Buying a health insurance policy can be a tedious task. Whether buying online or offline through agents, you will come across numerous terminologies that are important to understand while making a choice to buy a health insurance cover. From this unit onward, we are going to discuss some common terms and try to better understand the concept with the help of examples. So, first, let us start with:
Prateek Agarwal’s son needed emergency treatment and had to be hospitalised suddenly. Since Prateek did not have enough cash with him, he went to the nearest ATM to withdraw cash. The expenses on his son’s hospitalisation and subsequent treatment were more than he had expected. Left with no other option, Prateek went to his friend seeking financial help.
If Prateek had bought a health insurance plan that included a cashless benefit plan, he would have been in a better position to face this medical emergency. However, unaware of cashless medi claim policies, many people like Prateek fall in a debt trap while paying for necessary medical expenses.
Cashless hospitalisation is just one of the benefits that health insurance policyholders enjoy. This feature helps policyholders to seek necessary medical attention and emergency treatment at their choice of hospital. The insurance companies issue a health insurance card to their customers that they have to show to the insurance desk at the hospital during admission. The insurance company then settles the claim made by the hospital subject to the condition that the amount raised does not exceed the insurance coverage amount.
In India, there are two types of cashless health insurance claims available that policyholders may choose from. These include:
- Cashless Family Health Insurance
- Cashless Health Insurance for Senior Citizens
Policyholders can avail the benefits of cashless hospitalisation unbiased of whether they are opting for planned treatment or have to be hospitalised to meet medical emergencies.
Cashless Hospitalisation Exclusions
While cashless medi claim plans help to defray the rising medical costs of hospitalisation and subsequent treatment, not all kinds of expenses are covered under this kind of treatment. Cashless medi claim plan benefits exclude expenses like:
- Expenditure on attendants hired
- Ambulance charges
- Charges on toiletries used
- Additional service charges
- Additional expenditure on the oxygen mask, diapers, nebulizers, etc.
- Documentation charges
Your Medi claim Policy May Be Rejected. Know Why ...
However, some policyholders find the claims made on their medi claim policies getting rejected for certain reasons. These include:
- Claim on expenses made on hospitalisation and treatment of an illness not covered under the policy;
- Claim exceeding the amount of sum assured;
- Incorrect details regarding pre-existing disorders or incomplete personal details filled in the policy form;
- Delay in intimating about the hospitalisation to the TPA.