Salient features of the cashless mediclaim policy

Insurance

oi-Sneha

By Deepak Yohannan

Updated: Friday, August 24, 2012, 12:16 [IST]

You are out partying with your friends in the middle of the night and suddenly a friend falls ill. It's late and there is hardly any help around. You rush your friend to the nearest hospital only to find out that without a hefty amount of cash, he cannot be admitted.

Helpless, you run from pillar to post to arrange whatever you can, but the amount falls short. Though this sounds filmy, it is often the case with many people. Have you imagined what can happen in an emergency if you do not have enough money to proceed with the treatment? Well, to keep these very problems at bay, the insurance companies introduced the cashless mediclaim policy which quite literally allows you to get treated at a top hospital by just producing a card and nothing else.

What is cashless mediclaim?

TPAs or Third Party Administrators have tie-ups with some of the leading hospitals in the country. When you buy a health insurance policy, you are issued an ID card by the TPA. This card acts as a passport to avail a cashless procedure. You just need to produce the card at any listed hospital and you can get admitted and treated without having to make any payment. You must however always keep the list handy and constantly check for updates to confirm that the hospital you are in is associated with the TPA. Otherwise, you cannot make a cashless claim.

Important points to remember

As mentioned above, it is very important for you to constantly check with the TPA to ensure the hospital of your choice is affiliated to the TPA. It may so happen that at the time of buying the policy the hospital is affiliated, but not so when you are making the claim. Keep checking the TPA website for updates. Then, you must be aware of the list of illnesses covered in your cashless policy. There are a number of exclusions and you must be aware of those. Also, make sure you know exactly how the cashless procedure works. There are generally two kinds of cashless mediclaim policies, one in which you pay the bills and then get it reimbursed from the TPA and the other where the TPA makes the payment directly to the hospital. It is important to know what you have as that will ease up the discharge formalities at the hospital.

Discontinuation and discounts

As a health insurance policyholder, you must be aware of the discounts available to you. Many companies offer discounts if you do not opt for a mediclaim policy. This is because insurers feel that hospitals cheat them by overbilling and so they generally avoid cashless procedures. Many companies like New India Life Insurance, Oriental Insurance and United India Life Insurance have already discontinued the cashless facility from a lot of hospitals. The rule has mostly been in effect since July 2010, so if you have bought a policy prior to that, inquire with your insurer to know the status of your policy and whether you still have a cashless cover.

Cashless mediclaim policies are very handy, but sadly they are hardly available these days. In the feud between hospitals and insurance companies, the common man has lost out. However, if you still find one, it's definitely advisable to go for it. But before you opt for it, see all the available discounts on non-cashless policies and only then make your final purchase.

The author is the CEO of MyInsuranceClub.com, India's first Web Aggregator for insurance products approved by the Insurance Regulatory and Development Authority (IRDA).

For more articles by Deepak Yohannan, please visit MyInsuranceClub.com

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