Health Insurance: What is the procedure to avail cashless facility?

– Radhika

Yes, cashless claim settlement is considered hassle free. It is a service provided by an insurer through its TPA (Third-Party Administrator) in its set of network hospitals. In this, the insurance company directly pays the expenses incurred for treatment in a network hospital as per the terms and conditions of the policy. Insurers provide policyholders with a list of participating network hospitals. There is no need for the policyholder to pay the hospital bills if they receive treatment at any of the network hospitals. The insurer settles the bill directly with the hospital. However, if you opt for treatment in a non-network hospital, the claims will have to be settled by way of reimbursement.

For a perfectly healthy 27 year old unmarried, what is the right amount of health insurance coverage wise? I already have corporate insurance of 3 lakhs.

– Mathews

Considering the uncertainty, rising medical bills and hospitalization costs, it is advisable to buy an individual comprehensive insurance plan, especially in case of critical illnesses. So, affordability wise, the more coverage you can take, the better. However, your corporate insurance policy should have a minimum sum insured of Rs 5 lakh, otherwise you will end up paying the huge hospital bills on your own. Also, the individual health insurance policy gives you the option to choose the policy as per your requirements and without any sub-limits, capping and co-pays.

(Questions were answered by Sanjeev Bajaj, Joint Chairman and Managing Director, Bajaj Capital. Please send your queries and thoughts to mintoney@livemint.com)

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