Worried about Corona virus spreading in India? Buy Health Insurance and get coverage now. View Plans
Take informed decisions with IIFL Insurance:

Challenges Faced During Cashless Mediclaim Policy

Cashless Mediclaim is a popular health insurance option that enables quicker and easier transactions. The concept behind a cashless health insurance policy is to equip policyholders with extra safety with more immediate and direct transactions.

During times of emergencies, the policyholder may not always be able to submit the due payable immediately. This may delay the treatment procedure, which puts the policyholder’s health at risk. The cashless Mediclaim policy takes over all the agreed share of the payment directly from the insurance company to the hospital. It allows policyholders to make their share of the payment later, if any, depending on the policy terms. The defects of the reimbursement option inspired cashless health insurance. In reimbursement options, the policyholder makes the payment independently and later claims the same amount from the health insurance company. This procedure can be time-consuming, while the policyholder might be unconscious to take care of the formalities, or their family members may not gather the necessary funds in time. The neat cashless Mediclaim policy avoids all these deadly threats during a time-sensitive process.

The cashless health insurance option is popularized for its convenience and immediacy. It is designed to provide reliability and an extra sense of security for its clients.

Challenges In Mediclaim Policy In India – 

The perks of the cashless health insurance policy are abundant, but even with all those advantages, opting for a cashless Mediclaim policy may not be as beneficial for everyone. There are a few factors to consider before choosing high-value health insurance because some people might have better-suited health insurance options. When opting for a cashless Mediclaim policy, some things to consider are age, job profile, financial aspects, and medical history. 

For senior citizens, there exist co-payments up to 20%, which is additional to the high premium range. For people who take up a lot of international travel and those who might need medication from hospitals abroad, this policy would prove beneficial as they provide global coverage. The high premium range might not be supportive of your finances. Like all health insurance policies, cashless Mediclaim policy also has exclusions.

Some of the challenges that come with cashless health insurance policies are as follows:

# Finding network hospitals – The fee processing and transactions, the insurance claim authorization, and all other documentation procedures are minimal but require networked hospitals that are in allegiance with the health insurance company. In India, the ratio of networked hospitals is lesser. During emergencies, if the hospital that the policyholder admitted to does not agree to cashless health insurance, the entire purpose of high-value health insurance is defeated. Find health insurance companies that have networked with multiple hospitals. The processing duration is much lesser and automated in networked hospitals.

# Insured sum – since the premium payments for high-risk health insurance is much higher than that of the regular health insurance plans, the chances of the entire insured sum being utilized for an individual’s healthcare are less likely. However, when treatment is demanded overseas, the insurance company offers coverage that regular health insurance does not cover. 

# Co-payment for senior citizens – the high-value health insurance comes with a co-pay amount reaching up to 20% for senior citizens. Since the premium amounts are high on their own, additional payments may not be financially supportive for the larger community of people.

Despite the high premium payments, high-value health insurance plans also come with waiting periods of a minimum duration of 2 years. They can be as high as 4 to 5 years, depending on the individual health insurance plan. 

Benefits Of Cashless Mediclaim Policy – 

Cashless Mediclaim policy comes with perks specifically curated to treat emergencies while giving the policyholder maximum benefits and health security. 

1. Time-efficient pretreatment procedures – 

Cashless Mediclaim policies were curated to achieve maximum time efficiency. Document processing before the treatment is authorized rapidly. The pre-documentation and pre-treatment formalities are already filled out and submitted in the network hospitals. The hassle of readying the payment for later reimbursement can be challenging to achieve within a ticking time frame. Since cashless Mediclaim policy is mainly used for emergency cases like accidents, the procedure needs to be time-efficient, which it is. 

2. Shorter waiting periods – 

All insurance policies have a minimum waiting period before the sum amount can be claimed to cover the treatment. Most cashless Mediclaim policies issue shorter waiting periods so that the policyholder can reach a state of medico-financial security sooner.

3. Lesser documentation formalities – 

The documentation process may be tiring, but the pretreatment registration and treatment payment sanctioning are quicker, requiring little to no last-minute effort. This is because the documentation for a cashless health insurance policy is already filled out by in-network hospitals, leaving lesser to deal with on the day of the treatment. As per the policy terms, the medical conditions that can avail coverage are authorized by the hospital personnel and communicated with the health insurance company. 

  • Extensive coverage – The emergency medical conditions covered in the cashless Mediclaim policy are versatile. The pre and post-hospitalization expenses are covered in most standard cashless Mediclaim insurance policies. This kind of coverage includes doctor fees, diagnosis, treatment, and recovery. The other unique supportive treatments and room expenses are part of the health insurance coverage issued. 
  • Extra security – This is a cashless health insurance policy gives additional assurance of financial and health-related safety. The worry of not having enough funds immediately ready or wasting time in documentation and funds collection during emergencies or health insurance coverage exclusions can be eliminated.


Cashless health insurance in India comes in three broad types:

  • Individual cashless Mediclaim policy 
  • Family foster cashless Mediclaim policy  
  • Senior citizen cashless Mediclaim policy 


Top 5 Cashless Health Insurance In India – 

Some of the best cashless health insurance policies in India are

1. Apollo Munich optima resource health insurance – 

The health insurance covers a minimum of Rs.3 lakhs sum that can be availed. It accommodates policyholders starting from 5 to 65 years of age and offers pre and post-hospitalization fees. It comes with a minimum three years waiting period, which includes a sum insured amount enhancement, tax benefits, and restore and multiplier benefits. 


2. ICICI Lombard health care plus – 

The cashless Mediclaim policy covers pre and post-hospitalization expenses. Another perk of this policy is that pre-existing diseases that would typically be on the exclusion list are offered coverage after a minimum of the 4-year waiting period. But confirm the policy terms with the insurance provider before signing up. It comes with flexible sum insured and quick claim settlement processes in various plans that support individuals and families. 


3. Care health plan / Religare – 

The cashless health insurance policy offers up to Rs. 6 crores sum amount and includes coverage for pre-existing diseases after four years waiting period. Pre and post-hospitalization coverage for all age categories are accommodated. The insured members can take up the perk of free annual medical check-ups, which is part of the policy terms but do confirm with the insurer about the perks of your health insurance plan.  


4. Niva Bupa Health insurance – 

The sum insured comes around Rs. 5 lakhs but issues coverage for pre-existing conditions after a shorter waiting period of 2 years. Like all other health insurance policies, pre and post-hospitalization fees are included in the coverage. There is a lifetime renewal option, tax benefits, and a paperless claim settlement procedure that does not take more than 4 hours to process. Maternity and newborn care are part of the services covered. 


5. Bajaj Allianz health insurance family floater –

The health insurance coverage can get to around Rs. 5 lakhs, including pre and post-hospitalization fees, along with extensive coverage for age categories 18 years to 65 years. The health insurance company has allegiance with several networked hospitals, making it easier and quicker to claim.

Buy Insurance - 18002101330