What must you know about cashless mediclaim cover in India?

In India, owing to the growing innovative means that are being provided by various insurance providers, there is a growing scope for coverage that is being offered by them. The scope of this coverage has enabled newer means by which various benefits can now be availed at affordable costs. When it comes to health insurance in India, insurance companies are increasingly providing cashless option to the policy subscribers. This option enables the policy holders to cover their expenses easily, without having to spend any money as the incurred costs are borne by the insurance company. However, since the Indian market for insurance is still in a dynamic phase and there is tremendous scope for further development and institutional approach towards it, not every hospital comes under the coverage of cashless facility. In fact, a select group of hospitals, that varies from one insurance provider to another, and is known as group of network hospitals come under this purview.

In view of this, following are the important things that you must know about cashless mediclaim cover in India:

1. When a policy subscriber purchases a health plan from an insurer, the insurer provides the option of being cashless. This is majorly limited to hospitalization and related treatment options (may include pre and post-hospitalization as well, from plan to plan). The cashless mediclaim allows the policy holder to avail the direct benefits of the health cover without requiring any hard cash to take care of the incurred costs. The incurred costs are directly borne by the insurer and therefore, in case of non-availability of immediate hard cash, this facility actually acts like a boon for the policy holder.
2. It must be however kept in mind that there are certain terms and conditions that come with this option. One such important condition is that the incurred costs must not exceed the sum assured that is covered by the plan. Thus, if the treatment cost crosses the basic sum assured, this facility cannot be availed.
3. The hospitals that are covered under cashless facility being provided by an insurer are known as network hospitals. These hospitals are mentioned and pre-declared at the time of policy purchase initially and apart from these network hospitals, treatment in any other hospital or facility is not covered by the cashless option. This limits the overall scope of this option in case of any sudden hospitalization, if the insured person has to be admitted to any nearby hospital due to a sudden emergency.
4. The overall benefits provided by the cashless option are rather limited because certain costs like ambulance cost, service cost, any attendant charges, any documentation fee etc. is not covered under this option.
5. There may be an option for co-payment if the treatment cost exceeds the sum assured. Under this option, the insurer will pay for the amount that is covered as sum assured while the excess amount will have to be paid by the policy holder.

HDFC Life offers various health insurance plans that seek to secure your finances in case of any health-related emergency.

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