How to make the best use of cashless mediclaims

MUMBAI: Cashless hospitalisation is in today. If cashless were to be efficiently used, you can simply walk into a network hospital, flash your card and undertake treatment without paying a penny. But these “hassle-free” plans can actually end up being more painful for you. Here is a checklist which could come in handy at stressful times. If it’s a planned hospitalisation, talk to your third-party administrator (TPA). Get an estimate of the medical cost for your treatment and choose the hospital from the mentioned network accordingly. n Keep your mediclaim cards handy. Also, keep the contact details of your TPA. Check the list of network hospitals covered under your mediclaim policy along with the room specifications. Check the room details, as some mediclaim policies accommodate only simple air-conditioned rooms as against deluxe rooms, because of rising medical costs. Some policies also have imposed sub-limits. The most common sub-limits imposed by insurers are room rents, doctors’ fees and diagnostics. So, when you sign up for a policy, check if the insurer has assigned a maximum amount for a specific expense. If you have a sum insured of Rs 1 lakh and the insurer has capped your room rent at 1-1.5% of the sum insured, then your room rent cannot exceed Rs 1,000. Similarly, insurers cap the doctor’s fee at 25-30% of the bill amount. If the actual bill amount exceeds any of these sub-limits, then you will have to pay the balance from your pocket. Stay within the sum assured of your mediclaim. If you hail from a small or mid-sized town, you should look at a cover of Rs 2-3 lakh. If you reside in a metro, you should not look at covers less than Rs 4-5 lakh. Finally, cashless mediclaim does not cover OPD consultation/procedure done in pre-hospitalisation period. The recent budget has given an additional deduction of Rs 15,000 year under Section 80 D if you pay medical premiums for your parents. Earlier, you could avail of deduction up to Rs 15,000 per annum on the premium payment for dependent parents, spouse or children. The money should be on its way. Although there are administrative hassles in a cashless product, you can’t rule it out. It’s a must have in your financial kitty today.
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