Cashless Treatments with Health Insurance- Understand Its Benefits And Limitations

Cashless medical insurance is invaluable during a health crisis. This type of health insurance ensures that you do not have to go through the hassles of cash payments, and there is no undue delay in treatments. The health insurance company covers your costs. The only condition is that you must be admitted to the health insurance network hospital. However, recently in April 2024, IRDAI has directed insurers to provide cashless treatment across all hospitals.  

Let’s dive into the details of cashless health insurance plans.

What are cashless treatments?

Traditionally, it was the norm to wait in long queues to settle hospital bills. Cashless treatments eliminate this hassle. Cashless treatment is essentially a solution that the insurance company provides by settling down your hospital bills for you.

You don’t have to wait for cash to admit yourself or a loved one in a hospital. However, the complete treatment may not be cashless, as there is some threshold limit to the maximum sum assured under your cashless health insurance policy. 

Why should you choose cashless health insurance?

Following are some essential benefits of choosing cashless health insurance plans for your family or yourself: 

• Convenient process 

Cashless medical insurance removes the burden of paperwork and bill settlements from your shoulders. Your insurer handles everything directly with the hospital, allowing you to focus on recovery.

• Eliminates financial stress 

Medical emergencies are stressful enough. With cashless treatment, you don’t have to worry about upfront costs or scrambling for funds. This allows you and your loved ones to prioritise your health and well-being.

• You get the best treatment 

A good deal of cashless health insurance plans offer coverage for a wide network of hospitals. This empowers you to choose the health insurance network hospital that best suits your needs, potentially including top-tier institutions within the network.

• Tax benefits 

The Indian Income Tax Act offers tax deductions up to ₹50,000 under Section 80D for premiums paid towards cashless health insurance. This translates to financial savings on top of the healthcare benefits.

Limitations of cashless treatments

Some of the demerits of cashless treatments are: 

• Most hospitals/insurers do not approve/cover cashless treatment in self-harm or suicidal cases. 
• The cashless medical insurance plans do not benefit in case of war or nuclear radiation injuries. 
• Cashless benefits cannot be availed in criminal cases, including wounds caused by several weapons. 
• If your insurer rejects the cashless treatment form, you cannot avail of its benefits. 

What about reimbursement-based health insurance?

In the case of a reimbursement-based health insurance claim, you, as the policyholder, must settle payments or bills with the hospital first on your own. You can then apply for reimbursement with the insurer after the treatment. To file reimbursement, relevant documents (such as bill payment receipts) must be submitted.

How to claim your cashless treatments?

To claim your cashless treatment, you can choose a network hospital from the list provided by your insurer. Inform your insurer about filing a pre-authorisation form at the hospital. You can claim your benefits easily if you have a health cashless card approved by your insurer. 

In case of emergency, inform the insurer within 24 hours of admission. Submit the form to the insurer’s representative with necessary documents like identity proof, policy papers, etc. Once the insurance company approves, you can get started with your cashless treatment. 

How to save yourself from claim rejection for cashless treatment?

If the insurance company rejects your cashless treatment form, you can file for reimbursement after the treatment. But during the treatment, you have to pay from your own pocket.

Following are some significant reasons why insurance companies reject cashless claims: 

• The treatment or medication might not be covered under your specific health insurance plan. For example, some plans exclude pre-existing conditions within a waiting period, cosmetic surgeries, or dental procedures.
• Cashless claims are generally only accepted at hospitals within your insurer’s network. Treatment at a non-network hospital would likely require a reimbursement claim process instead.
• Not informing the insurance company promptly about hospitalisation (48 hours before planned procedures), can lead to claim rejection.
• You should not hide any pre-existing diseases or conditions like smoking while applying for insurance. 

Key takeaways

Medical expenses are soaring in the country due to rising costs for medicines and healthcare facilities. Therefore, it becomes essential to have the right cashless medical insurance to take care of all the payments, and you will be able to provide much-needed care to your family without worrying about bills. PhonePe offers a user-friendly platform to buy and maintain your cashless medical insurance, ensuring your family’s health is always protected.