Q. I am Preetam Chandhok, a 36-year-old, Delhite, looking to purchase health insurance. Recently, one of my friends had a bitter experience where their health insurance didn’t provide coverage during a medical emergency in Shimla. This incident made me worried about the reliability of health insurance when travelling outside of my home city. I would like to know the process for using health insurance in such situations. Specifically, I’m interested in understanding whether I would need to pay upfront for medical services and then be reimbursed or if there are provisions for cashless claims in case of emergencies in other cities.
While it’s unfortunate to hear about your friend’s experience, your concerns reflect a sentiment that many people share. Your apprehension regarding health insurance coverage in an unknown place is completely valid. To address such concerns, the IRDAI has made several positive developments recently. One of them is enabling a ‘Cashless Anywhere’ facility across India. Last month, the General Insurance Council kicked off this initiative which allows insurers to settle claims even when treatment is taken in non-network hospitals.
Even earlier, you could have sought medical care on a cashless basis in any of the network hospitals in the country, not just in your home city. But to make it even better, the Cashless Anywhere facility transcends all barriers when it comes to claim settlement challenges faced by policyholders. So you don’t need to worry about whether the hospital is part of the network of your insurer. You can seek treatment at any hospital of your choice.
Also Read: What is the best age to purchase a health insurance plan?
Once the initial checks are done, you can simply avail the required medical services without having to pay anything upfront. The hospital bills will be settled directly between the hospital and your insurance company. This is quite useful during a medical emergency when it may not be possible to reach a network hospital.
To add to that, this facility offers cashless claims even for planned treatments, including surgeries. So if your preferred hospital is not a part of the chain of network hospitals, you need not worry and may continue seeking treatment there. This often happens when a patient wants a specific doctor who may work at a non-network hospital. Or it is an ailment that needs a specific kind of care available at only select hospitals.
Also Read: Health Insurance Tax Benefits for Salaried Employees – What You Need to Know
For planned treatments, you must inform the insurer 48 hours before the hospitalisation. For emergencies, intimation needs to happen within 24 hours of admission. There are certain conditions that the hospital, albeit non-network, must qualify for. For instance, it must have at least 15 beds. This is to ensure the credibility and quality of service provided at the hospital and to avoid fraudulent claims. Also, it’s extremely important to be mindful of blacklisted hospitals. If one ends up taking treatment at a hospital which has been blacklisted, Cashless Anywhere will not be applicable.
Since this is a new initiative, it may take some time to get things smoothened out. But this is a step which would ensure that soon, all major hospitals and insurance providers would offer a cashless settlement of medical bills without any restrictions. Many insurance companies have already started doing that and you may do your research before you decide to make the purchase.
Also Read: Why family floater health plans aren’t for the elderly
In the end, I must also add that even if the cashless claim processing is not available at the hospital for any reason that does not mean your health insurance wouldn’t provide the required coverage. You can always opt for reimbursement of medical expenses incurred outside the network hospitals. In such cases, you would need to settle the bills upfront and then file a reimbursement claim with the insurance company along with the necessary documents.
Siddharth Singhal, Business Head – Health Insurance, Policybazaar
Unlock a world of Benefits! From insightful newsletters to real-time stock tracking, breaking news and a personalized newsfeed – it’s all here, just a click away! Login Now!
Download The Mint News App to get Daily Market Updates.
Published: 12 Mar 2024, 10:30 AM IST