Cashless Health Insurance Claims: Meaning and How It Works

  • postauthorOnsurity Editorial
  • postdateFebruary 15, 2024
  • postreadtime5 min read
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Cashless Health Insurance Claims

Have you ever read the full policy document that comes with your health insurance policy? Whether you are renewing your policy or getting one for the first time, there are plenty of terms and conditions you need to know about, like cashless health insurance claims. Knowing these terms and conditions will help ensure that you have the right cashless Mediclaim policy for you. 

Cashless health insurance claims or cashless claims is something you need to ensure you have. This simple, yet very effective feature can help save you a lot of time and energy when it comes to the insurance claims process. That’s what we want to help you understand today.  

By the end of this blog, you should know how cashless health insurance claims work and how to avail them. Here’s your guide to cashless health insurance claims. 

Also, Read: Health Insurance Claim Process

What Are Cashless Health Insurance Claims? 

Whether you have your own health insurance policy or employee medical insurance, you will have the ability to make a cashless claim. Very simply, these are insurance claims where your insurance company pays the hospital directly for your hospitalization. With cashless health insurance claims, you don’t have to worry about withdrawing money or writing a cheque if you are hospitalized, except for the non-admissible amount, your insurance company takes care of the whole process. 

Of course, it’s not an automatic process. There’s still plenty you need to do and remember. That said, cashless health insurance claims do take away some of the hassles of having to file the paperwork for reimbursement, so it’s worth doing if you can. 

Your insurance company will have a wide network of “partner hospitals” that accept cashless insurance claims. Be sure to check with them and find your nearest hospital. It is a good thing to know.  

Cashless Health Insurance Claim Benefits 

The benefits of cashless health insurance claims include: 

  • You don’t have to withdraw large sums of money or write a cheque in case of hospitalization 
  • There is no need to go through the long and complex procedure of claims reimbursement 
  • Your insurance company takes care of the claims process, so you can focus on getting better rather than worry about the paperwork
cashless health insurance claims

If a hospital near you is part of the insurer’s network, they may accept cashless claims for everything your insurance covers. Check with your group health insurance provider if you are on an employee medical insurance plan how many partner hospitals they have. This is good to know, in case of an emergency. 

While you approach the hospital for a cashless health insurance claim you need to carry with you-  your insurance health card copy, your government ID proof and any other documents that would be required based on the features of the cashless Mediclaim policy.  The insurance desk in the hospital will guide you in case any other documents are required. Onsurity members can download their health card via the Onsurity app. 

The insurance claims process will depend on the type of hospitalization – planned or emergency. If you are getting a planned procedure, you need to talk to the insurance desk in the hospital. They shall give you a preauthorization form which you have to fill in partially. Some details will be filled in by the desk, who will then coordinate with your insurance company to either accept or reject the claim.  

If your hospitalization is an emergency process, you will have 24 hours to make a cashless health insurance claim. Just like with a planned procedure, you need to visit the insurance desk to make the claim. That’s why we recommend reading your cashless Mediclaim policy policy document now. That way, in case of an emergency process, you will know exactly what you need to carry and what is covered.  

To ensure that your cashless health insurance claims process is accepted, do remember that: 

  • The hospital needs to be part of your insurance company’s network 
  • The procedure must be covered under your health insurance plan 
  • You need pre-authorization for planned procedures, and bills for emergency ones.  

Also, Read: Difference Between Network and Non-network Hospitals

Are your cashless health insurance claims denied?

There can be some instances where your insurance claims might be denied. While it is easy to blame the hospital or insurance company, many times it can be because your paperwork is not proper. To ensure that there is no unwanted stress at the time of hospitalization, keep the following in mind: 

  • Claims cannot be made for items that are listed under exclusions. What they depend on policy to policy, but some common exclusions include maternity, out-patient expenses, administration expenses, equipment costs, prosthetics etc.  
  • The insurance claims are being made for a procedure that is covered by your health insurance policy up to the amount covered. Some treatments may have sub-limits, so be sure to check those. 
  • You did not file a pre-authorization request before a planned procedure or failed to make the claim within 24 hours of emergency hospitalization. 

Cashless Health Insurance Claims under the Group Health Insurance with Your Onsurity Membership 

If you have a healthcare membership with Onsurity where group health insurance is covered for the members. Our partner insurer has over 6500 partner hospitals for you to avail cashless health insurance claims. We’ve made the process easy with claims support built right into the app. To know more about that, here’s a blog we wrote all about making claims through the Onsurity App.

The Onsurity App also makes it easy to find a network hospital near you. Just tap the ‘Cashless Hospitals’ icon on the home page, and enter your city or postcode. If you have any doubts regarding the process overall, just reach out to our Good Doctors Team. They will be happy to assist you. 

Onsurity’s affordable employee healthcare for startups and SMEs also gives employees access to doctor teleconsultations, discounted health check-ups and medicine delivery, and fitness tracking. With us, health benefits for startups are economical, flexible, and practical. Just as they should be.  

cashless health insurance claims with onsurity

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