Categorized | Health Insurance

what you need to know about cashless mediclaim policy

The insurance system in India has at long last woken up to the predicament of the middle-income group. An individual who is not rich enough to head off to a high end clinic nor excessively poor to avail the government sourced social insurance plans, can now be secured by a cashless Mediclaim Policy in hospitals. Pondering on few points linked with the health plan can spare you of unwarranted situations when there is an actual time to utilize it.

Cashless arrangement

The most evident assistance you get while using this health plan is cashless claim, i.e., you do not need to empty your pockets to avail the medical facility. Instead, everything is settled with the help of a TPA who represents your health insurance company and pays your medical bills on behalf of insurance company till your amount of the sum Assured is exhausted. However, there are certain conditions attached which you need to take care of while getting admitted in the hospital.

Empanelled network of hospitals

Your insurance provider has empanelled a list of hospitals to provide you the services. You need to approach only listed hospitals to get treatment in order to get cashless arrangement. Therefore, it is imperative that you are aware about which hospitals are tied up with your Insurer and you get this list when you sign the policy document.

Update your TPA as well as the hospital authorities of the admission

If treatment is planned and Insured needs to be hospitalized, it should be informed to TPA at least 2 days prior to admission. If it is an unfortunate situation then TPA should be updated within 24 hours of hospitalization. Hospital authorities, on the other hand, should be made aware of the cashless health scheme and details while taking the permit to enter the premises.

Do not miss your insurance card

Whatever is the emergency, you should keep your policy card with you. This contains information like insurance company name, type of the health policy you possess as well as your policy number. Displaying your card at every step of Hospitalization would make the process hassle-free.

Duly fill your pre-authorization form

You have fill a form to provide details of your cashless mediclaim policy. This form is now sent to TPA who would provide the necessary details and would arrange for cashless hospitalization.

Certain reasons and Exclusions can become the base of Claim rejection


TPA has got the right to dismiss the claim raised in following conditions:

If the coverages do not include ailments for which insured is hospitalized

If the pre-authorization form is incomplete or incorrect

If the documentation required is incomplete or found to be faulty

If assured amount is used up

Besides, there are certain charges like cost of oxygen masks, nebulizers, diet charges, visitor’s fees which are not to be paid by the insurer. Raise the claim amount only which is acceptable. Keeping these points in mind will help to avoid unnecessary troubles at the last moment.