content bg top

News & Views

Tuesday, Aug 7, 2012

Health Insurance & Cashless Policies: The dos & don`ts

   [Source :]
[Source: The Economic Times]

What are cashless policies?

Cashless policies mean that the health insurance company settles the bill directly with healthcare provider, whether a hospital or a nursing home. This is to reduce the direct financial burden on insured individual at the time of hospitalization. Therefore, whatever bill is raised by the healthcare provider, Insurance company settles it directly through a Third Party Administrator. The TPA acts as a mediator between hospitals and insurance company and settles the medical bills of the insured. It is readily essential for the insured to understand the role of hospitals while availing the cashless mediclaim facility.

You can avail of the cashless facility at any of the hospitals in the insurance company’s network by presenting valid documentation on admission. Cashless facility can be availed in case of planned and emergency hospitalisation and thus help you with your medical services

How does insurance health cashless facility work?

To avail the insurance health cashless facility one needs to approach the hospital which is under the PPN (Preferred Provider Network) of your insurance company. The health insurance companies have tie ups with various hospital and to avail the cashless facility you have to get admitted in one of the hospitals with which your insurance company has a tie up with. While you purchase health insurance you need to keep a check if your hospital falls under the preferred provider network of your insurance company.

Once you need to avail this facility all you will have to do is fill a form while getting admitted to the hospital. The completed form is sent to the TPA, depending upon the terms of the policy the TPA, will issue an authorisation or a denial letter to the hospital and also spell out the expense limit.

Once this is done the hospital will immediately start treatment and all your claims up to the admissible limits will be processed by the company in coordination with the third party administrator

Advantages of insurance health cashless facility

Cashless health insurance is of great advantage during medical emergencies

Cashless health insurance facility reduces a customer’s financial burden and helps him recover with peace of mind.

It helps customers who do not have immediate liquid money for pay for their hospitalisation expenses. Thus while you purchase health insurance policy always consider your overall limits under the plan, the depth of coverage and the hospitals so that you avail excellent health care facilities

What you need to keep in mind while you purchase health insurance with cashless facility?

Cashless facility are only available in select hospitals

There is always a risk of delayed response from the TPA as the insurers mostly outsource this function

Poor liaison between TPA and hospitals can cause unnecessary delays in treatment or discharge.

How to choose the best cover?

A good mediclaim policy allows you and your family covered under the policy to take benefits during medical crisis. The two options available are individual and floater policy. Most insurance companies may not cover dental and pregnancy related issues. It’s important to know the insurance guidelines before applying for a health insurance policy. Over all it is very important that you should invest in a health insurance plan to protect yourself from the rising medical costs. The other features that contribute towards choosing a good plan for yourself are:

Maximum renewable age: Beyond this age your health insurance cover will be discontinued. Therefore it is advisable to opt for a policy with a higher renewable age.

Sum Insured:It is the total annual liability under the policy, you should look at a plan that gives you the maximum coverage in your budget

Copayment: It means you claim amount will be divided amongst you and your insurance company by a certain percentage. It is wise to check for this option beforehand.

Limits on specific treatments: Insurers put limits on certain specific treatments such as cataract or cardiac treatments. Make sure that you are ok with these limits.

Waiting period: Check the policy conditions for the various policies and get a clear picture of the waiting periods of specific diseases.

Hospital room rent &Maternity cover: Keep in mind the upper limits here and see if this covers the costs in the hospital of your choice. Check for various sub-limits.

Empanelled Hospitals:Check if your hospital is empanelled under the insurer. This would make life easier while availing cashless facility.

Day Care Treatments:Compare the list of day care procedures covered and choose the best for you

To choose the best health policy from the wide range available in market is a tedious job. However, your task is becoming easier as these days as it is so easy for you to get information online.

Share your Thoughts