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Cashless hospitalization - Facility, Meaning & Process

About Cashless Hospitalization



Cashless Hospitalization Facility is given by the Insurance Company ie Insurers in India where any active policy holder means insured customer can get admitted in their respective network hospitals and undergo the required treatment without any payment for medical expenditure during hospitalization. In other words policy holder can get medical treatment at the best hospitals any where in India, without paying from his or her own pocket. The eligible medical expense incurred usually settled directly with the hospital by the Insurance Company with the required prior approval of the TPA (Third-Party Administrator). All of health insurance companies offer cashless hospitalization facility in their TPA approved hospital. So cashless mediclaim service can be availed only in approved network hospitals of the insurers.

Cashless Hospitalization Meaning Policy holder can hospitalize to approved TPA hospital list & can get treatment up to sum assured as per policy terms & conditions. Expenses will be directly manage by Hospital, Insurance Company & TPA.

Cashless mediclaim service is of two types:-

Planned Claim - When an insured person is aware of the hospitalization 2-3 days in advance

Emergency Claim - When an insured person or a family member requires emergency hospitalization, either due to sudden illness or an accident.

Cashless Hospitalization Process any insurer having insurance policy from insurance company have to submit their mediclaim card/ TPA card while being admitted to any hospital for any treatment. Hospital send insurer details along with valid report/ documents of illness for approval from TPA/ insurance company for hospitalization. Once approval granted treatment given by hospital comes under cashless treatment & patient need not to pay any amount to hospitals up to limit of insurance policy under terms of policy. In that case pre & post hospitalization expenses done by insurer can also be submit to insurance companies/ TPA's which will be reimburse.

You should Remember the following while availing the cashless facility:

  • Inform your TPA before getting admitted to a hospital or in an emergency situation, any of your family members to do so by calling to TPA.
  • Remember to carry ID card of patient, as proof at the time of hospitalization.
  • Carry all previous necessary investigation and medical reports.
  • Provide complete information to your health insurer by filling claim intimation form of that company or TPA.

TPA may ask to make the payment to hospital where patient was taken in emergency and submit the bills for reimbursement if hospital is not in approved list. If after few days patient is moved to TPA approved hospital then bill of that hospital will be paid by TPA directly.

The process of cashless treatment approval is mostly common for all insurance companies.