What Does Cashless Hospitalisation Actually Mean?

How the process usually runs

• You are admitted at a hospital that is in your insurer's network.
• The hospital insurance desk sends a pre-authorisation request to the insurer or TPA.
• The insurer approves an amount based on the policy terms.
• At discharge, approved amounts are settled directly; non-payable items are paid by you.

What you may still pay

Consumables, non-medical items, amounts above sub-limits, co-payment and any deductible are commonly borne by the policyholder. The list of non-payable items is defined in the policy and by regulation.

If the hospital is outside the network

You typically pay first and file a reimbursement claim with bills, discharge summary and reports. Keeping originals organised matters.

Worth checking in advance

Network hospital lists change. Check your insurer's current list for hospitals near your home and workplace rather than assuming a hospital is still included.