1

Cashless Mediclaim Policy- What You

Should Know?
21/Dec/15
How many times do you remember getting a call from a
relative or friend telling about an emergency
hospitalization and need for cash? Many a times you
run to the nearest ATM and withdraw money to get
your family member admitted in a hospital. Cashless
hospitalization is a service that is designed to avoid
those tensed moments during hospitalization. All the
medical bills are directly settled by the insurance
company, provided the amount doesn't exceed the sum
assured. There's just one catch to a cashless mediclaim
policy, it can only be availed in network hospitals.
Cashless hospitalization is proving to be beneficial for
users, especially
in emergency situations as a
seriously ailing patient may not be able to arrange
money before being treated. In addition, it is also very
likely that he does not know many people in the city. A
cashless hospitalization can simply solve this situation.

Types of Cashless Health Insurance in

India:

There are many types of cashless health insurance in

India which can be broadly classified into following
categories:

1. Cashless Family Health Insurance

This is the cashless family health insurance policy

where sponsor owns the policy and the people covered
under it are called its members. One can get his whole
family covered under one policy or plan.

2. Cashless Health Insurance for Senior

Citizen

This is the cashless health insurance for senior citizens

who cover hospitalization expenses, ambulance
charges, and preexisting diseases subject to terms of
the policy.

How Cashless hospitalization Works?

Health insurance companies tie up with different

hospitals after checking quality of their medical
services
and
negotiating
rates
for
different
procedures. These hospitals are known as network
hospitals and when you get hospitalized in any one of
them, you do not have to settle the bill with the
hospital. Your insurance company that is represented
by TPA (third party administrator) will coordinate and
settle the bill with the hospital.
Basically, there are two ways through which you can
avail cashless hospitalization-

1. Planned Hospitalization
You know beforehand that you will be hospitalized in
next few days and it means, you have ample time to
decide from which hospital you want to avail services.
Here is what you need to do

Read your health insurance policy or call

on the toll free number of insurance company to know
nearby network hospital.

Once you have finalized the network

hospital, take your policy card to the hospital and ask
for a preauthorization form, which you can get from
the insurance desk at hospital or you can also
download it from the TPAs website. Usually, the first

part is filled by the patient, while the other part is

filled by attending physician.

Submit your form at the insurance desk,

where it will be scrutinized to ensure its authenticity.

Then the form will be faxed to the TPA who

will process it and either approve or reject it

If your form is approved then TPA will send

authorization letter detailing the sanctioned amount
for the treatment.

2. Emergency Hospitalization
This is where you need immediate medical care. You
should make sure that you initiate the cashless
mediclaim facility within 24 hours of hospitalization.
Things you will need to do are

Show your health insurance card at the

hospital, which will contain your policy number, name
of your insurance company and the type of health
policy you are holding.

Fill in the pre-authorization form after

which the person at the insurance desk will expedite
your claim process. However, if you cant wait for the
TPA approval, you can pay hospital bills and later
reimburse it from your insurance company.
The protocol says that in emergency conditions, a TPA
should process a claim within 6 hours.

What is Not Paid in Cashless health

insurance?

There are some expenses which are not even covered

by cashless hospitalization

Attendant/Visitor fees

Ambulance charges

Toiletries

Service charge

Expenses
nebulizers, etc.

for

oxygen

mask,

diapers,

Documentation charges

Top
Reasons For
in Mediclaim Policy

Claim

Rejection

Wondering why your claim is rejected by the insurance

company? We have listed below some of the top
reasons of rejection1.

If the illness for which you have been

hospitalized is not covered by your insurance policy

2.

If you exhausted entire sum assured for

that period

3.

If the information contained in the preauthorization form is insufficient to approve the claim

4.

If the information provided on the preexisting ailment is insufficient in the pre-authorization

form

5.

Delay
hospitalization

in

intimating

TPA

about

TPAs cannot reject or partially disallow claims=

Bombay High Court
The Bombay High Court has held that decisions to
reject or partially disallow health insurance claims are
to be taken by insurance companies and not by TPAs
who offer various services to policyholders on the
behalf of insurance companies. The move is likely to
bolster the claim process because it has been seen
that TPAs are given incentives by insurance companies
to reject claims and in their attempt to earn
incentives, TPAs reject claims at the first stage.

Points to Remember before

Cashless Hospitalization Plan

buying

1.

Cashless hospitalization is available only at

network hospitals

2.

It is the hospital responsibility to give a

justification of the treatment you are undergoing

3.

Remember to keep a photocopy of all

documents, including medical bills, lab reports, claim
form and discharge papers

4.

Remember to carefully read terms of your

cashless policies because there are many conditions
that could make you ineligible to avail cashless
hospitalization

5.

Usually, an insurance company agrees to

pay part of the sum required for the treatment of the
patient. In some cases, if the policyholder exceeds the
sum assured, then the policyholder will require to pay
the excess amount

Future Insights of Cashless Insurance

Recently, health insurance companies are lining up

cashless OPD to make life easier for patients. It means
now patients dont need to be hospitalized for
minimum 24 hours to avail cashless hospitalization.
Apollo Munichs Maxima is offering vouchers for
consultancy and pharmacy and similarly, ICICI Lombard
is also planning to launch cashless OPD product.

Dont Put Your Health at Stake, Trust

Only Leader When it Comes to Choosing
the Cashless Mediclaim Procedure
Making the complicated insurance comparison an
uncomplicated process, the team at PolicyBazaar is at
its best when it comes to finding a right cashless
hospitalization plan. By entering basic details like
name, age, annual income, etc, you will be able to get
mediclaim quotes at free of cost!
Compare health policies from various providers at
PolicyBazaar and ensure that you get the right cover
for yourself and your family.

Articles

Videos

Expert Speak

News / Media

FAQ

Ask

10

Buying Health Insurance Policies

Online
MANISH CHAUHAN 78 COMMENTS

Finding a suitable health insurance policy is akin to finding a

needle in a haystack. There are 21 health insurance
companies in India and many offer more than one type of
health insurance product. Joining the bandwagon are life
insurance companies who are now offering health insurance
policies as well! So how do you buy one? First, make sure you
know what you need whether it is an individual health
insurance or a family floater you are seeking; how much cover
you need and when you need it.

How do I go about buying a health insurance

policy?
Traditionally, health insurance policies have been bought
either because they were sold or because of awareness
among investors through advertisements. And a majority of us
rely on the group health insurance cover provided by our
employers anyway.
The simplest way to go about buying a policy is to get in
touch with the insurers and ask for premium rates. But this
has its own limitation you could easily take a month to get
all the details and the insurance agent could really be slow in
his response after all its a health insurance policy he is
selling and it fetches him less commission!
Go online : Another easy way is to use insurance comparison
sites or aggregators as they are called. Aggregators provide a
single window to compare quotes and features from multiple

11

insurance companies and help a customer select the most

suitable one. There is a whole lot that have mushroomed in
India of late.
The best health insurance aggregator website in our opinion is
Coverfox.comwho gives you the results in a decent interface.

How do aggregator sites work?

Once online, all you need to do is provide your age, how much
coverage you need and for how long typically this is one
year with most insurers today. The portal will collect personal
information email id, city and phone number to reach out to
you later on do provide this if you are a serious buyer.
Once you enter all relevant details, you are shown a plethora
of policies and you can check each one out before selecting
the one you want to buy. Most of the aggregator sites will
collect payment from you upfront and liaise with the
insurance company who will close the deal with you.
Aggregators get a small marketing fee from the insurance
companies for policies that they sell online. In response to this
article, Deepak Yohannan, CEO and co-founder of iGear
Financial Services says The process of buying online
insurance has been made as simple as buying a flight or a
movie ticket online. In the last one year, there have been
considerable improvements in the online buying process.
Example
Suppose you are 30 years old and need health insurance for
Rs 3, 00,000/- for a year. The following is a sample of the
health insurance covers that are on offer. Lets just talk about
individual health insurance plans for now.

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Imagine the time you would have spent on collecting this data
and comparing it if you were to do this offline.

Filtering the unwanted

How do you select what you want to buy? Remember that the
aggregator site provides you comprehensive information on
each policy and even lets you compare them some sites will
allow you to compare two policies at a time while others will
allow you to compare more. The comparison feature compares
side by side almost everything an insured would want from a
health policy this way an aggregator site is very powerful to

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help you decide which policy scores better. After you have
compared and selected your policies, all you need to do is
apply the same filtering techniques one would use when
buying a policy offline to select the best one that you will
finally buy. There are a host of parameters that one could
apply.
In the example above, with so many policies available with
such a wide range of premiums, a best practice could be to
pick a policy with the highest, lowest and midway premiums
for comparison and then apply the filtering parameters. We
apply two of the most important comparison parameters first.
Firstly, start with the maximum renewal age as the first option
select the insurer which allows you to renew the policy till
maximum age. If you want to change to a new insurer at an
advancing age, this will be looked at as a new policy and will
come with a higher premium. Its best to stick to a policy
which can be renewed till the maximum age. Secondly, check
when all the insurers will allow pre-existing illnesses to be
covered. The earlier they start covering all pre-existing
illnesses, the better. Usually there is a waiting period of a
couple of years before which expense incurred on pre-existing
illnesses start getting covered.
The waiting period varies from company to company. Filter
more by checking on what are the special features that are on
offer and go through the exclusions with a comb. Exclusions
are most important as far as a health policy is concerned
you dont want to get a claim rejected because you did not
know what was not included in the policy. Does the policy
cover maternity expenses or ambulance expenses? Generally,
there will be sub-limits for many of the expenses within the
overall limit, for eg, room rent could be 1.5% of sum insured
per day. So if you are staying in expensive cities like Mumbai

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or Delhi, for a cover of Rs 3,00,000/- the room rent charges

come to Rs 4500/- per day. Think whether the hospital you
want to go to will have a room that can be accommodated in
this range. If not, you would be better of settling with a no
sub-limit policy.
Its worth noting that most of the policies will cover expenses
incurred a month before and 60 or 90 days after
hospitalization; free annual health check claims and a 24 hour
helpdesk among a host of other common services which
generally should not be used as key comparison parameters.
Here is how the data looks like in our example for the highest,
lowest and mid-way premium figures.

Which one would you buy from the above? Its clear that the
first policy is better as pre-existing illness are covered from
the third year onwards and there are no sub-limits on room
rent and doctor fees so if this meets your criteria, go for it
irrespective of what the premium is.
Checkout

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After having selected a policy that suits you best, all the
aggregator sites are pretty friendly in terms of helping you
check out to buy the policy online after you have registered
with them. The insurance company will contact you for
paperwork within a week of payment.
Issues buying online

Firstly, there are many aggregator sites available in India.

Not each one will cover all the 21 insurers and you could
lose out on some of them. The best way around this is to
use maybe 2 or 3 of them and compare and buy from one
that best suits your requirement.

Some aggregator sites might not have the correct data!

Its best to re-check the details of the policy you have
finalized with the insurer, either on the insurers website
or offline at a local office, before buying.

You still need to undergo medical tests if you are 45 years

of age.

Advantages of buying online ?

For starters, buying online has now become a very simple
process. You do not have to go through the hassle of going
through an agent, who would have a tie-up with limited
number of insurance companies and may not be able to get
the product that you want. The agent may try pushing a
product which they want you to buy. Also, there is complete
transparency in the process when you buy online everything
is there in front of you and then you can make a decision.
With an agent you really do not know if some facts are being
hidden and only the good part of the policy is being
highlighted to you. You realize the worst when the policy

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document comes to you or when you start the claim process.

Having said that, if the agent is a completely trustworthy
person, buying online and offline are the same, says Deepak.
So, here are the advantages:

You save time everything can be done at the click of a

mouse.

Its cheap, you save the costs for the insurer. This is
passed onto you.

You dont have to make a trip to the insurers offices and

wait for time from the agents.

Most of the aggregator sites are easy to use and compare

its a one stop shop to buy policies.

Most of these sites are safe to operate and buy a policy

using card details.

Most aggregators have a FAQ section and ask an expert

section which helps you reach out on queries you might
have.

Quick Bites
Keep the following points in mind when buying health
insurance:

Ask insurers for premium rates or dig the figures out for
yourself on aggregator sites.

Do not base your decision on the premium alone

remember, the policy with the cheapest premium might
not be the best one for you. Also, there is no one policy

17

that can be termed as best for everyone. Select one that

meets your criteria, lifestyle and family requirements and
buy it irrespective of what the premium is.

If you live in a metro, take a cover of 4-5 lakhs; in a

smaller city, 2-3 lakhs of cover will do.

Check whether your policy will guarantee long term

insurability.

Check whether a floater plan is more beneficial for you.

Most importantly, check the policy wordings on what the

exclusions mean to you.

Opt for a cashless plan.

Take health insurance even if you have one from your

employer.

Reveal all your family illness history; if you hide anything,

it will only come back to hurt you.

Buy from a health insurance and not from a life insurance

company.

Buy a critical illness policy separately than as a rider to

your basic health insurance.

Disclaimer: The views and analysis expressed are those of

the author and should not be construed in any way to be the
sole reason of buying a policy online. Please do adequate
research yourself before buying.
This is a guest post from TheWealthWisher, a personal finance
blogger who writes on www.thewealthwisher.com

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FAQ's
1. Why do I need health insurance?
With the advancement in technology, treatments and the availability of
more effective medicines has driven up the cost of healthcare. All this
increase ends up being a burden for the consumers, making healthcare
unaffordable for many. This is where HDFC ERGOs health insurance
policies come into play, as they take care of the hospitalization and
treatment charges, leaving the consumer free of financial woes.

2. What are the benefits of having a health insurance policy?

Having a health insurance policy covers any expenses you might incur
due to hospitalization. This includes in-patient treatments, pre and
post hospitalization charges, day care procedures, domiciliary
treatments,
etc.
For more details log on to (Link of specific page)

3. Is it possible to apply for the policy online?

Yes, the HDFC ERGO health insurance can be applied online with just a
few clicks. There are forms available for submission on the website.
Various online payment options are available.

19

4. What kinds of policies are available for a health insurance plan?

HDFC ERGO provides a number of flexible health insurance policies
that you can choose from based on your needs and requirements.
o The Health Suraksha plan from HDFC ERGO provides cover for inpatient treatment costs, pre-hospitalization and post-hospitalization
expenses,
and
such
other
major
expenses.
o The Health Suraksha Gold plan is an economical plan providing a
cover for in-patient treatment costs, pre-hospitalization and posthospitalization expenses without sub limits, maternity benefits,
convalescence
benefits
and
E-opinion.
o The Health Suraksha Regain plan gives the additional benefits of
automatic availability of sum insured upon its exhaustion offering you
financial security with no sub-limits

5. What other policies are available?

There are a number of policies also available in addition to your health
insurance
policy
o The Health Suraksha Top Up Plus plan is designed to supplement
your primary health insurance policy plan by providing additional
coverage
benefits
at
economical
costs.
o The Critical Illness policy assures a right insurance policy in your
hand which pays a lump sum benefit amount on the first diagnosis of
any
of
the
critical
illness
listed
o The Critical Illness Platinum policy is your perfect savior covering
15 Critical Illnesses and providing a Lump Sum Benefit amount on its
first diagnosis.

20

6. How do I know which policy is best for me?

HOf all the policies offered by HDFC Ergo, you should choose the policy
that best suits your needs. A basic table to compare the policies is
shown above.

7. How can I find how much premium I will have to pay?

The premium for health insurance depends on factors like plan type,
tenure of the plan, age, health adversities if any, sum insured, number
of members covered, etc. There is an online premium calculator
available on our website which you can use to calculate the amount
payable for various health insurance policies.

8. Is there any limitation on age at entry for health insurances?

HDFC ERGOs health insurance plans are open to children from the age
of 91 days. There is no limit for maximum age at entry.

9. What is the procedure for claim settlements?

The
procedure
to
be
followed
for
a claim
settlement:
o You need to register your claim within 7 days of discharge.
o The duly signed claim form and all the information/documents
required need to be sent within 15 days of the occurrence of the
Incident.
o (Please refer to claim form for complete documentation.)
o If there is any deficiency in the documents/information submitted,
you will receive the deficiency letter within 7 days of receipt of the
claim
documents.
o On receipt of the complete set of claim documents, the payment for
the admissible amount will be sent, along with a settlement statement
within
30
days.

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(The payment will be sent in the name of the proposer.)

10. How can I find hospitals where I can avail the cashless facility?
HDFC ERGO has a network of over 5000+ hospitals which will provide
you with cashless facilities. You will be provided a list of all the
associated hospitals. You can also use our hospital locator to find all
the associated hospitals in your area.

* Additional

premium (child) in a floater is available with more than 4

family members A maximum of 5 Family members can be covered
under a Family Floater Plan 2 Year Premium 10% Discount on
premium if Insured Person is paying premium of 2 years in advance
For example: (1) Proposed Insured Age 33 years opting for Health
Suraksha Individual - silver 2 year policy with Sum Insured of Rs. 2
Lac. Calculation 2863X 2 X 90% = Rs. 5153.4/- plus taxes. (2)
Proposed Insured Age 35 years opting for Health Suraksha Individual
- Silver 2 year policy with Sum Insured of Rs. 2 Lac. Calculation
(2863+3593) X 90% = Rs. 5810.4/- plus taxes. Family Discounts 1)
Family Discount of 10% if 2 or more family members are covered
under Health Suraksha on Individual Sum Insured basis Optional CoPay Discounts (1) 25% discount on base premium if the Insured opts
for 20% Co-pay option on his/her Health Suraksha Plan (2) 10%
discount on base premium if the Insured opts for 10% Co-pay option

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on his/her Health Suraksha Plan Optional Benefit which can be

availed at additional Premium (1) Regain Benefit- additional
premium of 5% of the base premium (2) Enhanced Culumative
Bonus- additional premium of 2.5% of the base premium Regain
benefit & Enhanced Cumulative Bonus- additional premium of 7.5%
on the base premium Special Conditions Co-Pay Option and Regain
Benefit cannot be taken together. Loadings Floater plan option is not
available

Health Suraksha Regain

Uncertainties and unfortunate events can catch you off guard and unprepared
in form of illness and injuries. The escalating medical treatment and
recuperating costs add more pain to injury by draining your savings. Now be
prepared with for those ill-fated times with an extensive medical coverage that
lets you focus on the health recovery of you and your loved ones without
making you torment about the finances.
Get a comprehensive health insurance plan with a diversified portfolio of
services from the best health insurance policy online with HDFC ERGOs
Health Suraksha Regain.
HDFC ERGOS HEALTH SURAKSHA REGAIN PLAN
HDFC ERGO comprehends your needs of a secure and healthy future that
guarantees coverage in case of medical exigencies while befitting your budget
well. Health Suraksha Regain Plan acts as your companion in emergencies
and provides a comprehensive medical insurance plan that offers coverage for
in-patient treatment costs, pre-hospitalization and post-hospitalization
expenses, and such other major expenses.
With Health Suraksha Regain insurance plan, you can avail the additional
benefits of automatic availability of sum insured upon its exhaustion. Our
seamless services offer you financial security with no sub-limits on the hospital
room rents, hospital charges, diseases and doctor fees.

23

Get instant quotes online on your desired health insurance policy and buy the
right Health Suraksha Regain Plan for you and your family, on just a click. (*
Subject to the change in Tax Laws)

Key Highlights

Features

Regain Benefits

Discounts

Exclusions
Key Highlights

Optimized health insurance plans at affordable cost

A network of more than 5000+ hospitals to choose from to avail cashless services

No limit for age at entry

Sum Insured 300000, 400000, 500000, 750000 & 1000000

AYUSH cover available without any sub limit

Enhanced Cumulative Bonus @ 10% per claim free year upto 100% of Sum insured

Option to choose from Individual or Family Floater Health Insurance plans

REGAIN benefit Automatic availability of Sum Insured upon its exhaustion

Get benefits on Income Tax under Section 80D of the Income Tax Act

Enjoy hassle free claim procedures with least documentation and settlement times

No Sub-limits on any disease, room rent, hospital charges and doctor fees

24

Home
Insurance
Health Insurance
Cashless Health Insurance

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Cashless Health
Insurance
Overview
To understand cashless health insurance an understanding of health
insurance in general is necessary. Health insurance is an instrument that
can be used to ensure that, in case of a medical emergency, policyholders
are able to provide their families with the best medical help possible.
There are times when this medical help might be too expensive for some
people and that is where a health insurance policy steps in to help pay the
bills. The cashless mediclaim policy is a type of insurance where
policyholders can be hospitalised, get the relevant treatment and be
discharged without having to pay anything from their pockets.
Check Your Eligibility

Key Features
The features of any cashless policy will depend on the insurer who
provides the insurance but some of the most common features are:

Pre & Post Hospitalization Medical Expenses

In-patient Care
No-claim bonus
Complementary health check up
Daily cash benefits
Cover for ambulance charges
Cover for domiciliary treatment

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Cover for critical illnesses like cancer, heart attack,

stroke, etc.

Tax benefits

Free-look periods

Understanding Cashless Hospitalization

Q. What is cashless hospitalisation?
A. What is meant by cashless hospitalisation is that when you get
admitted in the hospital for treatment, for an illness covered by your
health insurance policy, you dont have to pay for the treatment from
your own pocket.
Q. How does cashless hospitalisation work?
A. Health insurance providers enter into agreements with various
hospitals which state that patients holding cashless mediclaim policies
wont have to pay the hospital for treatment. The charges will be paid
directly to the hospital by the insurer.
Q. Is there anything that the policy will not pay for?
A. These policies generally cover only the expense of the treatment. This
could include cost of medicines, medical procedures, fee for
anaesthesiologist and surgeons, ambulances, rooms, etc. They will not
cover expenses that are non-medical in nature. Most insurers provide lists
of items that the policy wont pay for and should be consulted by
policyholder. The list could include items like tissue paper, air
conditioning, television, etc.
Q. Why is it important to take cashless health insurance?
A. If you were to need hospitalisation for something and did not have
enough money to pay for the treatment, or even a part of the treatment,
your options for proper medical care would be severely limited. With
cashless health insurance you can be assured of the best possible
treatment even if you dont have the money to pay for it.

27

Q. Is it different from other policies like family floater, individual, etc.?

A. No, a cashless policy is essentially the same as an individual policy or a
family floater policy. It will even provide the same benefits as them and
have the same exclusions. The best way to describe it would be to say that
the cashless part of a health insurance policy is actually a benefit or a
feature rather than a type of policy.
Q. How is it different from co-pay?
A. In co-pay policies, policyholders and insurance providers share the
hospital expenses. A certain percentage of the medical bills are paid by
the policyholder while the remainder, the lions share, is paid by the
insurance company.
Q. How is it different from reimbursement?
A. If you go for treatment to a hospital that is not a part of the network
hospitals, you need to make the payments from your pocket and then
submit the bills to get a reimbursement from the insurer. In a cashless
policy, the payment is made directly by the insurance company if
treatment is done in a network hospital.
Q. What is the tenure of the cashless health insurance policy?
A. Cashless health insurance policies, like most health insurance
products, come with a standard tenure of 1 year. They need to be renewed
every year. Some insurers, however, do offer tenures of 2 years at a time.
Q. How long can I renew the policy for?
A. Most cashless mediclaim policies can be renewed throughout the
lifetime of the policyholders.
Q. What if I fail to renew the policy in time?
A. In case you fail to make the payment for the policy by the due date,
you will be given a grace period of 15 days. However, it must be noted
that in most cases, insurance policies are not active during the grace
period.
Q. Is this type of a policy transferable?

28

A. Yes, these health insurance policies can be transferred from one

insurer to another.
Q. Do these policies cover pre-existing illnesses?
A. Yes some insurers may offer cashless policies for pre-existing
conditions however, this facility may be subject to conditions set forth by
the insurer.

Advantages of Cashless Health Insurance

Cashless health insurance policies offer policyholders a wealth of benefits
like:

With this policy in effect, policyholders dont have to

have ready cash to cover medical expenses.

Some cashless health insurance policies will be valid

outside India as well. This is more of a feature and will
depend on the insurer.

It will provide for tax benefits under section 80D of the

Income Tax Act 1961. The limits defined are Rs. 20,000
per year for senior citizens and Rs. 15,000 for all others.

Some of the insurers will also provide policyholders

free medical check-ups at regular intervals.

Who should buy Cashless Medical Insurance?

Just the convenience of cashless insurance is enough to convince anyone
of buying this policy but those that could benefit the most from these
policies are self-employed individuals where there is no regular income
coming in. For such people a cashless policy could make a lot of
difference in case of an emergency. The same can be said for individuals
who cannot afford the cost of expensive medical treatments. A cashless
policy could also be of great help if the person plans on traveling abroad
as some companies offer health insurance cover outside India too.

29

Exclusions
While health insurance plans do offer to cover most of the medical
emergencies and conditions, the cover is subject to exclusions. These
exclusion are of two types, temporary and permanent. Temporary
exclusions are expenses that the policy wont cover for a period defined
by the insurers while permanent exclusions are expenses that the policy
will never cover. These things could be:

Pre-existing illnesses
Congenital disease
HIV/AIDS
Non-medical expenses
Injuries or ailments acquired in the course of
conducting illegal activities
Routine medical exams
Dental procedures
Joint replacements unless it is necessitated by an
accident
Experimental treatments
Injuries or medical conditions caused by terrorist acts
or wars

An Example
Consider 2 people, Divya and Parul. Each of them is married and covered
by a substantial health insurance plan. The cover provided by their health
insurance plans too is the same, and covers the same medical treatments.
The only difference is that Divya has a co-pay family floater plan and
Parul has a cashless family floater plan. It so happens that they need to be
hospitalised for the same illness. Each one of them gets admitted and
receives the same medical treatment, which costs the same at both

30

hospitals, but when the time comes to be discharged Divyas bill is

considerably higher than Paruls. How could this be?
The difference in the bills cropped up because Divyas co-pay policy only
paid part of the medical expenses. The remainder was to be paid by her
along with the bill for the sundry expenses which means that Divya now
has to dip into her savings to pay the bills. On the other hand Paruls
cashless policy paid for the entire treatment and all she had to pay for
was sundries that were not covered by the policy.
This is but one example where a cashless policy makes the most sense.

Top Health Insurance Policies with Cashless

Hospitalization:
1.

Max Bupa Health

Insurance:

Health Companion:
o
It is a comprehensive family floater
health insurance plan
o
Offers cover for hospitalisation,
hospital accommodation, pre and post hospitalisation
medical expenses and day care treatments
o
Offers cashless facility at your nearest
network hospital
o
Direct claim settlement
o
Offers tax benefits
Heartbeat:
o
family

Designed especially for the Indian joint

31

Offers cover for up to 14 relationships

with individual and floater sum assured
o
Cashless approval within 4 hours
o
Assured policy renewal for life
o
Offers a wide range of hospital cover
including maternity facility, newborn care, vaccination
cover and much more
2.
Apollo Munich Health
Insurance:
o

Optima Restore:
o
Offers a wide range of cover
o
Offers restore benefit
o
Offers everyday cash for shared
accommodation
o
Comes with tax benefits under section
80C of the Income Tax Act
o
Multiplier benefit
Easy Health:
o
Offers a comprehensive cover
o
Offers cover on individual sum basis
with an add on optional cover for critical illness
o
Offers daily cash for shared
accommodation
o
Provides recovery benefit

32

Offers cashless service for planned

o
admission

Optima Cash:
o
Optima Cash by Apollo Munich is a
top up health insurance plan
o
Offers a vast cover including day care,
convalescence benefit and parents hospitalisation and
much more
o
Sum insured enhancement
o
Offers cashless service facility to
ensure the policyholder doesnt have to worry for cash
at the time of a medical emergency
Optima Vital:
o
It is a unique critical illness health
insurance policy
o
Offers cover for critical illnesses and
other conditions
o
Offers sum insured enhancement
o
Offers portability
o
Provides cashless service
Optima Super:
o
o
the plan
o

It is a top up health insurance plan

Offers waiver of deductible benefit on
Cashless service with pre authorization

33

Offers portability
Offers tax benefits
Offers value added service like health

o
o
o
risk assessment
3.

Reliance Health
Insurance:

Health Gain:
o
It is a general health insurance policy
offered by Reliance
o
Provides different plans including
family floater plan and individual plan
o
Cashless hospitalisation in over 4000
plus network hospitals
o
Lifelong renewal of the health
insurance policy
o
Quick and hassle free claim settlements
Health Wise:
o
Health insurance policy with a
comprehensive cover
o
Provides cashless hospitalisation
o
Reinstatement of base sum insured
o
Offers a variety of options to choose
from
o
Easy medical claim settlements

34

4.

ICICI Lombard Health

Insurance:

Health Care Plus:

o
Individual health insurance cover for
each member of the family
o
Flexible sum insured
o
Flexible deductibles
o
Offers cashless facility
o
Long term cover
5.
Religare Health
Insurance:
Care:
o
Health insurance policy with
comprehensive coverage
o
Speedy claim settlement
o
Cashless treatment at 4600+ hospitals
& Daily allowance
o
Auto recharge of policy sum insured if
it has exhausted
o
Lifetime renewability
Joy:
o
Offers a wide cover including new born
cover
o
A combination of hospitalization and
maternity insurance

35

100% increase of sum insured with no

o
claim bonanza

Cashless treatment at 4600+ hospitals

Waiting period of 24 hours for

o
o
maternity claims

Enhance:
o
It is a top up health insurance policy
o
Cashless treatment available
o
No paperwork required
o
Lifetime renewability
o
Health check-ups for insured members
every year
6.
New India Assurance
Health Insurance:
Floater Mediclaim Policy
o
It is a health insurance policy offering
a wide cover
o
Offers cashless benefit
o
Offers critical care benefit
o
Hassle free claim process
Asha Kiran Policy
o
Offers health insurance cover for the
family
o
Offers cashless benefit
o
Critical illness benefit

36

Hospitalisation necessary to get a claim

Senior Citizen Mediclaim Policy

o
Health Insurance policy designed
especially for senior citizens
o
Pre acceptance health check up
o
Offers a wide health insurance cover
o
Provides cashless hospitalisation
o
Hassle free claim process
7.
Future Generali Health
Insurance:
Health Suraksha- Individual
o
It is an individual health insurance
policy
o
Pre acceptance medical tests up to 40
years
o
Offers additional accidental
hospitalisation
o
Provides cashless hospitalisation
o
30 days renewal policy
Health Suraksha- Family floater
o
It is a family floater health insurance
policy
o
Offers portability
o
Free health check up

37

Offers cover for a wide range of

medical conditions
o
Quality health insurance at a low
premium
o

Future Criticare
o
It is a critical illness health insurance
cover
o
The policy will pay a lump sum benefit
on the diagnosis of specified critical illness
o
Offers cashless service at network
hospitals
o
Offers tax benefits under section 80C
of Income Tax Act
o
Hassle free and easy claim process
Why Buy Online
With the busy schedule that most people maintain, these days, it is very
difficult to sit and talk to an insurance agent, just to understand which
health insurance policy is the best. With BankBazaar.com not only is this
process simplified but it also offers much more flexibility. Instead of
sitting with someone and talking about various plans, all you have to do is
enter your basic information and we will provide you with a choice of
plans, from different insurers, which suit you the most. You can even
apply for these plans using the BankBazaar website.

News About Cashless Health Insurance

Rajasthan Government to launch a new Cashless Health Insurance

scheme

38

The Government of Rajasthan today declared its plan to launch a

cashless health insurance plan. The plan is designed to include more
than 1 crore people starting from 13th December. To execute this plan of
launching a new cashless health insurance scheme, the Rajasthan
Government has signed a Memorandum of Understanding with the
New India Insurance Company.
The government has so far covered 67% of its people by creating health
cards. Consumers having Bhamashah Yojna Card will also be able to
enjoy the benefits of this new health insurance scheme. The e-health
cards would be made ready by December 13th, 2015. As per this new
scheme, a person would be able to enjoy the benefits provided under
this scheme in 1700 select hospitals. The scheme would provide coverage
up to Rs. 3 lakhs which is subject to pre and post hospitalization.

25th November 2015

App from Remedinet Technologies for Cashless Settlement of

Health Insurance Claims
Remedinet Technologies launched two mobile apps that provide the
status of cashless health insurance claims to patients and hospitals.
The apps were launched on Windows 8.1, Android platforms and
Microsoft Visual studio. Hospitals can download the Remedinet
Hospital mobile app to access information regarding claims while the
customers can download the Remedinet Consumer app to check the
status of their claims. For the consumers, the application will act as a
boon since it is easy to navigate and information can be accessed just
by entering details such as name of the patient or reference number of
the claim.

39

13th May 2015