Cashless Health Insurance

Healthy living is an expensive luxury that not everyone can afford. The current era has experienced such high rates of inflation that it is now utterly impossible to live comfortably and save money at the same time.

  • We put so much effort and willpower into working hard every day to earn our living. But because life is unpredictable, even the smallest mishap can leave us broke.

  • A health emergency is frequently unanticipated and unexpected. Until a condition worsens to the point where a person needs to be hospitalized, people are unaware that they are ill.

  • We may experience financial instability if we have unpaid medical bills in such a circumstance. However, cashless health insurance makes sure that you won’t have to deal with such inconveniences.

Cashless Health Insurance Online

Any of the network hospitals on the provided list that your insurance company has partnerships with accepts cashless mediclaim. You will be able to select the top medical care offered at the time because the hospital and insurance provider will work directly with one another to settle the bill.

  • It goes without saying that having cashless medical insurance in place is essential in this situation because you won’t have to pay the costs.

  • It can be difficult to deal with the panic that sets in when one of our loved ones experiences a medical emergency. A cashless medical insurance policy is necessary in these difficult times so that you won’t have to worry about coming up with large sums of money right away.

Continue reading to learn more about cashless health insurance and how it will protect you in such situations.

What Is Cashless Medical/Health Insurance?

The majority of health insurance plans have a benefit called “cashless hospitalization.” What, however, does this feature actually entail? Basically, this feature makes it simpler and more convenient for you to pay your hospital bills.

  1.  You can relax knowing that your insurance company or the TPA (third-party administrator) will handle your finances in the event of an emergency medical situation.

  2. You can use the cashless mediclaim at any hospital on the list of network hospitals with which your insurance company has agreements. You can choose the best medical care available at the time, and the hospital and insurance company will deal directly with each other to settle the bill.

  3. Having cashless medical insurance in place is crucial because you won’t be responsible for paying the costs in this scenario.

Usefulness Of Cashless Health Insurance

Having cashless health insurance, also referred to as a cashless mediclaim policy for family health and well-being, protects you from stressful situations like figuring out how to pay for expensive medical bills. The following are some major reasons why cashless health insurance is crucial:

  1. Focussing on the treatment ensures

  2. Option to select the best therapy and physician without worrying about cost

  3. Saves the time, money, and effort required for the entire hospitalization process.

  4. Direct payment of bills between the insurance provider and the network hospital

Features That Are Important For Cashless Health Insurance

There are a few rules and regulations pertaining to the cashless health insurance facility, subject to the conditions and agreements of your policy. For a successful claim on medical bills, one must carefully review the following features:

  • To enable the cashless claim, the insured person must only be admitted to one of the hospitals on the listed network.

  • One should look into the number of affiliated hospitals that the insurance provider has before purchasing cashless medical insurance. The availability of many hospitals offering cashless hospitalization and medical care would be ensured by a higher number.

  • Respecting the deadline for the cashless health insurance application process is essential.

  • Both planned and unplanned claims may be made under a cashless health Mediclaim policy.

Cashless Health Insurance Options in India

There are primarily three types of cashless health insurance available in India, and they are as follows:

1. Family health insurance that accepts cash

The policyholder’s entire family can receive cashless treatment under this cashless family health insurance policy.

2. Cashless Senior Citizen Health Insurance

For senior citizens, there is a cashless health insurance program that, subject to the terms of the policy, will pay for pre-existing conditions, ambulance fees, and hospitalization costs.

3. Cashless Critical Illness Health Insurance

People with critical illnesses, such as cancer, heart attacks, etc., can receive cashless treatment through a cashless critical illness health insurance policy.

What Makes Cashless Health Insurance Important?

When you are cash-strapped or do not have immediate access to cash during a medical emergency, cashless health insurance is essential. It is intended to do away with all forms of cash payment for prompt medical care. Additionally, it enables people to receive the highest caliber medical care without worrying about finding money to cover hospital bills.

What Is the Process for Cashless Health Insurance?

The inconvenience of having to pay cash at the hospital when you’re in need is essentially eliminated by cashless health insurance. Insurance companies offering cashless health insurance conduct direct negotiations with hospitals in their network to determine the cost of the treatment received by the insured person.

  • These hospitals, which become known as the insurance company’s network hospitals, work in conjunction with them.

  • The insured does not have to pay the hospital at the time of discharge if they are hospitalized in a network hospital. Instead of doing so, the insurance provider or their TPA (third party administrator) will work with the hospital to arrange payment.

  • Furthermore, health insurance providers now provide cashless OPD services to their insured clients. This implies that patients are no longer required to stay in the hospital for a minimum of 24 hours in order to use cashless hospitalization services.

Claiming Cashless Health Insurance For Emergencies

When a medical emergency strikes suddenly and without warning, an unplanned hospitalization results. These can include incidents where the victim was not informed that they were being admitted to the hospital, such as an accident or heart attack. Cashless insurance can significantly lessen the stress at this difficult time. Take these actions:

  1. The insurance company should be notified of the hospitalization within 24 hours so that the insurance card, copy of the policy, customer ID proof, customer address proof, and other forms can be generated.

  2. The network hospital will then complete the forms for a cashless claim and send them on to your insurance company.

  3. The insurance company will then get back to the network hospital with an authorization letter. The bill will then be settled between the parties involved, and all that is left for you to do is take care of your loved one.  

  4. A reimbursement is an option if admission to one of the hospitals on the specified list of network hospitals is not practical. In this case, you would be responsible for paying the entire bill. Later, you could submit a claim to your insurance company with the necessary paperwork and medical bills.

The Workings of Cashless Health Insurance

  • The inconvenience of having to pay cash at the hospital when you’re in need is essentially eliminated by cashless health insurance. In order to pay for the treatment received by the insured person, insurance providers for cashless health insurance engage in direct negotiations with hospitals in their network.

  • They collaborate with these hospitals, which come to be known as the insurance company’s network hospitals.

  • The insured does not have to pay the hospital at the time of discharge if they are hospitalized in a network hospital.

  • Instead of doing so, the insurance provider or their TPA (third-party administrator) will work with the hospital to arrange payment.

  • Furthermore, health insurance providers now provide cashless OPD services to their insured clients. This implies that patients are no longer required to stay in the hospital for a minimum of 24 hours in order to use cashless hospitalization services.

How to Avail Cashless Hospitalization?

In essence, there are only two ways to receive cashless hospitalization:

Planned Hospitalization

When you know ahead of time that you must be hospitalized in the coming days, this is referred to as planned hospitalization. In this situation, if you want to use cashless services, you must select a network hospital. When planning a hospital stay, follow these steps to receive cashless hospitalization:

  • To find the closest network hospital, call the insurance company’s toll-free number.

  • Once you’ve chosen a network hospital, present the hospital with your insurance card and request a pre-authorization form. This form is available at the hospital’s insurance desk or online through the website of the insurance company.

  • Your application should be turned in at the insurance desk where it will be reviewed to ensure its validity.

  • The TPA will then receive the form by fax and process it before either accepting or rejecting it.

  • When your pre-authorization request is approved, TPA will send you an authorization letter with specifics about the treatment’s sanctioned cost.

Emergency Medical Admission

You should start the cashless mediclaim facility within 24 hours of hospitalization if you need emergency hospitalization because you need immediate medical attention. The following describes how to obtain cashless hospitalization:

  • Present your health insurance card, which will include your policy number, the name of your insurance provider, and the kind of health plan you are currently holding, at the hospital in the network.

  • Fill out the pre-authorization form, and the insurance desk employee will speed up the claim procedure. You can pay hospital bills and later receive reimbursement Claimfrom your insurance provider if you are unable to wait for the TPA approval.

A TPA is required to process an emergency hospitalization claim within 6 hours in emergency situations, per protocol.

What Does Cashless Health Insurance Not Cover?

Cashless health insurance does not always provide coverage for all medical costs. Check them out below:

  • Visitor/attendant fees

  • Hospital fees

  • Toiletries

  • Service fees

  • Costs for diapers, nebulizers, oxygen masks, etc.

  • Charges for documentation

Things to Consider Before Purchasing a Cashless Health Insurance Plan

The following are some considerations to keep in mind when using a cashless health plan to access the facility of cashless hospitalization:

  • Hospitalization without payment is only possible at network hospitals.

  • It is the hospital’s duty to explain why you are receiving the treatment you are.

  • Prior to leaving the hospital, don’t forget to make a photocopy of all relevant paperwork, such as the claim form, medical bills, lab results, and discharge papers.

  • You risk having your cashless insurance claim denied. To avoid the TPA rejecting your preauthorization request, make sure all the information on the form is accurate.

  • Always read the fine print of your cashless health insurance policy because there are several circumstances under which you might not be eligible for cashless hospitalization.

  • In most cases, an insurance company agrees to pay a portion of the insured sum needed for the patient’s care. The policyholder is responsible for paying the excess amount if the insured amount is exceeded.

  • Cashless health insurance does not always provide coverage for medical costs.

Rejecting claims for cashless insurance

Your claim might be denied even after you’ve chosen a network hospital and submitted all the required paperwork. A few reasons for claim rejection are listed below:

  • Insurance does not provide coverage for a specific illness.

  • You have used up all of the insurance coverage for that time.

  • The data entered into the form is insufficient.

  • Delayed notification of hospitalization to the insurer.

One of the main advantages of having health insurance with a cashless facility is obvious—you are spared the hassle of making financial arrangements during an already stressful time like a medical emergency.

Top Causes of Cashless Mediclaim Policy Claim Rejection

Some of the most common reasons for rejecting a cashless health insurance claim are listed below:

  • If your insurance policy does not provide coverage for the illness that caused your hospitalization

  • If you have used up your entire insurance benefit for the specified period of time

  • if the pre-authorization form’s information is insufficient to approve the claim

  • If the pre-authorization form doesn’t contain enough details about the pre-existing condition,

  • Delayed hospitalization notification to TPA

 India’s Top Cashless Health Insurance Programs for 2022

The following list of the top 5 best cashless health insurance plans for 2022 is provided: –

Bajaj Allianz Health Guard Family Cover

The Bajaj Allianz Health guard family cover may be the best cashless medical insurance for your family if you’re trying to protect them with a comprehensive cashless insurance policy.

Care Health Insurance Care Plan

Another top cashless insurance plan that offers sufficient protection for both your finances and health is the Care Health Insurance Care Plan.

HDFC ERGO Optima Restore Health Insurance Plan

A well-known and highly regarded cashless health insurance plan in India is HDFC ERGO Optima Restore.

Max Bupa Health insurance Plan

You absolutely cannot avoid this other powerful health insurance strategy.

ICICI Lombard Health Care Plus

Cashless treatment is available within four hours with this well-known health insurance plan.

Other forms of cashless health insurance in India

The following plans are available to you in addition to cashless policies for individuals.

  • Health insurance for your family that doesn’t require cash payments: With this kind of insurance, your family is also covered under your policy. Under the family health plan, you can insure every member of your family for a single premium.

  • Cashless Health Insurance for Senior Citizens – This plan covers a variety of charges or expenses for senior citizens, including ambulance, hospitalization, and pre-existing conditions.

Things To Keep In Mind

  1. Notably, a cashless mediclaim policy and cashless health insurance cover various facets of a health insurance plan. As a result, be sure to understand the type of cashless facility you are using.

  2. The Cashless Mediclaim policy only covers hospitalization costs, so you are responsible for any additional costs.

  3. Depending on the terms and conditions of your policy, cashless health insurance offers complete coverage.

  4. Cashless health insurance plans include a number of exclusions, so it’s important to carefully read the policy wording.


Q1. Can I receive cashless medical care at any hospital?

No, you can only receive care at hospitals that are part of your insurance company’s network if you have cashless health insurance.

Q2. Where can I find a list of hospitals that are part of the cashless health insurance program?

Ans: To learn about the closest network hospital that offers cashless treatment, get in touch with the customer service department of your insurance provider. You can find the network hospital where your cashless health insurance policy is accepted by visiting or the insurance company’s website.

3. Do cashless health insurance plans cover outpatient physical therapy?

Ans: Yes. A number of health insurance plans provide cashless coverage for OPD treatments, provided they are received at an insurance company-approved provider.

Q4. Do I have to let my cashless health insurance company know about my upcoming hospital stay?

Ans: Yes. A minimum of 48 hours prior to being admitted to a network hospital, most health insurance companies demand that you notify them of your intended hospitalization.

5. Am I eligible for tax advantages under cashless health insurance?

According to Section 80D of the Income Tax Act, your cashless health insurance policy qualifies for tax benefits.