May 4

Cashless Health Insurance

Team Antworks

Health insurance is an instrument that can be used to ensure that, in case of a medical emergency, policyholders are able to provide their families with the best medical help possible. There are times when this medical help might be too expensive for some people and that is where a health insurance policy steps in to help pay the bills.

Key Features:

The features of any cashless policy will depend on the insurer who provides the insurance but some of the most common features are:

Pre & Post Hospitalization Medical Expenses
In-patient Care
No-claim bonus
Complementary health check up
Daily cash benefits
Cover for ambulance charges
Cover for domiciliary treatment
Cover for critical illnesses like cancer, heart attack, stroke, etc.
Tax benefits
Free-look periods

Understanding Cashless Hospitalization:

What is cashless hospitalisation?

What is meant by cashless hospitalisation is that when you get admitted in the hospital for treatment, for an illness covered by your health insurance policy, you don’t have to pay for the treatment from your own pocket.

How does cashless hospitalisation work?

Health insurance providers enter into agreements with various hospitals which state that patients holding cashless mediclaim policies won’t have to pay the hospital for treatment. The charges will be paid directly to the hospital by the insurer.

Is there anything that the policy will not pay for?

These policies generally cover only the expense of the treatment. This could include cost of medicines, medical procedures, fee for anaesthesiologist and surgeons, ambulances, rooms, etc. They will not cover expenses that are non-medical in nature. Most insurers provide lists of items that the policy won’t pay for and should be consulted by policyholder. The list could include items like tissue paper, air conditioning, television, etc.

Why is it important to take cashless health insurance?

If you were to need hospitalisation for something and did not have enough money to pay for the treatment, or even a part of the treatment, your options for proper medical care would be severely limited. With cashless health insurance you can be assured of the best possible treatment even if you don’t have the money to pay for it.

Is it different from other policies like family floater, individual, etc.?

No, a cashless policy is essentially the same as an individual policy or a family floater policy. It will even provide the same benefits as them and have the same exclusions. The best way to describe it would be to say that the cashless part of a health insurance policy is actually a benefit or a feature rather than a type of policy.

How is it different from co-pay?

In co-pay policies, policyholders and insurance providers share the hospital expenses. A certain percentage of the medical bills are paid by the policyholder while the remainder, the lion’s share, is paid by the insurance company.

How is it different from reimbursement?

If you go for treatment to a hospital that is not a part of the network hospitals, you need to make the payments from your pocket and then submit the bills to get a reimbursement from the insurer. In a cashless policy, the payment is made directly by the insurance company if treatment is done in a network hospital.

What is the tenure of the cashless health insurance policy?

Cashless health insurance policies, like most health insurance products, come with a standard tenure of 1 year. They need to be renewed every year. Some insurers, however, do offer tenures of 2 years at a time.

How long can I renew the policy for?

Most cashless mediclaim policies can be renewed throughout the lifetime of the policyholders.

What if I fail to renew the policy in time?

In case you fail to make the payment for the policy by the due date, you will be given a grace period of 15 days. However, it must be noted that in most cases, insurance policies are not active during the grace period.

Is this type of a policy transferable?

Yes, these health insurance policies can be transferred from one insurer to another.More on health insurance portability

Do these policies cover pre-existing illnesses?

Yes some insurers may offer cashless policies for pre-existing conditions however, this facility may be subject to conditions set forth by the insurer.

Advantages of Cashless Health Insurance:

Cashless health insurance policies offer policyholders a wealth of benefits like:

With this policy in effect, policyholders don’t have to have ready cash to cover medical expenses.
Some cashless health insurance policies will be valid outside India as well. This is more of a feature and will depend on the insurer.
It will provide for tax benefits under section 80D of the Income Tax Act 1961. The limits defined are Rs. 20,000 per year for senior citizens and Rs. 15,000 for all others.
Some of the insurers will also provide policyholders free medical check-ups at regular intervals.

Exclusions:

While health insurance plans do offer to cover most of the medical emergencies and conditions, the cover is subject to exclusions. These exclusion are of two types, temporary and permanent. Temporary exclusions are expenses that the policy won’t cover for a period defined by the insurers while permanent exclusions are expenses that the policy will never cover. These things could be: