The Process of Cashless Hospitalization in Health Insurance

The Process of Cashless Hospitalization in Health Insurance

The Process of Cashless Hospitalization in Health Insurance


​​​​​Cashless health insurance plans have become a major requirement due to rising hospitalization costs and the pressure to set up money on the policyholder when planning or emergency hospitalization is reduced. Health insurance itself has great importance. It helps you go for a treatment that you need to have without hesitation regardless of affordability. Cashless hospitalization makes the deal even sweeter when it ensures that the insurance provider takes the burden of your hospital bills directly.

Due to the cashless facility being so beneficial and vital to health insurance, it is important to understand how cashless hospitalization actually works and what benefits are available to the health insurance policyholders.

How it works

The first and most important thing to understand is that the cashless benefit is provided only in the insurance provider’s network hospitals. Simply put, insurance providers tie up with hospitals in a specific area by checking the quality of their service and by checking prices for different procedures to treat the patient. Providers enter into an agreement with such hospitals and the company creates a network of such hospitals for the benefit of the policyholder. And these benefits can be availed by the policyholder for planned or emergency hospitalization and all costs for treatment will be borne by the health insurance provider.

The main advantage of cashless health insurance plans in India is that they relieve the pressure of having to arrange money through relatives and friends to afford treatment for you or your loved ones.The policyholder will therefore not be required to pay anything in the event of hospitalization and will be represented by the insurance provider and will interact with the third-party administrator or TPA. These two parties will briefly coordinate with the hospital and settle the bill. Cashless hospitalization can be done for planned or emergency hospitalization. * Standard T&C Apply

In case of planned hospitalization

Planned hospitalization is when you have enough time to decide which affiliate network hospital you want to join based on the nature of the illness. The most important part is to make the insurer aware of the nature of the disease and to get approval from the TPA.

When you go to a planned hospitalization, you will have time to fill out the required documents for admission, such as a pre-approval form. Once you have filled out such a form, you will need to submit it to the Insurance Desk (now every network hospital has a separate insurance desk to meet the needs of policyholders). Authorization forms can be obtained for websites or from the hospital insurance desk.

After you fill out and submit the form, the form will be approved or rejected based on the terms and conditions set out in the policy. There are many diseases that are not covered by the policyholder.Once the form is approved, it is the job of the third-party administrator to send the letter of acceptance to the hospital and begin treatment. * Standard T&C Apply

In case of emergency hospitalization

This is the area where the policyholder has to get the cashless plan approved within 24 hours of admission to the hospital.The same procedure must be followed for emergency hospitalization to fill out the pre-authorization form and obtain approval from a third-party administrator. In case of emergency hospitalization, it is mandatory to get the TPA form approved within 6 hours so that treatment can continue.In the event of an emergency, the policyholder will have the opportunity to pay the hospital bills and then claim the costs. * Standard T&C Apply

To avail the cashless claims benefit under health insurance, make sure you renew you policy on time. During the renewal process you can use a handy tool called health insurance premium calculator to compute your insurance premium amount. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.


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