Emergency hospitalisation of a family member is an ordeal for most families. Apart from the emotional trauma that the family goes through, there is the additional burden of financial expenses. In such emergencies, a good health insurance policy can be the perfect solution.
A health insurance policy provides you with two options of claim settlement in case of hospitalisation — cashless and reimbursement hospitalisation. Cashless hospitalisation, which is a norm now in health insurance, is a policy where the insurer settles the claim directly by making the payment on behalf of the insured. Reimbursement hospitalisation, on the other hand, requires you to pay for all the expenses yourself first and reimburses the expenses later.
All the original bills and the discharge summaries must be submitted to the insurer at the time of making the claim. The cashless hospitalisation facility is a more convenient option, provided that your preferred hospital is listed as a network hospital.
In case of an emergency hospitalisation, the cashless hospitalisation facility has to be initiated within 24 hours of hospitalisation. You need to produce your health card at the network hospital. A pre-authorisation form has to be filled up and produced at the third-party administrator (TPA) desk and they will process your claim within four hours.
In case of a planned hospitalisation, you can call on the toll-free number 48 hours before hospitalisation and find out the network hospital nearest to your office or residence. You need to submit the pre-authorisation form at the hospital, which will be sent to the TPA for approval. Once the same is approved, the TPA sends an authorisation letter, mentioning the amount that has been sanctioned.
The type of coverage offered by a cashless health policy varies from insurer to insurer. It is better to read the terms and conditions of various insurers before you choose a policy. Generally, such policies cover all medical hospitalisation expenses and exclude the non-medical expenses such as registration charges, visitors’ fee etc.
Most policies have some exclusions such as pre-existing illnesses, HIV/AIDS, injuries or illnesses caused due to unlawful activities, joint replacement, injuries due to war, etc. For certain surgeries, the insurer may pay only a specified percentage of the total cost while the remaining cost will be borne by the insured.
Cashless hospitalisation can be availed only at network hospitals. Any pre-existing illness must be mentioned while purchasing the policy. You will have to keep photocopies of all important documents such as medical bills, medical reports, discharge summary, and claim form with you. If the hospitalisation expense exceeds the sum assured, you will have to pay the excess amount on your own.
The health insurance market in India is growing at a fast pace. Besides, the tax deduction on the premiums that you pay for your health insurance policy is an added attraction. With prudent selection of a cashless health policy, much of the burden associated with hospitalisation and medical treatment can be mitigated.
(The author is Sanjay Datta, chief underwriting claims and reinsurance, ICICI Lombard)
Prudent healthcare
Judicious selection of a cashless health insurance policy can help you mitigate much of the burden associated with hospitalisation facility and medical treatment