A health insurance policy must have a cashless claim settlement feature for a hassle-free experience to deal with any untoward medical emergency. A common feature in mediclaim policies these days, the cashless claim settlement feature lets a policyholder's insurer to directly settle the hospital bills. Compared to this, a claim settlement under the reimbursement process could be a tedious and long process for policyholders involving lots of paperwork.

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What is a cashless claim?

Under a health insurance cover, the cashless claim settlement feature is one wherein the insurer directly settles the medical bills, mostly the hospitalisation charges.

This is considered an excellent feature as the insured is spared from the burden of paying the bills by himself/herself at the hospital and the amount is reimbursed after a couple of days, said Venkatesh Naidu, CEO — Bajaj Capital Insurance Broking Ltd.

“All the hassle of submitting the medical bills and getting the reimbursement is avoided under the cashless claim feature. Most of the health insurance plans offering cashless claim features allow policyholders to take advised treatment at any cashless network hospital of choice,” Naidu told CNBC-TV18.com.

While taking any treatment, it is always advised to check if the hospital falls under the cashless network as the feature is only available with the network hospitals of the insurer. Taking treatment at a hospital outside the cashless network means the settlement of medical bills through reimbursement, a bit of a lengthy process.

Need for the cashless claim process

According to Naidu, the most difficult aspect to deal with while taking care of a loved one at the hospital is going through the financial hassles when paying the medical bills and handling long paperwork. During a medical emergency, one would prefer staying close to the family and support them rather than managing the papers and worrying about accumulating the finances.

To avoid being trapped in such a situation, it is best to invest in a medical insurance plan that offers a cashless claims facility during hospitalisation. The feature rightly takes away all the stress of arranging and handling finances and papers. The feature works best during any medical emergency, Naidu said.

How to avail of claims for cashless health insurance?

In order to avail the cashless claim facility, the insured has to be treated in an empanelled hospital. The process may vary perse the type of treatment — planned or unplanned.

In case of planned treatment, policyholders can submit the cashless claim form to the insurer and the insurance company will inform the hospital about the same. A confirmation letter would be shared by the insurer that needs to be submitted to the hospital.

In case of any unplanned emergency treatment, policyholders need to notify their insurance company administrator within 24 hours of hospitalisation. After the generation of a claim intimation number, the hospital would fill in and submit the cashless claim form to the insurer. The medical expenses will then be paid by the insurance company.

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First Published:Sept 12, 2022 5:07 PM IST