Understanding Cashless Health Insurance: What it is and how it Works

Are you tired of being held hostage by the relentless grip of medical expenses? Do you yearn for a shield to protect your health and finances from unexpected blows? Look no further than cashless health insurance, where you can seek treatment without worrying about draining your savings.

To help you understand what is cashless health insurance, you must read this article. It also highlights the benefits and the coverage you get under such insurance!

What is Cashless Health Insurance? 

Cashless medical insurance is an insurance policy that allows you to access medical services without the need to make any upfront payment or deal with reimbursement claims later. You become a member of a network of linked healthcare providers and insurers when you purchase a cashless health plan. 

How does a Cashless Health Plan Work?

When you require medical treatment, you simply need to visit any of the network providers. Present your health insurance card to the provider at the time of registration. They will verify your insurance details, ensuring your eligibility. Once your insurance is confirmed, the provider directly communicates with the insurance company for payment settlement.

The insurance company reviews the medical expenses incurred during your treatment and determines the eligible amount covered as per your policy terms. They then directly settle the payment with the healthcare provider.

Coverage Under Cashless Health Insurance

Cashless health plan covers your various medical expenses seamlessly, including:

1. Inpatient Hospitalisation

It typically covers the expenses related to inpatient hospitalisation. This includes room charges, nursing fees, surgeon fees, and medical supplies. 

2. Pre and Post-Hospitalisation Costs

It extends its coverage to pre and post-hospitalisation expenses. This includes diagnostic tests, consultations, medications, and follow-up visits. 

3. Daycare Procedures

Specific medical procedures that don’t require an overnight stay, known as daycare procedures, are covered under cashless health plan. This includes chemotherapy sessions, dialysis, cataract surgery etc. 

4. Medical Procedures and Surgeries

Cashless health insurance covers organ transplants, cardiac procedures, joint replacements, and cancer treatments. 

Benefits of Cashless Health Policy

Cashless health plans bring many benefits, allowing you to prioritise your well-being without the financial burden. Some of them are:

1. Quick and Easy Healthcare Access

You may access a network of hospitals, clinics, and healthcare providers with cashless medical insurance. You can seek medical treatment at any network hospital without arranging for cash upfront. The insurance provider settles the bills directly with the hospital, ensuring a smooth, hassle-free healthcare experience.

2. Financial Security and Protection

It provides financial security and protection against unexpected medical expenses safeguarding you from the burden of high healthcare costs. 

3. Access to Quality Healthcare

Access to a network of healthcare providers allows you to receive various high-quality medical treatments. 

4. Timely Medical Care

You can seek immediate treatment without delay or concerns about arranging funds in emergencies. 

5. Comprehensive Coverage Options

Cashless health policy typically offers comprehensive coverage for a range of medical expenses. It includes hospitalisation costs, doctor consultations, diagnostic tests, surgeries, medications, etc.

Steps-By-Step Claim Process of a Cashless Health Insurance

Navigating the claim process of a cashless health policy is a very straightforward and seamless experience. Here is the step-by-step process for claiming cashless health plan:

Step 1: Choose Network Hospitals and Providers

To initiate the cashless claim process, select a healthcare provider or hospital part of the network empanelled by your insurance company. 

Step 2: Intimate the Insurance Company

Before treatment, inform your insurance company about your hospitalisation or planned medical procedure. Provide your policy number, diagnosis, and expected date of hospitalisation.

Step 3: Verification and Pre-Authorisation

Present your health insurance card and valid ID proof upon reaching the network hospital. The hospital’s insurance desk will verify your details and initiate the pre-authorisation process. 

Step 4: Processing and Approval

The insurance company evaluates the pre-authorisation request based on the policy terms and conditions. If the request is approved, an authorisation letter is sent to the hospital outlining the approved amount and duration of coverage.

Step 5: Avail of Cashless Treatment

After the pre-authorisation is approved, you can proceed with the scheduled medical treatment or hospitalisation. The hospital will bill the insurance company for the approved expenses, and you will not be required to make immediate payments.

Step 6: Additional Expenses and Reimbursements

In some cases, additional expenses might not be covered under the policy or exceed the approved amount. These expenses are “non-payables” and must be settled directly with the hospital. 

Step 7: Claim Settlement

After the completion of treatment, the hospital sends the final bill and medical documents to the insurance company for payment. The insurer reviews the documents, and the claim is processed appropriately. 


Hopefully, now you understand what is cashless health insurance. It offers a seamless and convenient way to access medical services without worrying about immediate financial burdens. 

Further, if you want to avail the advantages of a cashless health plan, Niva Bupa Health Insurance is here to assist you. As a trusted insurance provider, Niva Bupa one of the best health insurance company in India offers a wide range of health insurance plans with cashless facilities and comprehensive coverage. Visit their website now!


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