How does the Mediclaim policy operate?

A cashless Mediclaim policy is one in which the insurance company and the network hospital settle medical expenditures and hospitalization charges directly. The policyholder is not required to pay any cash. This perk allows you to avoid the reimbursement process at any network hospital.

With cashless Mediclaim coverage for families, you can get the greatest treatment without having to worry about finding the money. Let's take a look at how it works and what you should know about cashless mediclaim coverage.

What Is the Process of Cashless Mediclaim?

When you buy a Mediclaim policy, the insurance company gives you the option of making cashless claims. In other words, you will not be obliged to pay any cash for the costs of medical treatment and hospitalization in the insurance company's network facilities. The insurance company will manage the expenses directly.

To use the cashless Mediclaim service, the patient must be admitted to one of the network hospitals. These hospitals have agreements with insurance companies to provide cashless services. Following verification, policyholders may be approved to make cashless claims, according to the terms and conditions of the policy.

What are the different types of cashless medical claims in India?

In India, there are numerous types of cashless Mediclaim policies. Consider the three major types of cashless health insurance available in India: -

1. Cashless Individual Health Insurance

Individual cashless Mediclaim policy provides coverage for a single person. It can cover all of the individual's medical bills while also providing the advantages of cashless hospitalisation.

2. Cashless Family Health Insurance

You can cover your entire family under a single insurance under this form of cashless Mediclaim policy for a minimal premium amount. A cashless Mediclaim policy for family is typically more expensive than an individual plan.

3. Senior Citizen Health Insurance Without Cash

This sort of cashless Mediclaim, as the name implies, provides coverage and benefits to senior citizens. According to the policy, they will receive cashless payments for ambulance fees, hospitalization bills, and much more.

Cashless Mediclaim Exclusions

When buying a cashless Mediclaim coverage for your family, make sure to read all of the exclusions listed in the policy documentation. You will be better prepared for any potential contingency this way. Exclusions are situations in which you may be unable to make a claim under the policy.

Here are a few exceptions: -

• The cashless mediclaim coverage does not cover self-inflicted injuries, injuries caused by suicide attempts, and so forth.

• Except for accidents, any treatment or medical expenses spent within 30 days of the policy's start date are excluded.

• The cashless Mediclaim policy excludes medical treatments for congenital disorders.

• Expenses related to the intake or misuse of alcohol or drugs are also not covered.

• The policy may not cover abortion or miscarriage-related treatment.

Exclusions may vary amongst cashless Mediclaim policies. Raising a claim for any of the exclusions may result in the claim being rejected right away.

Key Points to Remember

Before purchasing a cashless Mediclaim policy, keep the following considerations in mind: -

• Only network hospitals provide the convenience of cashless claims.

• Keep a copy of everything, including lab reports, medical bills, discharge papers, and the claim form.

• Read the policy's terms and conditions carefully because there may be circumstances that make you ineligible to make cashless claims.

• The insurance company agrees to cover the medical bills. However, if the amount exceeds the total insured, the policyholder must pay the difference.