Insurance

Guideline to Avail Cashless* Hospitalization

Most Health Insurance companies offer the facility of cashless* hospitalization, and policies are routed through a Third Party Administrator (TPA). Policy holders need to be aware of the terms "Network Hospital" and "Non-network Hospital". Network Hospitals are those with which your TPA has an agreement — if you are admitted to a Network Hospital, you are entitled to cashless* treatment, subject to the terms and conditions of your policy. If admitted to a Non-network Hospital, you need to pay the bills to the hospital first and then seek reimbursement through your TPA.

Cashless Doesn't Mean Free Treatment

There is nothing called free treatment. In a cashless* hospitalization, the cost of treatment (fully or partially) is borne by the Insurance Company on behalf of the Policy Holder. The TPA is the mediator between the Hospital and the Insurance Company in settling bills. The Hospital is only a facilitator and has no authority to approve or disapprove any cashless* request — this decision rests with the TPA/Insurer under IRDA protocols.

Procedure for Cashless Hospitalization

Hospitalization normally takes place under two circumstances — Planned or Emergency. For a planned admission, consult a doctor who will advise the probable date of hospitalization; the policy holder must then apply for approval of estimated hospital expenses to the TPA at least a week prior to the scheduled admission date. Our Corporate Help Desk can assist with the pre-authorization procedure (though final approval rests solely with the TPA).

• Contact the Corporate Help Desk at the Hospital.
• Present the original health insurance card issued by your TPA, along with a photocopy of a government-issued ID proof (PAN card / Driving Licence / Voter ID).
• Produce a photocopy of your employee ID card if it is a corporate group insurance policy.
• Collect and complete the pre-authorization form pertaining to your TPA, with the treatment section signed by your treating doctor.
• Return the completed form to the Corporate Help Desk for verification.
• The Help Desk will forward the form to your TPA and update you on the approval status.

Emergency Hospitalization

In an emergency, the Corporate Help Desk takes up your case with the TPA on a priority basis, and approval is usually received within a few hours on a working day. If cashless* approval is delayed and you cannot wait due to a medical emergency, you may proceed with treatment by paying the necessary cash deposit — refundable if TPA approval arrives before the discharge process has commenced.

When Cashless Requests May Be Rejected

• The ailment is not covered under your insurance policy (e.g. pre-existing condition, specific exclusions such as road accidents under the influence of alcohol).
• Information in the pre-authorization form is insufficient for the TPA to decide, and further information is unavailable.
• You have exhausted your eligible medical insurance cover for the year.

Expenses Not Covered Under Cashless Hospitalization

The following are generally not reimbursable and must be settled directly with the hospital at discharge:

• Registration / Admission Fee
• Telephone Charges
• Visitors / Attendant Charges
• Ambulance Charges
• Diet charges not part of the administered treatment
• Document Charges, Toiletries, Non-medical Expenses, Service Charges