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The Insurance Times
the right to deny pre authorization. In that case insured will not be able to avail
cashless facility and he will have to submit the claim for reimbursement.
Q. What are network and non network hospitals?
Network Hospitals:
The company ties up with hospitals for cashless claim process. When you avail of a
cashless treatment in any of these network hospitals, the company would settle the
claim with the hospital directly.
Non-network Hospitals:
Non network hospitals are the ones with which the company does not have a cashless
tie up. When you avail treatment in non network hospital, you will have to first settle
the bills yourself and then submit the relevant documents and bills to the service
provider or TPA. The claim amount, subsequently, is reimbursed to you based on
policy terms and conditions.
Q. What is Pre-Authorization?
Pre-authorization is an authorization issued either by the insurance company or the
TPA, specifying the value of the medical treatment that can be claimable under their
insurance policy. To receive a pre-authorization, policyholder need to submit duly
filled in the Pre-authorization form available at the hospital or TPA.
Q. What is a floater policy? How is it beneficial?
In case of a floater policy, all members of the family are covered under one single
policy. A single premium is payable for the entire family and the amount of cover
(Limit) "floats" overthe entire family (OneSum assured). This offersyou the flexibility
356 Guide for Health Insurance
