header Health Insurance

Be Prepared to Handle Challenges Regarding Cashless Mediclaim

21 October 2022, 2:26 PM

Many health insurance companies in the nation offer cashless mediclaim policies. In the event of hospitalisation, this service offers customers a practical way to safeguard themselves against rising medical costs without incurring any out-of-pocket costs.

Insurance companies work with multiple hospitals nationwide to activate the cashless facility for this feature. These affiliated facilities are also referred to as "Network Hospitals." Your insurance company intervenes to pay all of your medical bills directly when you receive treatment at one of these network hospitals.

Cashless mediclaim coverage can significantly reduce stress in a medical emergency by providing you with full financial support. In addition, it is less complicated than dealing with reimbursements, where you must first pay your medical expenses out of pocket before receiving a refund from your health  insurance provider.

Different Versions of Cashless Medical Insurance In India

There are numerous cashless medical insurance plans available in India. These consist of:

Individual Cashless Health Insurance 

This type of cashless health insurance provides financial support to the policyholder. The insurance plan stipulates a set amount of medical coverage that may be used to pay hospitalisation costs as needed.

Family Floater Cashless Facility 

A family floater cashless medical insurance policy provides coverage for all family members under a single insurance policy with a fixed amount. The covered people can use the financial help offered under the family floater insurance to cover hospitalisation costs during the policy's duration.

Cashless Medical Insurance for Seniors 

 This kind of insurance offers financial support to senior people. The purpose of the senior citizen cashless mediclaim policy is to help seniors manage their hospitalisation costs during the most critical times.

Concerns with the Cashless Mediclaim Plan

Although the cashless mediclaim policy system is a significant development for the insurance industry, several wrinkles still need to be worked out. The following are some challenges regarding choosing this feature:

Lack of Network Hospitals 

 You must only visit hospitals that have been registered as network hospitals to use the cashless mediclaim service. Therefore, you must be familiar with every hospital on this list; otherwise, you will risk getting into difficulty if there is a medical emergency.

Partially Settled Claims 

 In certain circumstances, the insurance provider only offers a portion of the payout in the form of a cashless settlement. The balance is set aside for reimbursement, indicating that you must pay the remaining expenses out of your pocket during the emergency.

Processing Time 

A Third Party Administrator's (TPA) approval may be required in urgent situations, which could delay the processing of your claim. When you are given the approval to facilitate cashless medical claims, only then can this receive financial support. In certain situations, the insurance provider may request that you pay the expense upfront before being reimbursed later.

Inadequate Documentation

Adherence to documentation is necessary to receive cashless treatment, particularly the pre-authorisation form that must be provided to the TPA. Unfortunately, due to ignorance, policyholders often fail to follow the documentation, which makes it challenging to submit a cashless claim.

Exclusions Will Affect Too 

Your medical insurance does not pay for some treatment-related costs. This could involve items like registration fees, charges for food and toiletries, spending for paperwork, dental work, and more. To avoid being surprised later, you should thoroughly read your plan's terms and conditions before purchasing it.

How Can Cashless Mediclaim Policy Challenges be Met?

If you don't want to get caught up in a problematic health insurance claim settlement process, there are a few procedures and guidelines to keep in mind. Which are -

  • To secure a cashless mediclaim payment, look over the list of Preferred Provider Network (PPN) hospitals and always choose a network hospital for your admission.
  • A pre-authorisation form must be submitted to be eligible for a cashless claim. This medical claim form must be completed and delivered to the Third Party Administrator (TPA ) within a specific time frame. You must submit the form within 24 hours, after the patient's admission if the hospitalisation is urgent. If hospitalisation is anticipated, the form must be submitted at least 4-5 days beforehand. For a seamless medical claim settlement process, the full set of hospital invoices should also be supplied with the TPAs.
  • Always keep your health card close at hand in case the TPA requests it for identification.
  • Before submitting a claim, look over the list of treatments not covered by your insurance.


Although simple, a cashless settlement has several drawbacks regarding keeping the commitment made. The difficulties could be the responsibility of policyholders, TPAs, or hospitals. Passing the buck would be pointless because the policyholder would be left with the bill in the end. As a policyholder, you should exercise caution to ensure that procedures are followed so that you can receive a cashless payout quickly and easily.

Read more-


1. What is the claim procedure?

A claim procedure is an insurer's performance of its obligation to accept, investigate, and act on a claim made by a policyholder.

2. What is preferable, cashless or reimbursement?

Overall, the simplicity of a cashless claim process makes it superior to the reimbursement procedure for health insurance.

3. When does the Indian health insurance provider reimburse claims?

From the day of notification to the insurer, the average time it takes to settle a health insurance reimbursement claim is between 20 and 46 days.

4. What causes claims to be denied?

A claim denial happens before it's processed and is usually caused by flawed data. In contrast, a claim that has been examined and determined to be unpayable is subject to claim denial. This could be due to provisions in the patient-insurer contract or other factors that surface during processing.

5. How can I avoid having my insurance claim denied?

When filling out the proposal form, be honest and precise about your health conditions, family history, occupation, earnings, current insurance coverage, and lifestyle preferences (online or manual).

Health Insurance banner
Health Insurance

Plans starting at only ₹7/day*

Enter your details to buy Health Insurance
By proceeding, I agree to the Terms & Conditions