A cashless Mediclaim policy helps you receive prompt medical treatment without having to pay any upfront medical bills. In cashless hospitalisation, the insurer directly settles the bill with the hospital. Along with financial convenience, such policies also qualify for Section 80D tax benefits, allowing you to save on taxes while securing health coverage.

However, in order to enjoy a smooth cashless experience, it is necessary to understand how it works. Read on to know more.

Types of Hospitalisation Covered by Cashless Mediclaim Policy

1. Planned Hospitalisation

This includes non-emergency procedures such as elective surgeries, pre-scheduled treatments and specialist consultations. You must inform the insurer in advance (usually 48 to 72 hours earlier) to obtain a pre-authorisation.

2. Emergency Hospitalisation

In urgent cases like accidents or sudden illnesses, inform the insurer or TPA as soon as possible after admission. Hospitals generally assist in sending the pre-authorisation request on your behalf.

Step-by-Step Process to Use a Cashless Mediclaim Policy

1. Verify Network Hospitals

In a cashless health insurance process, it is important to check before admission whether the chosen hospital is listed under the insurer’s network of hospitals. 

Each insurer provides an updated list on their website or mobile application. Choosing a non-network hospital will require you to pay upfront treatment fees. Then, later, you have to file for reimbursement with your insurer.

2. Carry Essential Documents

There are a few documents that you need to submit to the hospital:

• Health insurance card (or e-card)
• Government identity proof
• Previous medical reports and prescriptions
• Policy copy (if available)

By having these readily available, you can avoid delays during the hospital admission process.

3. Fill Out the Pre-Authorisation Form

At the network hospital’s insurance desk, you need to complete a pre-authorisation form. The appointed doctor will provide all the medical details required. 

This form is then to be submitted to the insurer for approval of a cashless claim.

4. Wait for Approval

Initially, after submission of the necessary documents, there will be a waiting process for cashless mediclaim usage. The insurer, during this time, evaluates your policy terms and coverage, waiting periods, pre-existing disease, declarations, treatment necessity, etc. 

After approval, an authorisation will be shared with the hospital, and the treatment can then proceed as cashless.

5. During Discharge

The hospital prepares the final bill and sends it to the insurer for settlement. During this time, you may need to pay for items not covered under the policy, such as:

• Personal comfort items (e.g., toiletries)
• Administrative surcharges
• Room upgrades beyond eligibility limits

Note: Make sure to review the hospital bill before signing anything.

Benefits of Cashless Mediclaim Policy

1. Immediate Medical Access

Cashless hospitalisation ensures that treatment begins without having to wait for arranging funds. 

In emergencies or critical situations, this immediate access can be crucial for timely care and better recovery outcomes.

2. Reduced Financial Burden

With the insurer directly settling the covered hospital expenses, you are not required to pay large sums upfront. 

It eases financial pressure on patients and families, especially during unexpected medical events.

3. No Need for Complex Reimbursement Processes

Traditional reimbursement claims require bill submission, verification and waiting for settlement. 

Cashless hospitalisation removes this lengthy process. The hospital and insurer coordinate directly, saving time and effort.

4. Stress-Free Hospital Experience

Medical situations can be emotionally draining. The cashless feature ensures you focus on treatment and recovery instead of dealing with financial paperwork during hospitalisation.

5. Greater Transparency in Billing

Network hospitals follow standardised billing practices aligned with health insurer guidelines. 

It helps to ensure clarity in expenses and reduces the chances of overcharging or hidden costs.

6. Suitable for Emergency Treatments

Whether a scheduled surgery or a sudden emergency, the cashless facility works in both situations. It adapts to diverse medical needs while offering consistent financial support.

7. Ensures Continuity of Treatment

Even if you or your family members are unable to arrange funds immediately, treatment can proceed smoothly, as in cashless hospitalisation, the insurer coordinates directly with the hospital.

8. Ideal for Senior Citizens and Dependants

This facility is especially beneficial for elderly parents, children and individuals with chronic medical conditions. 

They may require frequent medical attention, and cashless services can help avoid delays, reduce stress and maintain quality care for them without financial strains.

9. Encourages Preventive Healthcare

Many network hospitals also offer health check-up facilities under certain plans. 

It promotes early diagnosis and timely medical intervention and helps in better long-term health management.

Best Practices to Follow for a Smooth Cashless Experience

• Check sub-limits and room rent caps before admission. The room category selection can affect the eligibility of many claim components.
• Inform the insurer early, even for emergency admissions.
• Keep digital copies of all health insurance documents.
• Use insurer apps for quicker status tracking and updates.
• Clarify exclusions with the insurer to avoid unexpected out-of-pocket expenses.

Final Words

A cashless mediclaim policy gives necessary financial support during hospitalisation. By being aware of the process and keeping documents ready, you can ensure a smooth and stress-free treatment experience at network hospitals. 

With the right preparation, you can safeguard both your health and savings when you need support the most.