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Cashless Mediclaim is a policy in which the medical expenses and hospitalization charges are settled directly between the insurance company and the network hospital. The policyholder does not have to pay any cash. This benefit enables you to bypass the reimbursement formalities at any network hospital.
With a cashless Mediclaim policy for family, you can avail the best treatment without worrying about arranging any cash. Let us now look at how it works and the essential things you should know about the cashless mediclaim policy.
How Does Cashless Mediclaim Work?
When you purchase a Mediclaim policy, the insurance company provides you with an option to go for cashless claims. In other words, you will not be required to pay any cash for the costs incurred on the medical treatment and hospitalization charges at the network hospitals of the insurance company. The expenditures will be handled directly by the insurance company.
To avail of the facility of cashless Mediclaim, the patient must admit to one of the network hospitals. These hospitals have a tie-up with the insurance companies to provide cashless treatments. After verifications, the policyholders can get approval to avail cashless claims subject to the policy terms and conditions.
Types of Cashless Mediclaim in India?
There are many types of cashless Mediclam policies in India. Let us look at the three major types of cashless health insurances in India: -
1· Cashless Individual Health Insurance
The cashless Mediclaim policy for the individual offers coverage for only a single person. It can cover all the individual's medical expenses with all the benefits of cashless hospitalization.
2· Cashless Family Health Insurance
Under this type of cashless Mediclaim policy, you can cover your whole family under a single policy for a small premium amount. The sum insured for a cashless Mediclaim policy for family is usually higher compared to the individual plan.
3· Cashless Senior Citizen Health Insurance
As the name suggests, this type of cashless Mediclaim offers coverage and benefits to senior citizens. They will get cashless benefits for ambulance expenses, hospitalizations costs, and much more as per the policy.
Exclusions of Cashless Mediclaim
While purchasing a cashless Mediclaim policy for family, make sure to all the exclusions mentioned in the policy documents. This way, you will be prepared for any contingency you may face in the future. Exclusions consist of the case when you may not be eligible to get a claim under the policy.
Here are some of the exclusions: -
- The cashless mediclaim policy does not cover self-inflicted injuries, injuries due to attempted suicide, etc.
- Any treatment or medical expenses incurred within 30 days from the start date of the policy are excluded, except accidents.
- The cashless Mediclaim policy will not cover medical treatments related to congenital diseases.
- Expenses that can be traced to consumption or misuse of alcohol or drugs are also excluded.
- The cashless mediclaim policy does not cover self-inflicted injuries, injuries due to attempted suicide, etc.
- Any treatment or medical expenses incurred within 30 days from the start date of the policy are excluded, except accidents.
- The cashless Mediclaim policy will not cover medical treatments related to congenital diseases.
- Expenses that can be traced to consumption or misuse of alcohol or drugs are also excluded.
- The policy may not cover treatment arising from abortion or miscarriage.
The exclusions may differ with different cashless Mediclaim policies. Raising a claim for any of the exclusion can result in straight away rejection of the claim.
Should You Go for Cashless Mediclaim?
During unforeseen events such as a medical emergency, you may go through stress while arranging finances to pay exorbitant sums of money for medical treatments. The services offered under the cashless Mediclaim policy can safeguard you against financial stress. Here are a few reasons why you should go for cashless Mediclaim: -
1· Immediate Treatment
With the right cashless Mediclaim policy in place, you can skip the hassles of arranging cash to pay for the medical expenses incurred. You just have to inform the helpdesk at the hospital and the customer support team within 24 hours during an emergency and within 48 hours in the case of planned hospitalization.
2· Hassle-Free
The cashless Mediclaim policy for family offers hassle-free services at the network hospitals. All the medical expenses are settled directly between the insurance company and the hospital. No lengthy paperwork or documentation is required, making the process less cumbersome.
3· Coverage During Travel
Medical emergencies due to injury, illness, or any other kind of inconvenience can arise while travelling. It can be worrisome to arrange money in such situations. However, if you are covered under a cashless Mediclaim policy that offers a vast network of hospitals across the country, then you can avail of cashless claims during travel.
4· Tax Benefits
The premiums paid for the cashless Mediclaim policy for family, individual, or senior citizens are exempted from tax under section 80D of the Income Tax Act of India. Thus, you can save a fair amount of money on taxes under this policy.
Disclaimer: Tax deductions are subject to tax laws prevailing at the time of payment of premium or receipt of benefits.
5· Peace Of Mind
The Cashless Mediclaim gives you peace of mind. It can help you stand firm during any medical emergency. You will enjoy comprehensive benefits under this policy, from hospitalization to ambulance cover and daily cash allowance.
The premiums paid for the cashless Mediclaim policy for family, individual, or senior citizens are exempted from tax under section 80D of the Income Tax Act of India. Thus, you can save a fair amount of money on taxes under this policy.
Disclaimer: Tax deductions are subject to tax laws prevailing at the time of payment of premium or receipt of benefits.
5· Peace Of Mind
The Cashless Mediclaim gives you peace of mind. It can help you stand firm during any medical emergency. You will enjoy comprehensive benefits under this policy, from hospitalization to ambulance cover and daily cash allowance.
What You Should Know Before Choosing Cashless Mediclaim
There are many different plans available when it comes to cashless Mediclaim policies. To find the best cashless health insurance that gives you maximum returns, you should know these essential things before choosing cashless Mediclaim: -
1· Sum Insured
Sum insured is the maximum liable amount under the policy every year. It is advisable to choose a plan with sufficient coverage while keeping your budget in mind.
2· Co-payment
Co-payment refers to the amount the policyholder has to pay for a portion of medical expenses out of their own pocket. And the remaining amount is paid by the insurance company. Therefore, keep an eye on the co-payment clauses.
3· Waiting Period
It is the time span between the start of the policy and the time when you are eligible to claim some or all the benefits of the cashless Mediclaim policy. You must read the policy documents to see the waiting periods. Make sure to pick the plan with the least waiting period.
4· Maximum Renewable Age
You should always go for the cashless Mediclaim policy for family with higher renewable age. It can be in your best interest if you require an excellent Mediclaim policy for parents.
5· Daycare Treatments
A wide range of daycare treatments is covered under this policy. Compare different plans before choosing one. Make sure to pick the plan that covers the maximum number of daycare treatments.
6· Network Hospitals
The insurance company makes the list of network hospitals. Cashless can be made only at the network hospitals. Therefore, make sure that your preferred hospital is a network hospital.
5· Daycare Treatments
A wide range of daycare treatments is covered under this policy. Compare different plans before choosing one. Make sure to pick the plan that covers the maximum number of daycare treatments.
6· Network Hospitals
The insurance company makes the list of network hospitals. Cashless can be made only at the network hospitals. Therefore, make sure that your preferred hospital is a network hospital.
Key Points to Remember
Here are some of the key points to remember before buying a cashless Mediclaim policy: -
- Only network hospitals offer the benefits of cashless claims.
- Remember to keep a copy of all the documents, including lab reports, medical bills, discharge papers, and the claim form.
- Read the terms and conditions of the policy carefully as there could be some conditions that could make you ineligible to avail of cashless claims.
- The insurance company agrees to pay for the medical expenses. But if the amount exceeds the sum insured, the policyholder will be required to pay the excess amount.
Frequently Asked Questions (FAQs)
1. What is the policy term of the cashless Mediclaim plan?
The policy term for cashless Mediclaim policy is usually one year, at the end of which you must renew your plan. The term for some plans could be two years.
2. How does a cashless Mediclaim policy help me?
A cashless Mediclaim policy can help you safeguard against financial burdens during any medical emergency. It provides you with immediate access to healthcare without worrying about arranging any money.
3. How can I get the list of network hospitals to avail cashless claims?
You will get the list of network hospitals while buying the policy. You can also know about the nearest network hospitals in your locality.
4. What could be the possible reasons for rejection for a cashless claim?
A policyholder's claim for cashless treatment can be rejected for the following reasons: -
- If the patient is admitted to a non-network hospital.
- If the pre-authorization request is not shared on time.
- If the medical condition is not covered or the waiting period is not over.
5. What should I keep in mind while choosing a cashless Mediclaim policy?
The key points to consider while choosing a cashless Mediclaim policy include co-payment, sum insured, waiting period, and limits on treatments.
6. Can I avail cashless treatments at any hospital?
No. You can avail of cashless treatments at the network hospitals only.
7. What factors affect the premium paid towards a cashless Mediclaim policy for family?
The factors that affect the premium paid towards cashless Mediclaim plan include family medical history, gender, pre-existing illnesses, age, Body Mass Index (BMI), marital status, etc.
8. Can I avail tax benefits under the cashless Mediclaim plan?
Yes, you can avail of the tax benefit under the cashless Mediclaim policy for family.
Source: https://www.incometaxindia.gov.in/Pages/tools/deduction-under-section-80d.aspx
https://www.irdai.gov.in/ADMINCMS/cms/Uploadedfiles/Guidelines%20on%20Standardization%20in%20Health%20Insurance%202016.pdf
ARN No : Jan22/Bg/25D
