Things to know about cashless health insurance in India (Complete Guide)

Things to know about cashless health insurance in India (Complete Guide)

With the dramatic rise in healthcare costs, medical emergencies can make a big hole in your pocket. Hence, it has become imperative for everyone to buy health insurance plans in India. While buying health insurance plans, people consider various things such as coverage offered, premium and additional benefits etc. But, the most important thing one must consider in any health insurance plan is the ‘’cashless facility’’ offered to avail the quality medical care services at the right time.

Overview of cashless health insurance

Cashless health insurance is a health insurance policy that comes with a cashless claim facility. As the name implies, in cashless health insurance plans, you don’t have to face the hassles of paying cash during medical emergencies and then getting it reimbursed from insurers. In this, your insurer will directly settle the medical bills to the network hospital where you avail healthcare treatments. Hence, in order to avail the quality healthcare treatment at the rightly needed time, it’s important to have an ideal health insurance plan that is supplemented by the cashless facility. With cashless health insurance, you can get the timely treatment even without having a contingency fund for medical emergencies.

Features of cashless health insurance

Today, health insurance policies come with wide array of features cover each and every aspect of healthcare emergency. There are plans to suit the healthcare requirements of individuals, families, senior citizens, women and group of people etc. Almost every insurer today is offering cashless health insurance policies. Features of these policies are designed by the insurance companies. Let’s take a look at some of the standard features offered by cashless health insurance plans.

Following are the features of cashless health insurance:

• In-patient hospitalisation expenses
• Pre and post hospitalisation expenses
• Day care procedures
• Domiciliary treatments
• Daily hospital cash allowance
• Emergency ambulance cost cover
• Value added services
• Pre-existing illness cover
• Free health check-ups
• No claim bonus
• Organ donor cover
• Critical illness cover, etc.

Top 4 Advantages of cashless health insurance

An ideal cashless health insurance plan is the one that offers you unending benefits in the time of need. Let’s take a look at the major benefits offered by cashless health insurance.

• Extensive coverage:
  Cashless health policies provide comprehensive coverage for all health issues including in-patient care, pre hospitalisation and post hospitalisation, domiciliary hospitalisation, day care procedures, health check-ups and ambulance coverage etc. Many policies provide additional coverage such as critical illness cover, parental care, maternity expenses and new born child cover etc. to make the coverage extensive.
• Convenience of instant cashless treatment:
  Cashless health plans are the quickest with the convenience of an immediate treatment facility at network hospitals without having to pay the cash. The best part is hospital network is widely spread across the country in almost all the insurance companies. Hence, cashless medical treatment can be availed by you conveniently even when you are travelling.
• Worry-free access to funds:
  If you have a cashless medical insurance, you can avail treatment in the time of need without any worry irrespective of your financial condition at the moment. Cashless insurance offers a sense of security as there is no worry of depleting savings or liquidating assets. You will be in a better position to handle the unforeseen situation with the financial security offered by cashless health plans.
• Saves tax:
  Along with all the financial protection and convenience benefits, cashless health insurance plans also offer tax benefits.

Premiums paid towards health insurance plans taken for self, spouse, children and parents can be claimed under Section 80D of the Income Tax Act for tax deduction.

Following are the details –

Types of cashless health insurance policies in India:

There are various types of health insurance policies offered in India with cashless facility. Following are the types of cashless health insurance policies available in India:

• Cashless individual health insurance:
  Cashless individual health insurance policies provide coverage to an individual against various unforeseen medical events depending on the terms and conditions of the policy.
• Cashless family health insurance:
  Cashless family health insurance provides coverage to an entire family in a single policy against various unforeseen medical events as per the terms and conditions of the policy.
• Cashless senior citizen health insurance:
  Cashless senior citizen health plans provide healthcare coverage to senior citizens with many exclusive features like coverage for pre-existing illness, day care and critical illness etc.
• Cashless mediclaim/group health insurance:
  Cashless mediclaim insurance policies provide coverage to the group members. These are the employee sponsored health insurance plans providing coverage against various unforeseen medical events.

Top 5 best cashless health insurance plans

There are a wide variety of cashless health insurance policies available in the market. Best one or the right one out of these plans may vary depending on each individual’s requirement. However, here we have tried to list out five best cashless health plans available in the market.

Following are the details:

(Premium is taken for a 30-year-old healthy male for INR. 5 lakhs sum insured. Star family Health optima plan premium is for a 30-year male + a 28-year-old spouse, as the plan is family floater)

• Apollo Munich Optima Restore Plan

Apollo Munich Health Insurance is one of the leading private health insurers in India with a wide gamut of health plans in its product offering. The company offers best in class services with 4500+ network hospitals across the nation. Let’s take a look at some of the amazing features offered by optima restore health plan.

Following are the key features/facilities offered by the plan:

1. 1. 1. The plan offers comprehensive coverage for various expenses that include hospitalisation, daycare, pre hospitalisation and post hospitalisation, organ donor expenses and daily hospitalisation allowance etc.
      2. The policy offers no-claim benefit for each claim-free year which is up to 50% along with multiplier benefit that can double the NCB benefit up to 100% of sum insured.
      3. The plan comes with an automatic sum insured restoration benefit
      4. The policy offers you portability benefit which helps you get all the previous transferable benefits under the policy
      5. You can stay active and earn up to 8% renewal discount by using stay active mobile application
      6. Complimentary health check-up at the block of every two years
      7. Policy comes with an optional add-on cover called ‘critical advantage rider’ that covers eight major illnesses for up to INR. 10 lakhs. Policy also offers e-opinion facility post-diagnosis of critical illness
      8. Policy requires no pre-medicals for a person aged below 45 years and for sum insured below INR 15 lakhs

• Star Family Health Optima Plan

India’s first standalone insurance company, Star Health Insurance Company offers various uniquely crafted health insurance plans for you and your family. With its largest network of 9600+ hospitals, the company displays excellent service quality. Star family health optima is one of the best plans offered by the company to secure your entire family under one umbrella. Let’s take a look at the key features and facilities offered by the plan.

1. 1. 1. Policy offers extensive coverage for the whole family at reasonable cost of premium. Coverage mainly includes, hospitalisation, pre hospitalisation and post hospitalisation, 405 day care procedures, organ donor expenses, domiciliary hospitalisation and newborn cover etc.
      2. 100% automatic restoration of sum insured benefit
      3. Policy offers no claim bonus of up to 35% of the sum insured
      4. Recharge benefit to enhance the sum insured up to 30%
      5. Health check-up benefit of up to 1% of the sum insured
      6. Policy offers you portability benefit which helps you get all the previous transferable benefits under the policy
      7. Policy requires no pre-medicals for person aged below 50 years

• HDFC ERGO Health Suraksha Policy

HDFC ERGO General Insurance Company offers diversified range of health insurance plans to suit various healthcare needs of its customers. With wider network of 9500+ hospitals, the company endures your healthcare needs are addressed effortlessly. Health Suraksha plan of HDFC ERGO comes with various amazing benefits and features. Let’s take a look at the features of the plan.

1. 1. 1. Policy offers wider coverage that includes in-patient care, day care treatments, organ donor cover, pre hospitalisation as well as post hospitalisation and non-allopathic treatments, emergency ambulance charges etc.
      2. Policy offers optional add-ons like maternity cover, critical illness benefit and convalescence benefit etc.
      3. Policy offers family discount of up to 10% on premium for covering two or more family members
      4. Policy offers 5% cumulative bonus for each claim free year
      5. Automatic sum insured restoration benefit
      6. Health check-up allowance of up to 1% of the sum insured
      7. Policy requires no pre-medicals for person aged below 46 years

• Religare Care Policy

Religare Health Insurance is one of the most trusted brands that offers a wide range of health insurance plans. With 4700+ network hospitals, Religare makes global healthcare treatment easily available for you. Religare Care is one of the best plans offered by the company with various valuable features. Let’s take a look at the facilities offered by Religare Care policy.

1. 1. 1. Policy comes with complete package of wide coverage that includes in-patient care, pre hospitalisation and post hospitalisation, day care treatments, organ donor expenses, outpatient cover, daily hospitalisation allowance, ambulance charges and domiciliary hospitalisation etc.
      2. Sum insured restoration benefit of up to 100% is offered
      3. No claim bonus of 10% on each claim free year up to a maximum of 50% is offered. The plan also comes with additional no-claim bonus of 50% making the total to 100%
      4. Complimentary health check-up once a year
      5. Policy offers discount on choosing longer policy term
      6. Policy requires no pre-medicals for person aged below 46 years. However, the requirement may depend on sum insured chosen and health history

• ManipalCigna ProHealth Plan

ManipalCigna Health Insurance Company formerly known as Cigna TTK Health Insurance Company offers a wide range of health insurance solutions. ProHealth plan is one of the best products offered by the company to secure you and your family. Let’s take a look at amazing facilities offered by the plan.

• ProHealth policy offers flexibility in choosing the plan based on your healthcare requirements – plans available are Protect, Plus, Preferred and Premier
• Policy comes with comprehensive coverage that includes in-patient hospitalisation cover, day care treatments, organ donor expenses and pre and post hospitalisation cover etc.
• Policy offers up to 10% of long tenure discount and family discount on premium
• Restoration benefit of up to 100% of sum insured
• No claim benefit of 5% to 10% (depending on the plan chosen) is offered which can be accumulated up to a maximum of 100% of sum insured
• Policy comes with voluntary deductible of INR. 1 lakh, INR. 2 lakhs and INR. 3 lakhs which can help you reduce your premium to a certain extent
• Complimentary health check-up for every three years
• Policy provides you an option to earn healthy rewards that can reduce your premium
• Policy provides maternity cover and worldwide emergency benefit
• Policy comes with optional add-ons – critical illness cover and waiver of copay.

11 most important points to consider before buying cashless health insurance plans

To buy the right cashless health insurance plan, certain important points are to be considered. Following are the important points to consider while buying:

• Coverage:
  Coverage offered by the policy needs to be given utmost importance at the time of buying. It’s important to have adequate coverage in case of an unfortunate event. Not just the amount of sum insured, coverage offered needs to be comprehensive in terms of features and benefits also. Consider wider coverage policies that can cover almost every medical situation. There are policies that come with restoration features, wherein sum insured gets reinstated when it’s exhausted. Consider policies with such features.
• Exclusions:
  It is important to consider what is not covered in the policy before you buy it. Cashless health claims also can get rejected if you are not aware of the limitations. Being aware of exclusions helps you make a rational decision.
• Claim settlement ratio:
  The claim settlement ratio or incurred claim ratio of the health insurance company is an important consideration while buying your cashless health insurance. As the ratio signifies company’s potential to pay claims, it’s ideal to go with cashless health plans of insurers with high claim settlement ratio.
• Co-payment:
  Co-payment refers to portion of medical expenses that needs to be paid by you as an insured before placing the claims with the insurance company. Hence, it’s important to look for policies that have no co-pay clause.
• Network hospitals:
  Cashless facility can be availed only at network hospitals of the insurance company. Hence, to avail treatment without any hassles anytime, it’s good to go with insurer having wider hospital network.
• No claim benefits:
  No claim benefit is one of the common features in any cashless health insurance. Basically, you can avail this benefit for being healthy and not making any claim during policy year. Benefit for each claim-free year can be accumulated up to a maximum of 50% by most of the policies.
• Lifetime renewal:
  With the rising age, it’s difficult to get the comprehensive medical cover. Hence, it’s important to consider policies that are renewable for lifetime in order to avoid coverage hassles and high premium.
• Waiting period:
  Almost every cashless health insurance plan comes with waiting period, after which financial benefits can be claimed for specific treatments, illnesses and procedures. Policies with less waiting period can help you get financial aid without much waiting. Choose the policies based on your requirement.
• Portability:
  If you have to switch from one insurer to another for any reason, portable cashless health plans transfer all your earned benefits to the new plan. Hence, portability is an important consideration.
• Additional benefits:
  Health insurance policies do come with additional benefits like critical illness cover and accidental cover etc which can enhance your healthcare cover. Consider such features while buying cashless health insurance
• Cost:
  Though, the cost of the policy is not the primary consideration, it’s important to avail all the required benefits at an affordable cost. You can compare the quotes of various cashless health plans online on side by side basis.

How to buy cashless health insurance plans?

As most of the cashless health insurance plans are available on an online platform, buying is more convenient. Plan of your choice can be bought anytime, anywhere within a few clicks online. You can buy cashless health insurance plans through Turtlemint through following steps:

1. Go to Turtlemintand choose the category of insurance as ‘health’
2. Click on ‘buy new policy’ and select your profile details such as gender, members to be insured, age, health history and contact details etc.
3. Compare the plans available and select the cashless health plan based on your need
4. Provide necessary coverage details
5. Make the payment online. That completes the buying process!

Documents required for buying cashless health insurance plans

Following are the documents required for buying cashless health insurance plans:

1. PAN card is mandatory
2. Age proof – Birth certificate/SSLC mark sheet/Voter ID/Passport etc.
3. Identity proof – PAN card/ driving license/voter’s ID/ passport/aadhaar card, etc
4. Proof of address – Driving license/passport/latest electricity bill/ telephone bill etc.
5. Photographs

Requirement of pre-medical check-ups may vary depending on the policy’s terms and conditions.

What is the process of cashless health insurance claim?

Usually, in cashless health insurance policies, TPA (third party administrators) work like a bridge between the insurance company and the network hospitals that helps to speed up the claim process. Some insurance companies will have their in-house claim processing team which makes the process even quicker. Generally, TPAs or insurers will have their help desk set up in their network hospitals to help the claimant.

Cashless health insurance claim process may vary depending on whether it is emergency hospitalisation or planned hospitalisation. Let’s take a look at the process.

Cashless emergency hospitalisation

During medical emergencies, if the insured gets admitted at any network hospital, following is the process to be followed for cashless claim:

• Once the insured is admitted to the hospital, insured needs to show health card issued by his/her insurance company. Health card will have all the vital details such as name of the insurer, policy number and plan type etc.
• Insured needs to contact TPA/insurance desk and initiate the cashless claim by filling up pre-authorisation request usually within 24 hours of hospitalisation
• Third party administrator/insurance company will review all the initial documents submitted
• Once the cashless request is approved by the insurance company further documents are to be produced by the hospital to expedite the claim process
• Once final set documents submitted by hospital are verified, claim amount will be directly settled with the network hospital

Cashless planned hospitalisation

In case of planned hospitalisation at the network hospital for any treatment/procedures, following is the process to be followed:

• You can go through the insurance company’s website to take a look at the list of network hospitals available for treatment or can seek this information by contacting the customer support team of the insurance company
• Once you choose your preferred network hospital to get treated, you need to fill-up pre-authorisation cashless request form which can be downloaded online on TPA website or can be obtained from insurance desk at the hospital
• It’s important to submit this pre-authorisation from within specified time limit prior to hospitalisation. Time limit may vary from insurer to insurer
• Hospital authorities or an attending physician will also go through your request form, verify the details and sign
• The submitted request form will then be checked by TPA/insurance desk for eligibility and authenticity
• Post verification by insurance desk or TPA, approval will be sent to network hospital for cashless treatment
• On producing the final documents by hospital, payment of claim will be directly made to the hospital

Documents required for cashless claim settlement

Requirement of documents may vary on claim to claim basis. However, there are certain common documents that are needed for cashless health claims. Following are the documents required:

1. Claim form duly filled and signed
2. Doctor’s advice for hospitalisation
3. Discharge summary of the hospital
4. Doctors’ prescription, treatment details along with original medical bills and receipts given by hospitals, diagnostic centres, doctors and pharmacies
5. Diagnosis reports (ECG/Scan/X-ray, Lab test reports etc)
6. Police FIR copy for accident cases
7. Health card copy, etc.

Exclusions under cashless health insurance

Though, cashless health insurance policies provide comprehensive coverage against most of the medical emergencies and health conditions, there are certain exclusions applicable under these plans. Some of the exclusions come with waiting period, thus temporary in nature. Some of the medical costs are permanently excluded from the policies. Let’s take a look at exclusions under cashless health insurance.

Temporary exclusions

• Medical expenses incurred during the first 30 days (initial waiting period) of the policy
• Specific medical illnesses/treatments – usually come with the waiting period of 12 -24 months
• Pre-existing illnesses – usually come with the waiting period of 24 -48 months
• Maternity expenses – Generally come with the waiting period of 9 months to 6 years

Permanent exclusions

Following are some of the general exclusions under cashless health insurance:

• Non-medical expenses
• Pregnancy and childbirth
• Fertility treatments
• Sexually transmitted diseases
• AIDS/HIV
• Self-medication/treatment
• Unproven and experimental treatments
• Congenital illnesses
• Mental disorders/illnesses
• Cosmetic treatments
• Treatments received outside geographical limits
• Self-inflicted injury
• Breach of law
• War and nuclear perils
• Alcohol and drug abuse

To conclude, cashless health insurance plans give you peace of mind and sense of complete financial security against various health issues and emergencies without having to worry about personal financial condition. With a wide variety of plans available for purchase online, compare them on a cost-benefit basis and secure your health!

MUST INSURANCE, kothrud is a client focused insurance agency which does Insurance Counselling / Advisory / Consultation to clients to first carry clients NEED ANALYSIS. Only post this stage, we recommend you a right insurance solution which we think is a MUST for your INSURANCE need.

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Courtesy Article: Sidharth Hampanavar / September 30, 2019