Cashless Claims

Name: Cashless Claims
Brand: IndusInd General Insurance
Rating: 4.9 (310 reviews)

Health insurance in India is no longer just about coverage; it is increasingly about convenience and accessibility. From digital policy purchase to 24x7 claim assistance, today’s policyholders expect quick, seamless support when it matters most. And at the centre of this shift is the cashless treatment.

According to the IRDAI, during FY 2023–24, insurers settled 2.69 crore health insurance claims, paying out a total of ₹83,493 crore. Notably, 66.16% of these claims were processed through the cashless mode, reflecting a clear preference among consumers for faster, paperless settlements.

At IndusInd General Insurance, we are committed to delivering exactly that with our cashless health insurance plans that offer solid coverage of up to ₹5 crores* and start from only ₹382 per month*. With a quick claim settlement and a Cashless Everywhere facility, we ensure that your trust in us translates into real-time support when every second counts.

So, whether it is a planned procedure or an emergency, you can rely on us to make your treatment journey smooth, cashless and convenient, right from admission to discharge.

What is a Cashless Claim in Health Insurance?

A cashless claim in health insurance refers to the process where the insurance company directly settles your medical bills with the hospital, so you do not have to pay out of pocket for covered expenses. Instead of paying first and claiming reimbursement later, you simply undergo treatment, and the insurer takes care of the costs.

As per new IRDAI regulations, you can get this service at any authorised hospital in India, including your insurer’s network hospitals. This ensures faster access to care, minimal paperwork and reduced financial stress, especially during medical emergencies.

How to Apply for a Cashless Claim?

For Emergency Hospitalisation

Get admitted to any nearby hospital of your choice and present your health card along with an identity proof to avail of the cashless facility.

Notify us via the IndusInd Insurance app or our helpline or email, and submit a duly filled pre-authorisation form to us within 24 hours of hospitalisation.

After obtaining the form, we will review your request for authorisation and inform the hospital of the authorisation status.

If the request is approved, you can undergo treatment and sign all relevant documents before discharge.

We will approve your eligible medical expenses, while any non-medical expenses will need to be paid by you.

Upon completion of your treatment, we will make the payment of the bills directly to the concerned hospital.

If the request is rejected, you can always file a reimbursement claim as rejection of your cashless claim is not a rejection of the claim itself.

During Planned Hospitalisation

Visit the nearby hospital and show your health card and a valid ID proof at the hospital to avail the cashless facility.

Notify us via the IndusInd Insurance app or our helpline or email, and submit a completed pre-authorisation form to us at least 48 hours before a hospitalisation.

Once we receive the form, we will assess your authorisation request and update the hospital with the status.

If your request is approved, you can proceed with the treatment and sign the necessary documents before discharge.

We will cover all eligible medical expenses, while any non-medical costs will need to be settled by you.

After treatment, we will directly pay the approved amount to the hospital.

In case the request is not approved, you still have the option to file a reimbursement claim.

Disclaimer: Before selecting a hospital for treatment, refer to the list of blacklisted/notified hospitals, as any treatment undertaken at such treatment facilities shall not be covered under the policy, and all associated claims (including cashless and reimbursement claims) will be rejected.

Documents Required for a Cashless Claim in Health Insurance

Pre-Authorisation Form - Duly completed and signed.

Health Card - Provided by the insurance company with the policy.

Identity Proof - A valid photo identification proof of the insured, such as a voter ID card, Aadhaar card, PAN card, passport or driving license.

Disclaimer: This list is not exhaustive. Contact our support team for the complete list of documents required.

Benefits of Cashless Claims in Health Insurance

No Upfront Payments

With cashless claims, you do not have to pay hospital bills yourself. Instead, we settle eligible medical expenses directly with the hospital, allowing you to avoid the burden of arranging funds. This is especially helpful during emergencies when time and money are critical.

Quick Access to Medical Care

Since we are directly involved, your treatment starts without any unnecessary delays. A quick authorisation from us clears the way for the hospital to start medical procedures immediately, ensuring you receive timely care when it matters most.

Minimal Paperwork

Unlike traditional reimbursements, cashless claims cut down paperwork. Our direct coordination with the hospital means you do not have to deal with tedious forms or piles of documentation. This makes your claim experience smoother, faster and as efficient as possible.

Swift Claim Settlement

A simple notification and authorisation request from you kicks off the claim process. We then step in to settle your claim directly with the hospital, eliminating the need for you to wait for a reimbursement.

Health Insurance Cashless Claim: Inclusions & Exclusions

What is covered?

Inpatient Treatments - Pays for medical care and other related expenses if you are admitted to a hospital due to an illness or injury.

AYUSH Treatments - Ayurveda, Yoga, Unani, Siddha and Homoeopathy treatments are covered.

Daycare Procedures - Covers minor treatments not requiring long-term hospitalisation.

Ambulance Charges - If an ambulance is required during a medical emergency, we cover the resulting costs.

What is not covered?

Elective Treatments - Non-essential treatments like fertility treatments or vision correction are excluded.

Unapproved Treatments - Treatments not approved by IRDAI or WHO are not included.

High-Risk Events - Claims arising from war, nuclear activity or legal violations are not covered.

Self-Inflicted Situations - Injury resulting from a suicide attempt, substance abuse or breach of law will not be covered.

Disclaimer: This is not an exhaustive list. The inclusions and exclusions will differ depending on your choice of health insurance plan and add-on riders. Refer to the policy wordings for complete details.

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Factors to Consider before Buying Cashless Health Insurance

Network Hospitals

While cashless treatment is now possible even at non-network hospitals, choosing a network facility can speed up approvals and reduce paperwork. That is why it is wise to check an insurer’s hospital network.

IndusInd General Insurance has built a strong network of 10,000+ hospitals*, making it easier to access cashless care quickly and conveniently, no matter where you are.

Claim Process

When time is of the essence, a quick and efficient claim process becomes invaluable. So, before choosing a policy, assess how easily you can initiate and monitor claims with the insurer.

At IndusInd General Insurance, we offer instant claim submission through the IndusInd Insurance app and back it with a claim settlement ratio, so you are never left waiting in critical moments.

Coverage

Understanding the coverage limits of a health insurance policy is essential, as they define the maximum amount your insurer will pay for your treatment. It is important to choose a plan with a sum insured that aligns with rising medical costs and your personal healthcare needs.

At IndusInd General Insurance, we offer plans with a sum insured of up to ₹5 crore, making sure your coverage never falls short.

Exclusions

Every health insurance policy comes with certain exclusions, including medical conditions, treatments or scenarios that are not covered. These may include cosmetic procedures or self-inflicted injuries. Understanding these exclusions is crucial to avoid surprises at the time of claim.

Since we believe in complete transparency, our policy documents clearly outline all exclusions so you always know exactly what to expect.

Pre-Authorisation Requirements

Insurers typically require pre-authorisation to approve cashless treatment. This involves submitting a pre-authorisation form. Learn the process for pre-authorisation to ensure faster claim approvals and prevent last-minute confusion.

IndusInd General Insurance requires you to submit the pre-authorisation form 48 hours before planned hospitalisation and within 24 hours in case of an emergency. This gives you the flexibility to proceed with treatment without delay.

Deductibles and Co-Payments

Verify the deductibles or copayment clauses of your cashless medical insurance plans to ensure you know your financial responsibilities. This will also help you prepare for the mandatory expenses.

At IndusInd General Insurance, we offer health insurance plans with flexible deductible and co-payment options, allowing you to choose what best fits your budget and healthcare preferences.

Top Reasons for Cashless Claim Rejection

Many cashless claims require pre-authorisation from the insurance company. Failure to obtain this approval may lead to the denial of the claim.

Cashless claims can be processed at any hospital within the insurer's network or outside of it. However, receiving treatment at excluded hospitals will result in the rejection of your cashless claim.

Missing or incorrect documents, such as an invalid photo identification proof or an incomplete pre-authorisation form, are a common reason for claim rejection.

If the treatment sought is excluded from the policy, such as infertility treatments or cosmetic surgeries, the claim will be rejected.

Some treatments have specific waiting periods before claims can be made, and any violation of this timeline will result in rejection.

If your policy has expired or the sum insured is exhausted, the insurer will not accept your claim.

Failure to disclose relevant medical history or information when you buy cashless health insurance can invalidate the claim.

Key Takeaways

As per the latest IRDAI Annual Report, general and health insurers in India settled a staggering 2.69 crore health insurance claims, with the average claim amount being ₹31,086. While this figure may appear modest compared to high-end hospital bills, paying such an amount suddenly, especially in a medical emergency, can disrupt household finances or lead to borrowing.

That is where our cashless health insurance plans step in, offering seamless cashless claims that remove the burden of upfront payments. With a robust network of 10,000+ hospitals and a quick, digital claim-filing process through the IndusInd Insurance app, we ensure that help is just a tap away, anytime and anywhere.

To make things even more convenient, IndusInd General Insurance also extends cashless coverage to non-network hospitals, giving you the freedom to choose a hospital that best suits your needs.

So, whether you prefer the comfort of a trusted neighbourhood clinic or find yourself in a specialised facility far from home, we help you access cashless treatment without worrying about out-of-pocket expenses.

Do not let medical bills catch you off guard. Secure cashless coverage with IndusInd General Insurance today.

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Frequently Asked Questions (FAQs)

What is the new rule for cashless claims?

As per the updated IRDAI guidelines, cashless claims are no longer restricted to network hospitals. You can now get cashless treatment at any hospital, including non-network ones, provided the hospital is not delisted or excluded and agrees to the insurer’s terms.

How long does it take for a cashless claim to be approved?

As per the latest IRDAI guidelines, insurers are required to decide on a request for cashless authorisation immediately, and not more than one hour from the time they receive the request. This ensures faster access to treatment and minimises delays during hospitalisation.

Can cashless claims be rejected?

Yes, cashless claims can be rejected for various reasons, including incomplete/incorrect documentation, non-covered treatments or delays in pre-authorisation.

What is the difference between reimbursement and cashless claims?

In a cashless claim, your insurer settles the hospital bill directly with the hospital so you do not pay upfront (except for non-covered expenses). In a reimbursement claim, you pay the hospital first and later submit the required documents to the insurer to get your money back. Cashless claims are faster and more convenient, especially during emergencies.

Are pre-existing conditions covered under cashless health insurance?

Pre-existing conditions may be covered after a waiting period, depending on the terms of your policy. All our plans impose a certain waiting period before you can claim your IndusInd Health Insurance for treatment of pre-existing illnesses. We advise you to review your specific health insurance policy documents to determine the waiting period for your plan. This can help you determine your eligibility for coverage for pre-existing conditions.

Is it safe to buy two-wheeler insurance in Chennai online?

Yes, you can purchase two-wheeler insurance online in Chennai securely as long as you are taking the policy from an insurer registered under the IRDAI.

What is cashless pre-authorisation?

Cashless pre-authorisation is the process where a policyholder submits a pre-authorisation form to the insurer or TPA (Third-Party Administrator) to get approval for cashless treatment. The insurer or TPA reviews the medical details provided and processes the request after verifying the information related to the illness or injury. Based on the evaluation, they confirm the approval or rejection of cashless treatment in writing or through other communication channels.

How to check the cashless claim status?

You can easily track your cashless claim by following these simple steps - Visit our health claim status page. Enter your policy or claim number, date of admission/incident/loss and the captcha code. Click on "Track Now" to see the current status of your claim.

How to avoid cashless claim rejection?

To avoid this, understand your policy, choose eligible hospitals and submit a duly filled pre-authorisation form. If rejected, you can still opt for reimbursement by submitting the required documents to us for claim processing.

Does cashless health insurance offer any tax benefits?

Yes, cashless health insurance premiums qualify for tax deductions under Section 80D of the Income Tax Act. You can claim up to ₹25,000 for premiums paid for yourself, your spouse and dependent children. If you are a senior citizen, this limit increases to ₹50,000. You can also claim an additional deduction of up to ₹25,000 for premiums paid for parents, irrespective of their dependence status. If your parents are senior citizens, this limit increases to ₹50,000.

Can I transfer my cashless health insurance policy to another provider?

Yes, under the Insurance Regulatory and Development Authority of India (IRDAI) guidelines, you can port your health insurance policy to another insurer. The new insurer must provide coverage without a loss of benefits, such as the waiting period for pre-existing conditions, but certain conditions apply.