What is a Cashless claim?
A cashless claim lets you get treated at a network hospital without paying the covered amount yourself. Your insurer or its TPA settles the approved bill directly with the hospital. You still pay for anything excluded, above your sum insured, or below a deductible or co-pay.
How a cashless claim works
You get admitted at a hospital in your insurer's network and show your health card or policy details. The hospital sends a pre-authorisation request to the insurer or TPA with your diagnosis and estimated cost.
The insurer approves an amount (often in stages), and settles the admissible bill directly with the hospital at discharge. You only pay non-covered items, co-pay, deductible, and anything beyond your sum insured.
Where cashless can still cost you
Cashless only applies at network hospitals, and approval is for the admissible amount, not the whole bill. Room-rent caps, sub-limits, co-pay and non-payable consumables are still deducted, so the 'cashless' figure can be smaller than the sticker bill.
Example
You are admitted at a network hospital for surgery. The insurer pre-approves the covered amount and pays the hospital directly. You settle only the non-payable consumables and your policy's co-pay at discharge.
Common mistakes
- Assuming cashless means the entire bill is covered — sub-limits, co-pay and exclusions still apply.
- Going to a non-network hospital and expecting cashless — there you must use reimbursement instead.
- Not intimating the insurer in time for a planned admission, which can delay pre-authorisation.
Frequently asked questions
What if cashless is denied at the hospital?
A cashless denial is usually about documentation or a network/eligibility issue, not an outright claim rejection. You can typically still pay and file a reimbursement claim with the same documents afterwards.
Is cashless available at every hospital?
No. Cashless works only at hospitals in your insurer's network. For non-network hospitals you pay first and claim reimbursement.