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Cashless Hospitalization

Cashless hospitalization means as a Mediclaim policyholder one will not have to run around paying off the hospital bills and getting a reimbursement later. On the contrary the policyholder will be able to avail of medical services at designated hospitals and his bills will be settled through TPAs (third party administrators) who will additionally offer a 24 hours toll free helpline, access to physicians, specialties, diagnostic centers and ambulance services.

This comes as a great relief, especially in those emergency times where one doesn't have to run around in the middle of the night to collect amount for paying up hefty deposits prior to admission.

Cashless Hospitalization is possible only in the network panel of hospitals tied up with TPAs (Third party Administrators)

For this purpose, hospitalization can happen in two conditions - Planned and Emergency

During Planned Hospitalization-

You can fill the Pre-Authorization Form, available with the Network Hospitals upon showing TPA Health Card.
Once the Pre-Authorizatison Form is submitted, it takes a maximum of 4 days to revert to respond with letter. This time is taken to cross check your policy terms, conditions and exclusions.
Thereafter, an Authorization or Rejection, on case-to-case basis, will be either faxed to Hospital, or the Policyholder or to both.
Your cashless treatment will begin at the hospital, after the hospital receives Authorization confirming the same. Please ensure you pay for non-medical expenses and sign the relevant documents before leaving the hospital/ getting discharged.
You may also receive Rejection of your Pre-Auth request, if the ailment for which you are admitted in a hospital is not covered in your policy or if you seek admission in a NON-NETWORK hospital or in the case of Outpatient checkups etc, as the case may be.
You can then submit a claim for reimbursement purpose

During Emergency Hospitalization-

You will be admitted immediately and the hospital will intimate the insurance company and fax the Pre-Authorization Form for approval.
Once the Pre-Authorization Form is submitted, we will revert with Authorization / Rejection at the earliest possible. Nevertheless your treatment will be continued at the hospital. If you receive Authorization, then you will be using cashless service. In which case, please ensure you pay for non-medical expenses and sign the relevant documents before leaving the hospital .
If rejected, then you will need to pay for the treatment you have taken before getting discharged from the hospital. You can then submit a claim for reimbursement purpose.
If the ailment for which you are admitted in a hospital is not covered in your health insurance plan or if you seek admission in a NON-NETWORK hospital- the TPA card will not serve any CASHLESS purpose.

PLEASE REMEMBER -

Your hospitalization expenses will be paid from your sum insured only. If you opt for unreasonable expenses such as taking a Deluxe AC suite etc, you are and will be paying for it, as your premium will be increased next year depending on the claim settled this year.

The TPA will be authorizing a cashless service depending on your Mediclaim policy terms, conditions and exclusion. We are only administering your Mediclaim policy and will not be taking any policy decisions with regard to your policy.

BEFORE LEAVING HOSPITAL-

REMEMBER -

To pay for all non-medical expenses as your policy will not cover them.
To check all the bills and prescriptions for any medicine that is billed but not administered on you.
To that you sign on all documents and reports.
To note the total amount of the bill for your records for future purpose