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term may differ – what with competitive nature insurance.

These expenses are paid provided the expenses relate only to

the disease / sickness for which hospitalization was required.

 Cashless Facility

As one of the incentives offered to boost health insurance

footprint, IRDA launched Cash Less hospitalization in select

‘network’ hospitals. Insurance companies have tie-up

arrangements with network of hospitals in the country. If the

policyholder takes treatment in any of the network hospitals,

there is no need for the insured person to pay hospital bills. The

Insurance Company, either directly or through its Third Party

Administrator (TPA) will arrange direct payment to the Hospital.

All these claims have to undergo a ‘Pre-authorization’ wherein a

network hospital seeks pre-authorization to treat a particular

patient for a particular ailment. The provider has to provide

provisional diagnosis, anticipated line of investigations and

treatment that may be required. Based on the data submitted,

insurer (or TPA on their behalf) allots a certain amount to cover

legible expenses.

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