Cashless facility is available only in the network hospitals

Published in Mint on Jan 21 2014, Written by Kapil Mehta

I plan to buy a health insurance plan. I prefer cashless policy and would like to buy a Rs.3 lakh policy. However, while I was researching for a good policy, I found that the company I like has very few network hospitals in the area that I live in. Should I go for an insurer which has more network hospitals?

—Piyush Karnik

Cashless facility will be available only in the network hospitals. That’s why it is important that hospitals close to you or those that you prefer be empanelled with the insurer.

If during a medical emergency, you need to go to a non-network hospital then that claim will also be reimbursed to you. However, in that situation you will need to pay the bill and then claim from the insurer. This is typically a two to three month process.
I bought a car in Kolkata and got an insurance too. Now I am using that car in Delhi with the West Bengal number. Is the policy and the benefits valid?
—Srimanth

I spoke to a few insurers about your question. They all assured me that policy benefits remain valid even if you are using the car in another state. However, I am less sanguine that claims will be paid because there are so many more ways by which your claim can be denied. An insurer could say that you violated the Transport Department’s provisions and were driving illegally. Or they could aver that the premium would have been different if they had known you were driving in Delhi. As a matter of abundant caution you could inform them by email that you are driving in Delhi on a West Bengal number and ask them to get back to you if they have an issue. This shifts the onus to the insurer.

Can I port a post-paid health insurance for a cashless one? What is process and things to keep in mind? Will I lose out on any benefits?
—Venkatesh

Generally all health insurances are a mix of cashless and post-paid. Cashless settlement has become a basic element of health insurance and is not really a special benefit any more. Since cashless facility is available in network hospitals it is important to pick insures that have more network hospitals close to where you live.
Porting is possible in health insurance. The primary benefit of porting is that the waiting periods for specific diseases and pre-existing disease exclusion gets reduced by the period for which you held the previous policy

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