A cashless claim allows you and your family members to receive treatment at a network hospital without making immediate payments. The insurer settles the bill directly with the hospital, enabling you to focus on recovery rather than worrying about payments.

Step-by-step guide for cashless Health Insurance claims

Step 1: Choose a network hospital. Select a hospital that is empanelled with your insurance provider for cashless claims. You can find the list of network hospitals directly on the Upstox app or by visiting the insurer’s website.

Step 2: Inform the insurance provider. Notify your insurance provider or Upstox about your planned treatment at least 2-3 days in advance for scheduled procedures. For emergency treatments, you can get admitted to the hospital and inform the insurer within 24 hours of admission.

Step 3: Submit the pre-authorisation form. At the hospital, visit the insurance desk to request the pre-authorisation form. Fill out the required details, such as your policy number, health ID, personal information, and the nature of the treatment. The hospital will submit this form to the insurance provider for approval.

Step 4: Approval from the insurance provider. Once the insurer receives the pre-authorisation form, they will verify your policy details and coverage eligibility. The insurer typically responds within a few hours with their approval.

Step 5: Undergo treatment. After receiving approval, you can proceed with the treatment. The hospital and insurer will coordinate the payment process. Keep in mind that you might still need to pay for non-medical expenses or items not covered under your policy, such as consumables or luxury room charges.

Step 6: Claim settlement. Once the treatment is complete, the hospital will forward the final bill to the insurer for claim settlement. The insurer will review the final bill and settle the approved amount directly with the hospital. You will be required to pay any additional expenses that are not covered under your policy, such as deductibles or copayments.

Important points to remember

• Planned hospitalisation: Always notify your insurer or Upstox well in advance (at least 48-72 hours) to ensure a smoother process.
• Emergency hospitalisation: Ensure that the insurance provider is informed within 24 hours of hospital admission to avoid claim rejections.
• Network hospitals: Cashless claims are only available at network hospitals. Check the insurer’s list of network hospitals before hospitalisation.
• Non-covered expenses: Even with cashless claims, there may be certain expenses (like consumables and luxury items) that you’ll need to pay out of pocket.

Documents required for cashless claims

• Pre-authorisation claim form
• Health ID
• Government-issued ID (Aadhar, PAN, or Voter ID)
• Hospital, pharmacy, and other medical bills
• Discharge summary with the treating doctor’s signature, investigative reports, etc.
• Any other documents requested by the insurer

For any queries and assistance, reach out to the Insurance Support Team at Upstox on insurancesupport@rksv.in.