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Comprehensive list of network hospitals for various health insurers across India.
With the ever-rising cost of healthcare, a number of individuals are buying health insurance policies as a way to cut down on their healthcare bills. While health insurance is a boon for those who are looking a quality medical care, having to pay the hospital for treatment could prove to be expensive. While the amount spent would be reimbursed, the policyholder would still be required to make the initial payment, which could amount to a significant sum.
Enter cashless claims. A cashless claim is one where the policyholder is not required to pay for treatment or medical procedures that are covered under the health insurance policy purchased. The insurance company would directly settle the bill with the hospital in question.
This service makes healthcare even more affordable and accessible, as the policyholder does not have to worry about having to pay a hefty sum of money at the time of being admitted or during the course of treatment.
This kind of facility, however, is only available at network hospitals, or partner hospitals.
A network hospital is one with which the insurance company has an agreement with, which allows the policyholders to receive medical treatment on a deferred payment basis.
A cashless network hospital works similar to a regular or non-partner hospital for the most part. Policyholders can visit a network hospital and receive medical care without having to make a payment to the hospital. This includes the admission charges, room charges, cost of treatment, doctor/specialist fees and ambulance cost.
The medical bills would be settled against the Sum Assured that was opted for at the time of purchasing the health insurance policy.
All the above would be borne by the insurance company (provided the treatment sought is covered by the policyholder’s insurance policy).
The policyholder merely has to notify the hospital that the treatment would be under the cashless treatment facility and produce identification, such as the policy document or an identity card issued by the insurer.
When an individual is admitted to hospital for any procedure, whether routine or emergency, it is a stressful time for the family and the individual himself/herself. With most hospitals insisting on periodic clearance of bills, families have to scramble to pay astronomical bills while ensuring the individual receives quality medical treatment.
With cashless medical facilities, all bills will be paid directly by the insurance company once the treatment has been completed.
In the event that the policyholder is to be admitted to hospital away from home, hospitals part of the insurance company’s network across the country can be used to treat the policyholder without having to settle bills or make any payments.
In the event of an emergency medical procedure or if the policyholder is facing financial problems, cashless network hospitals are a saving grace since the policyholder is assured of quality medical care without the need to pay for the treatment.
In the event that a claim is to be filed, the following procedure is to be followed:
All procedures requiring a hospital stay over 24 hours are covered under cashless hospital claims.
The list of day care facilities (that require a stay of less than 24 hours) covered are mentioned below:
Surgical procedures and treatments in the digestive tract as well as male and female reproductive organs are also covered.
While a number of procedures and treatments are treated under cashless cover, there are a list of exceptions under which the insurance company will not pay for treatment. These are listed below:
Mr. X is a 45 year old man who purchased an individual health insurance policy and chose a Sum Assured of Rs.5 lakh. He was recently admitted to hospital for an emergency appendectomy, and chose a network hospital to undergo his procedure. The total cost of the procedure and care amounted to Rs.70,000, including the hospital stay. Mr. X had recently paid off his home loan and was short of ready cash. However, by opting for cashless medical care at a network hospital, he did not have to pay the hospital to settle the bills, as they were settled directly by the insurance company.
The Rs.70,000 was deducted from his Sum Assured, leaving him with Rs.4,30,000 to cover the cost of other medical expenses in future.