Cashless Claims in Health Insurance | Tata AIG (2024)

Cashless Claims Explained: A Comprehensive Guide

Health cover starting at Rs. 15/day*

Medical treatments are getting more and more expensive with every passing year, and rising inflation rates, taxes and other costs make it crucial to have a health insurance policy in today’s time. Usually, there are various types of insurance; however, buying a cashless claim insurance is quite beneficial in emergencies.

Here, you will get to know what a cashless claim is in health insurance, its benefits and how you can initiate your claim procedure.

A cashless claim in health insurance is the process in which the medical and hospitalisation bills of the policy taker are settled directly between the insurance company and the networked hospital. However, it must be noted that the expense amount should not exceed the sum of the policy coverage of the bought health insurance plan.

A cashless insurance claim has several benefits, which will be discussed further. However, its most prominent benefit is that it gives you a piece of mind and saves you from out-of-pocket expenses in case of any medical emergencies.

Individual Cashless Health Insurance- In this type of health insurance, the insurance company provides cashless medical expense settlement to the individuals. The individual is the policyholder and is provided with hassle-free cashless settlement on hospitalisation bills.

Family Cashless Health Insurance- Under the family cashless insurance claim, all the registered family members under the policy are insured, including the policyholder. All the family members are eligible to avail cashless medical and hospitalisation services provided. Usually, the insurance amount of such policies is high, as it is done for multiple members.

Senior Citizen Cashless Health Insurance- This type of policy is specifically for elderly people, and it provides them with cashless medical and hospitalisation benefits like ambulance service, treatment of pre-mentioned diseases in policy, etc.

Immediate Treatment Accessibility- Having cashless claims in health insurance helps you get immediate access to medical treatment in emergencies. If you have planned medical treatment, you have to inform the hospital, and all your medical bills will be taken care of by the insurance company.

Convenience of Cashless- Under the cashless mediclaim process, you do not need to worry about arranging cash for hospital bills and treatments. The policy will cover all your expenses and will make payments without you getting involved in any way.

Great Hospital Network- The insurance companies have connections with several reputed hospitals from where you can choose to get treated. Such a vast network of hospitals helps in getting the best and most expert treatment as per your medical requirements.

Minimal Paperwork- The cashless health insurance policy saves you from the hassle of arranging and signing several physical documents and keeping insurance papers safe. With cashless insurance, the insurance company takes care of all the complicated paperwork so that you can get treated without disturbance.

Tax Benefits- Buying a cashless claim policy for individual, family or senior citizens helps you avail of several tax benefits under Section 80D of Income Tax.

Peace of Mind- Having cashless critical illness insurance provides peace of mind in distressed situations. It gives you peace of mind to focus on your treatment and getting better; rather than being worried about medical bills.

The overall cashless claims process will involve the policyholder contacting their insurer upon hospitalisation, submitting their documents, the insurer verifying their documents and then settling their bill directly with the hospital, be it a network or non-network hospital

In all other respects, a cashless health insurance policy will function the same way a regular health insurance plan does.

With TATA AIG health insurance plans, you now get cashless claims in any network and non-network hospitals* near you in just 3 easy steps.

#GoCashless In 3 Easy Steps

Step 1: Send an SMS - "GoCashless” “” “" to 7669300780.

Step2: Talk to an expert

Step 3: Get cashless anywhere*

**Cashless facility cannot be extended to hospitals listed in the excluded providers published on the TATA AIG website. Furthermore, cashless services are not available for healthcare facilities that do not meet the minimum eligibility criteria set forth by IRDAI. TATA AIG reserves the right to exercise its own discretion in making the final decision.

Step 1: Search for your nearest network hospitals under your insurance policy and inform your Third-party Administrator (TPA) about your hospitalisation. However, if the hospitalisation is for planned treatment, then you need to inform the TPA at least 2 days in advance. In case of emergencies, this timeline is within 48 hours of hospitalisation.

Step 2: Once you are at the hospital, present your policy documents and patient insurance cashless card.

Step 3: The hospital will then give you the cashless claim form to initiate the cashless claim process. You can also download the form from the TPA website.

Step 4: Once you get the form, fill the form carefully and submit it at the hospital reception.

Step 5: The hospital will then share your filled cashless claim form with the designated TPA for authorisation of your documents.

Step 6: After the authorisation is done, the TPA will release the approval document, and the hospital will move forward with your treatment immediately. The medical expense then will be settled between the insurance company and hospital, without you getting involved.

Understanding how cashless health insurance claims work in network hospitals is essential when initiating a cashless claim process with Tata AIG.

Step 1: Look for the Tata AIG network hospitals in your area. In case of emergency, inform us within 24 hours. Further, if the treatment is planned, inform us 3 days before hospitalisation.

Step 2: Remember to carry the essential documents, such as the issued Tata AIG health insurance policy, insurance card, etc., while visiting network hospitals. Further, a valid ID proof will be necessary while filling cashless insurance claims at hospitals.

Step 3: Fill out the other necessary pre-procedural forms and submit them to the hospitals.

Step 4: A request should be raised by visiting the Tata AIG official portal to expedite the procedure.

Step 5: After reviewing the application, Tata AIG releases an authorisation letter that will be sent to network hospitals directly. The amount will be settled directly with the hospitals; you don't have to worry about anything.

Note: Here, the cashless settlement would be at ease as our 10,000+ network hospitals are aligned with TATA AIG's requirements.

Your well-being matters no matter where you are. That's why we've introduced cashless healthcare convenience, not only in our network but also in non-network hospitals across the nation. Choose the freedom of cashless transactions and alleviate stress during emergency situations.

Terms and Conditions

• For Planned Admission, the Company should receive the Intimation about the Planned Admission at least 48 hours prior to the proposed date of admission.

• For Emergency Admission, the Company should receive the Request for Cashless Facility in the Prescribed Form at least within 48 hours after the time of admission.

• The Hospital where the treatment is to be taken should meet the requirements of the Policy and the Company's internal guidelines.

• Cashless Facility would be available only if the treatment is found admissible under the terms of the Policy.

• The Request for Cashless Facility should be completed and signed by the Insured Person and the Hospital and submitted with all the requisite documents, including a copy of the Insured Person's Identification.

• The Request for a Cashless Facility needs to be shared with TATA AIG via email.

• Hospitals which are not in the Company's Network should provide a Letter of Consent to extend the Cashless Facility.

• The Company reserves the right to reject the request for a Cashless Facility. If the Cashless Facility is denied, the Customer may submit the papers on completion of treatment, and admissibility of the claim would be subject to the terms of the Policy.

• Government Identification Proof (AADHAR, PAN Card)

• Your Filled and Signed Cashless Claim Form

• Hospital Admission Form

• Summary of Discharge

• Medical Reports and Other Records

• Main Hospital Bill

• Main Hospital Bill with Breakup

• Hospital Pre-Authorisation Form

• Pharmacy Bills and Prescriptions (excluding hospital supplies)

• Emergency Contact Details

• Bank Statements

There are various reasons why your cashless medic-claim process might get rejected. It is important to know these reasons to avoid rejection or to reapply after rejection.

Incomplete Documentation: The health insurance policy terms and conditions are exacting and in order to get your claim settlement swiftly, you need to submit all the necessary documents. With proper documentation, the insurance company will reject your claim immediately. Make sure to cross-check the document requirements with your TPA before applying.

Lack of Communication: The policyholder must inform the TPA within the set period regarding their hospitalisation. The failure of clear and timely communication can result in your cashless claim insurance rejection.

Non-Disclosure of Information: If the policyholder fails to mention any crucial information regarding their health or any disease while buying the health insurance policy, then the insurance company is in a position to reject the medical claims related to the issue. It is advisable to be transparent and honest while filling out your insurance documents.

Policy Exclusions: Certain diseases, treatments and medical conditions are not covered under the cashless insurance claim. If you make claims for any of the excluded conditions of policy then your claim settlement will get rejected.

Lapsed Policy: Your cashless claim insurance can also get rejected because of a lapse in policy. If you have failed to pay policy premiums on time or it expired because of inactivity. Then, any claims made during this period will be rejected.

Be Transparent: You must mention every possible detail regarding your health or any ongoing diseases while buying the health insurance policy. It will prevent you from facing any trouble during the claim settlement.

Inform in Advance: If you are getting hospitalised for any planned treatment, then it is crucial to inform your TPA. Informing at least 2 days before your hospitalisation is necessary so that the authorisation and claim settlement process can be started on time.

Read Documents Carefully: Every policy buyer must read all the insurance documents carefully before agreeing and signing them. Read all the terms and conditions mentioned to clear every doubt regarding any terms and conditions. Make sure to read the list of inclusions and exclusions for medical treatment.

Get Treatment at Network Hospitals: The cashless health insurance claim procedure will only move forward if you go to any network hospital for treatment. The insurance company approves network hospitals and provides you with cashless treatment facilities, which other hospitals might not do.

Medical emergencies are unforeseeable and can occur anytime, what you can do is be prepared for it. Buying a health insurance policy with cashless claim settlement helps you stay relaxed and focus on your treatment.

Tata AIG health insurance has over 10 thousand network hospitals across India, providing cashless hospitalisation facilities. Along with this, our policy provides you with COVID-19 coverage, includes pre-existing diseases, and covers your ambulance cost, too.

Moreover, you can always compare health insurance plans to buy the best cashless claim insurance that covers all your needs and is economical for you.