How to get cashless treatment at any hospital: Health insurance rule changes explained

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The new health insurance rules now allow cashless treatment at any hospital, including non-network ones, without upfront payment. Claims are processed faster, with a one-hour limit at admission and three hours at discharge. The waiting period for pre-existing conditions has been reduced from four to three years. Additionally, you can use multiple health policies to cover a single hospitalization, ensuring broader financial coverage.

Recent updates in health insurance rules have significantly improved access to cashless treatment, even at non-network hospitals, allowing policyholders to receive medical care without the need for upfront payments. These changes aim to streamline the claim process, making it faster and more efficient, and offering more flexibility in treatment options.

Here’s a detailed guide on how to avail these benefits:

1. Understand your policy

First, verify if your health insurance plan reflects the new changes. Some policies may require upgrades or adjustments to provide cashless treatment at non-network hospitals. Ensure you’re aware of any exclusions or limitations.

2. Pre-authorization process

While you can receive cashless treatment at non-network hospitals, you still need pre-authorization. This is a crucial step to avoid out-of-pocket expenses. Once admitted or before hospitalization, either you or the hospital must notify the insurance company, which will review the treatment plan and estimated costs.

Steps to pre-authorize:

Submit your health insurance card, valid ID proof, medical reports, and the hospital’s treatment estimate to the insurer.

Wait for approval. Insurers generally respond within an hour during the admission process.

3. Submit documents

• Documentation is key for the pre-authorization process and smooth processing of your claim. Keep these documents ready:
• Health insurance card or policy details
• Valid identification (e.g., Aadhar, PAN card)
• Medical reports, including doctor’s prescriptions and test results
• Hospital’s treatment estimate or bill

In emergencies, some insurers provide post-treatment authorization. This allows you to receive treatment immediately and get it approved later. To benefit from this, you must notify your insurance company within 24 hours of hospitalization. This is a lifesaver in critical situations where you don’t have time to wait for pre-authorization.

5. New health insurance rule changes

Cashless treatment at non-network hospitals: You can now avail cashless treatment at hospitals not in your insurer’s network. Previously, you had to pay upfront and claim reimbursement later.

Faster claim clearance: Insurers are now mandated to clear cashless claims within one hour at admission and within three hours during discharge, ensuring faster access to funds and reducing delays that previously plagued hospital discharges.

Reduced waiting period for pre-existing conditions: The waiting period for pre-existing conditions like diabetes, hypertension, or other chronic diseases has been reduced from four years to three years, allowing quicker access to coverage.

Ayush treatments covered: The Insurance Regulatory and Development Authority of India (IRDAI) now mandates coverage for Ayush treatments (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) under health insurance policies, provided specific conditions are met. This expands the scope for patients seeking alternative treatments.

Moratorium period reduced: If you maintain continuous coverage for five years, the insurer cannot contest any claims due to non-disclosure or misrepresentation after this period (except for fraud). Earlier, this period was eight years, meaning you are now protected sooner.

Claims with multiple insurers: If you have multiple health insurance policies, you can now use all of them to settle a single hospital bill. For instance, if you have two policies worth ₹5 lakh and ₹10 lakh each, and your hospital bill is ₹12 lakh, you can combine both policies to settle the claim.

Benefits of the new rules

These new rules ensure faster access to funds, better flexibility, and improved coverage, particularly for those who need alternative treatments like Ayush. Cashless treatment at non-network hospitals will especially benefit those in smaller towns or cities where network hospitals may not be available.

By understanding and leveraging these new rules, you can ensure stress-free medical care, quicker claim processes, and better financial security during emergencies. Regularly reviewing your policy and staying updated on insurer guidelines will help you take full advantage of these changes and improve your overall healthcare experience.