Definition
Cashless Claim
A cashless claim is a settlement method where the insurer or TPA pays the network hospital directly, sparing the policyholder from upfront payment of covered costs.
For planned treatment the patient seeks pre-authorisation from the TPA, while for emergencies authorisation is sought after admission within a set window. The hospital and TPA exchange approvals, and the insurer settles eligible charges directly, with the patient bearing only deductibles, sub-limit excesses and non-payable items.
Cashless is the preferred route because it avoids large upfront outlays during a medical crisis. IRDAI has set turnaround norms for cashless authorisation and final discharge approval to curb delays, a frequent grievance in Indian hospitals.
Related terms
- Network HospitalA network hospital is a healthcare provider that has a tie-up with the insurer or TPA to offer cashless treatment to policyholders.
- Reimbursement ClaimA reimbursement claim is when the policyholder pays the hospital first and later submits documents to the insurer to recover eligible expenses.
- Pre-AuthorisationPre-authorisation is the insurer's or TPA's approval of a cashless hospitalisation before or shortly after admission, confirming the claim's eligibility and estimated amount.
Plain-English explainer from The Dispatch Investors Encyclopedia. General information, not financial advice.