It is a kind of health insurance policy, which allows you to get treatment at a hospital (hospitalisation, surgery, or both depending on the kind of policy) without having to pay for it at the hospital.The insurance company settles the bill directly. The aim is that you should not have to worry about arranging funds when faced with a medical emergency that needs hospitalisation.You, however, need to go only to a network hospital. With other mediclaim policies, you can go to any hospital, settle the bill yourself and claim insurance later.Cashless claims can be of two types:-
Planned: Where the insured is aware of the hospitalisation 2-3 days in advance.
Emergency: Where the insured or any covered family member meets with sudden accident or suffers from bout of illness that requires immediate hospitalisation.In case of pre-planned hospitalisation, you should get it pre-authorised from third-party administrators. A TPA is an important intermediary between the insurance company and the hospital. It verifies your policy details, on behalf of the insurer, and gives clearance for the cashless services to be processed.
In case of an emergency, you only have to give the network hospital the cashless treatment card number. In emergency cases, TPAs should not take more than six hours, and not more than four days for other cases.
Also, like any insurance policy, your cashless settlement policy will work only under certain conditions. You need to be sure of the details of the policy like which are the network hospitals, or which illnesses and surgeries are covered.There are many people who make wilful claims. A cataract operation costs Rs 10,000 at a good hospital, but they will go to a more expensive one.”Cashless settlements form just four to 20 per cent of the total hospitalisation expenses in India. For these policies to become more successful it is important that insurance companies ensure that customers are able to experience the convenience.