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Cashless mediclaim service offers an insured person the benefit of availing medical treatment at the best hospitals, without having to pay from his/her own pocket. Hospitalization bills, up to the sum insured are directly settled by the insurance company. In this process, prior approval of the TPA (Third-Party Administrator) is required.

If cashless mediclaim policy facility is offered in your health insurance policy, you need not run around arranging funds at the time of medical emergency. This cashless mediclaim service can be availed only in network hospitals of the insurer.

Thus, we can say that under such facility, the insurer directly pays to the hospital for the customers’ medical treatment. And the insured is saved from running for money at a crucial time.

Cashless mediclaim service is of two types:-
Planned Claim - When an insured is aware of the hospitalization two-three days in advance, it is called planned hospitalization. In this case, the customer is advised to take a pre-authorisation at least a few days before the scheduled treatment. One can obtain the pre-authorisation forms from the hospital desk or the third party administrators (TPA) website.

Emergency Claim - When an insured person or a family member requires immediate hospitalization, either due to grave illness, an accident or any other crisis situation, it is known as emergency claim.

One must understand that it is important to inform the insurance company at the earliest about the on-going emergency treatment/surgery. Customers can ward off unnecessary hassle by carrying along their cashless card, policy number and the contact details of the insurance provider.

Alternatively, one must also share these details with their immediate family members like spouse, sibling and parents so that the procedure for getting the approval for cashless claim begins within 24hours of hospitalization.

You should remember the following while availing the cashless facility:
  • Inform your TPA before getting admitted to a hospital or in an emergency situation, you must ask one of your family members to do so.
  • Remember to take your ID card as a proof at the time of hospitalization.
  • Have necessary investigation and medical reports ready with you.
  • Provide complete information to your health insurer in the prescribed format.
Treatment in a network hospital
Every insurer has the ties up with number of hospitals across India, which is then known as the insurer’s preferred provider network (PPN). Thus, if you want to go for a cashless claim, you must necessarily be treated in a PPN hospital.

Find a network hospital near you by clicking here.

It must be understood that insurers generally have a large hospital network. But its availability depends on the location where the policyholder lives. So, it is important to check the preferred provider network before buying the health insurance policy. It must also be noted that admission into a network hospital is directly related to the availability of the beds, especially in rural areas where the medical facilities aren’t readily available.

However, there are instances when the insured person has no access to the network hospital, especially in case of emergency situation. Under such circumstances, h/she has to go for treatment in a non-network hospital, wherein later, his claims will only be settled through reimbursement.

HDFC Ergo Health Insurance Ltd. (formerly Apollo Munich Health Insurance) offers cashless mediclaim service with all its products. Know about the complete claim procedure followed by HDFC Ergo Health (formerly Apollo Munich) here. The company’s nationwide network covers more than 10000 hospitals, where policy holders can avail this feature to access quality health care.
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