2 hrs ago
How Cashless Hospitalisation Works for Health Insurance Policyholders
Cashless hospitalisation lets a person use health insurance at a hospital in the insurer’s network.
The policyholder shows the hospital their insurance card and provides the required details.
The hospital asks the insurer to approve the planned treatment.
The insurer checks whether the treatment is covered by the policy.
If approved, the patient can receive treatment without paying the full covered amount upfront.
The insurer pays the hospital directly for approved eligible bills.
The patient may still need to pay for costs the policy does not cover, such as applicable deductibles or co-payments.
Policyholders choose a hospital in their insurer’s network to use cashless facilities, subject to policy terms.
They provide their health insurance policy card and required information to the hospital.
The hospital sends treatment details to the insurer to request pre-authorisation.
The insurer reviews the request against the policy’s coverage before deciding whether to approve it.
If approved, the insurer pays eligible covered bills directly to the hospital; exclusions and other non-covered costs may remain payable by the policyholder.
- Who
- Health insurance policyholders, network hospitals, and insurers.
- What
- The process for accessing cashless hospital treatment and paying eligible covered bills.
- Where
- At a hospital within the insurer’s network.
- When
- Why
- To access eligible health insurance coverage without paying the entire covered amount upfront.
Key facts
- Hospital choice
- Choose a hospital within the insurer’s network.
- Documents
- Show the health insurance policy card and provide required information.
- Pre-authorisation
- The hospital sends treatment details to the insurer for review.
- Coverage review
- The insurer assesses the request based on the policy’s coverage.
- Payment
- If approved, the insurer directly settles eligible bills with the hospital.
- Possible out-of-pocket costs
- Exclusions, deductibles, co-payments, and other non-covered expenses may remain payable by the policyholder.
Sources
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