that have a lesser waiting time.
  • Renewability: As age increases, it becomes challenging to get the cheapest mediclaim policy. Hence, it’s always better to choose the policies that provide lifelong renewability so that you don't have to compromise on the coverage.
  • Add-ons: Apart from the hospitalisation costs during ailments and accidents, cashless policies also offer some add-ons, such as maternity benefits and free health check-ups, etc. So, you may also choose some of these additional benefits based on your needs.
  • Claim Settlement Ratio: Another crucial point to consider while buying a cheap medical insurance is the insurer's claim settlement ratio. Insurers with high claim settlement ratio are more likely to settle your claims quickly and hassle-free.

Which is the Best Cashless Mediclaim Policy in India?

The below mentioned are the top five cashless policies in India. You may choose whichever suits best with your preferences.

1. Apollo Munich's Optima Restore
  • Minimum Age: 91 days to 65 years
  • Renewability: Lifelong
  • Waiting Time: 3 years
  • Sum Insured: 3- 50 lakhs
2. Star Family's Optima
  • Minimum Age: 16 days- 65 years
  • Renewability: Lifelong
  • Waiting Time: 2 years
  • Sum Insured: 2- 15 lakhs
3. HDFC ERGO Health Suraksha
  • Minimum Age: 3months - NA
  • Renewability: Lifelong
  • Waiting Time: 4 years
  • Sum Insured: up to 10 lakhs.
4. Religare Care
  • Minimum Age: 91 days- NA
  • Renewability: Lifelong
  • Waiting Time: 4 years
  • Sum Insured: 2- 60 lakhs
5. ManipalCigna ProHealth
  • Minimum Age: 91 days- NA
  • Renewability: Lifelong
  • Waiting Time: 4 years
  • Sum Insured: 2.5- 100 lakhs