Page 129 - Ebook health insurance IC27
P. 129
Sashi Publications
Domiciliary hospitalisation Domiciliary hospitalisation is allowed for a period
benefit exceeding 30 days is allowed to by insurance
Cashless hospitalisation companies if
benefit 1. condition of patient is not good and cannot be
Deductible shifted to hospital
2. lack of a local accommodation in hospital
3. lack of nursing facility in hospital
l Under cashless hospitalisation the insured is not
required to pay any amount for treatment to the
hospital. The insurance company directly
reimburses expenses to the hospital.
l This facility is administered by Third party
administrators (TPA)
l Cash less facility is available in specified hospitals
l Pre-authorisation must be granted by insurer/TPA
to avail the facility.
l TPA may not approve all expenses and
policyholder may have to pay the balance.
l Denial of cash less facility does not mean denial of
claim. The insured after treatment may submit the
claim in off-line mode in usual course.
l Deductibles are cost sharing mechanism.
l If deductible clause is incorporated in the policy
the pecified amount in respect of each claim must
be specifically mentioned.
l The insurance company pays the claim after that
specified amount
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