Cashless Mediclaim Policy: Understanding the Fine Details of Your Policy

Medical insurance is essential for every homeowner, especially considering the rising cost of healthcare. However, as important as it is, buying medical insurance is a complex task. Before you select a policy for yourself, you should be aware of its details in fine print. This will help you in protecting yourself from unpleasant surprises at the time of the claim. Let’s learn about the fine prints of the popular cashless Mediclaim policy.

What is cashless Mediclaim?

The first and foremost thing you must know about cashless Mediclaim policy is that the insurance company will settle all your medical bills to the amount promised in the insurance agreement. Your out-of-pocket expenses are also reduced in this case. You should be aware of the amount insured by the company before making any major decisions as underinsurance is not only common, but very disheartening as well.

One more basic enquiry you should do before taking a cashless policy is the name of the hospitals which come under its network. Cashless medical insurance can only be claimed at hospitals which are registered with the insurance company.

You have to be completely aware about this information or you will find yourself in trouble claiming the insurance for your medical bills at a hospital which has no link with your insurance company.  These hospitals have tie-ups with the insurance company and they provide full information about the quality of medical services and hospital charges.

Pre-existing conditions

Make sure that you ask your insurance advisor and read through the fine print of the policy regarding pre-existing conditions. Insurance companies often cite these conditions as reasons for not honouring a claim. You should also be honest about these conditions so that there are no issues in the future related to the claim.

Types of cashless Mediclaim policies

Cashless family health insurance– The family health plan allows the whole family of the insured person to take advantage of the medical insurance.  It’s very beneficial for people who don’t want to invest in different policies for each member of the family. Its hassle free as all members get the benefit without going through long term formalities.

Cashless health insurance for senior citizens- People who have crossed the age of 60 can take this policy to cover any pre-existing medical condition in the policy according to the term of the contract.  Ambulance charges and all other medical expenses are covered under this policy.

Ways to claim a cashless Mediclaim

Planned method- If you already know that you will need medical services in near future you should first contact the insurance company and enquire about the hospitals in their network.  Now take your pre-authorization form from the hospital and submit it after filling it without an error. TPA will receive you request and inform the hospital to accept or reject the patient while sanctioning the amount for the treatment.

Emergency- If you need Mediclaim under this condition then you should initiate the process of getting your claim within 24 hours of admitting the patient. It’s necessary to know if the hospital comes under your insured network before it’s too late. The process is the same as above but if you do not have time for TPA’s approval you can pay bills yourself which will be reimbursed by the insurance company.

Expenses not covered in cashless policies

You should also know that cashless insurance does not cover the expenses for visitor fees, service charge, documentation charges, toiletries, oxygen mask, diapers, ambulance charges etc.

Read carefully all the terms and conditions of your policy to gain maximum benefits. Remember, no matter what the insurance advisor says to you, it is always better to read the entire document carefully and ask questions, if any.