Cashless Health Insurance: Benefits, Process and Plans

Quick Overview

Cashless health insurance is a method of claiming where your insurer pays the eligible bill directly to the network hospital, after pre-authorization. It reduces the need to arrange the full amount for your bill upfront, but it does not mean “zero cost.” You still have to pay for non-payables, deductibles, co-pays, and anything beyond your policy limits. Additionally, no health insurance is “cashless by default” everywhere. Cashless depends on the hospital tie-up and whether your claim is admissible.

Even if you have health insurance, the hospital can still ask for a big deposit at admission. So the real question is: what does “cashless” actually mean in real life?

Cashless health insurance is how the claim is processed when you’re in the right hospital setup, and the claim meets policy rules. The insurer settles the covered part with the hospital, while you pay the rest (non-payables, exclusions, deductibles, co-pay, and anything beyond limits).

What is a Cashless Claim in Health Insurance?

A cashless claim is simply a way to file a claim. It is not a special “type” of policy.

People often ask: “Is my insurance cashless?”

The better question is: “Can my claim be processed cashless at this hospital?”

All retail health insurance plans offer cashless claims, but only when the hospital is in the insurer’s network (or agrees to support cashless in that case), and the claim is admissible.

Even at a network hospital, cashless can fail due to missing documents, exclusions, waiting periods, room-category issues, or medical details that do not match disclosures.

Eligibility for Cashless Health Insurance

You are eligible for cashless when:

Network Hospital: You are admitted to a network hospital.
Active Policy: Your policy is active and in force.
Covered Treatment: The treatment is covered and medically necessary.
No Blocks: Waiting periods, exclusions, and limits do not block the claim.
Pre-authorization Done: The hospital raises pre-authorization on time with the required documents.

Types of Cashless Health Insurance

There are no real “types” of cashless health insurance. Instead of looking for a “cashless policy”, think of cashless as a “feature” of the claim process that depends on the hospital setup and whether the expenses are admissible under your policy.

How Do Cashless Claims Work?

Planned Hospitalization (Scheduled Surgery or Admission)

Step 1: Confirm Cashless at the Hospital Desk
Share policy details and ask them to raise pre-authorization (cashless request) via the insurer/third party administrator (TPA).

Step 2: Raise Pre-auth Before Admission
Ask the hospital to send the pre-auth form + estimate + required medical documents at least 48-72 hours before admission.

Pro tip: Get the pre-auth reference number the same day it’s raised so you can track it.

Step 3: Respond Fast to Insurer Queries
Most delays happen because of missing doctor notes, investigation reports, or KYC. Ask the desk: “What’s pending right now?” and close it quickly.

Step 4: Approval Comes with Conditions
Cashless approval is subject to admissibility, and can be time-bound, for example: some insurers treat approvals as valid for a limited window.

Step 5: If the Bill Increases, Raise an Enhancement
If treatment costs go up, the hospital should send an enhancement request during treatment (not at discharge). If the insurer approves less than the revised estimate, you pay the gap.

Step 6: Discharge and Final Approval
As per IRDAI guidelines, insurers must decide cashless authorization within 1 hour of receiving the request. For discharge, insurers must give final discharge authorization within 3 hours of the hospital’s request. If it crosses 3 hours, the extra amount charged due to the delay is borne by the insurer.

Emergency Hospitalization (Unplanned Admission)

Step 1: Get Admitted First
Share policy details with the hospital insurance desk as soon as things stabilize.

Step 2: Pre-auth Request After Admission
The hospital sends the pre-auth form + required documents to the insurer/TPA, and cashless is approved if the claim is admissible. Raise pre-auth requests within 24 hours of emergency admission.

Step 3: Expect Queries and Paperwork
In emergencies, hospitals sometimes send incomplete estimates and documents. Keep pushing for what the insurer wants: admission notes, consult notes, investigations, past history, KYC.

Step 4: Enhancement if Costs Rise
Same rule: ask the hospital to raise enhancement during treatment so you do not get surprised at discharge.

Step 5: Discharge timelines still apply
IRDAI requires insurers to decide cashless authorization within 1 hour and provide final discharge authorization within 3 hours of the hospital’s request.

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Benefits of Cashless Health Insurance

So why is cashless medical insurance important for most families? Let’s unpack it.

Deposit Relief

Reduces the upfront payment burden at admission by settling the eligible part directly with the hospital.

Emergency Support

Helpful when you need treatment quickly during emergencies and cannot arrange funds immediately.

Discharge Ease

Less last-minute stress when approvals and final settlement happen on time.

Simple Process

The hospital insurance desk handles most of the coordination with the insurer/TPA.

Planned Clarity

Pre-authorization improves predictability for planned hospitalizations and helps you plan deposits and non-payables.

What is Covered and Not Covered Under Cashless Health Insurance?

Inclusions	Exclusions
Hospitalization expenses (room rent, surgeries, diagnostics during admission)	Cosmetic/plastic procedures (unless medically necessary)
Doctors’ and specialists' fees during hospitalization	Dental and eye treatments (unless due to an accident or specifically covered)
Medicines and diagnostic tests prescribed during hospitalization	Non-medical expenses (personal comfort items) and experimental/unproven treatments
Day-care procedures (treatment without 24-hour admission)	Treatments during waiting periods; pregnancy/fertility (usually excluded unless specified)
Ambulance charges (if included in your policy)	Injuries from war/terrorism/radiation
Annual health check-ups (only in select plans)	Injuries from hazardous/extreme sports done professionally

Anything not covered in cashless health insurance usually becomes your out-of-pocket payment. Even with cashless, you may have to pay for exclusions, non-payables, and any policy limits that apply.

How to Choose the Best Cashless Health Insurance Plan?

At Ditto, we shortlist cashless-friendly plans using a simple framework

Network Strength

Real coverage near your home, parents, and workplace, plus traveling

Policy Terms

Room rent rules, co-pay, consumables coverage, and waiting periods

Insurer Metrics

Operational and claims service track record

Premium Value

Whether the price is fair for what the plan actually offers

Based on the same framework, let’s see which is the best cashless health insurance policy in India.

Best Cashless Health Insurance

Top 5 Cashless Health Insurance in India

Insurer and Plan	Claim Settlement Ratio (Avg FY 2022-25)	Network Hospitals
HDFC ERGO Optima Secure	96.71%	13,000+
Care Supreme	93.12%	11,400+
Aditya Birla Activ One MAX	95.81%	12,000+
Niva Bupa ReAssure 2.0 Platinum+	91.61%	10,000+
SBI Super Health Platinum Infinite	96.13%	16,600+

Did You Know?

The “Cashless Everywhere” initiative was launched by the General Insurance Council in January 2024 to help people request cashless treatment even at non-network hospitals. However, it depends on the hospital’s willingness and insurer approval, so always keep reimbursement as a backup.

Common Cashless Claim Mistakes to Avoid

“Cashless Policy” Myth

Cashless is not a type of policy. It is a claim process that depends on the hospital setup and whether your claim is admissible.

Hospital Check

Always confirm cashless at the hospital insurance desk, because even network hospitals can temporarily pause cashless for an insurer.

Late Pre-Auth

If pre-authorization is raised late, approvals get delayed. Ask for the pre-auth reference number on the admission day.

Missing Papers

Small gaps, like missing notes or reports, can stall approvals. Ask what is pending and share it quickly.

Enhancement Request

If the estimate rises, ask the hospital to send an enhancement request during treatment, not at discharge.

No Backup Plan

Keep reimbursement as Plan B with a credit card or emergency buffer in case cashless does not go through.

What to Do if a Cashless Claim is Rejected?

Ask for the rejection reason in writing and the exact clause. If it is a documentation issue, fix it and request a review. If cashless still does not work, pay and file reimbursement, then escalate to the insurer’s GRO and IRDAI’s Bima Bharosa portal if needed.

Cashless Health Insurance Vs Reimbursement Claims

Basis	Cashless Claim	Reimbursement Claim
Where it works	Usually, only at your insurer’s network hospital	Works at any hospital (except for blacklisted)
Who pays the hospital first	The insurer pays the eligible part directly to the hospital	You pay the bill first, then claim from the insurer
When you pay from your pocket	At discharge, for non-covered items, co-pay, deductibles, and limits	Upfront during treatment, and later for any non-covered items/limits. Subject to reasonable and customary clause
Approval flow	Needs pre-authorization from the insurer	No pre-auth needed for payment, but the insurer verifies later, an intimation to the insurer is recommended
Documents	Fewer at the start, the hospital coordinates most of the paperwork	More paperwork from you: bills, reports, discharge summary, prescriptions
Best for	When you want lower upfront payment stress	When the hospital is not in the network, or cashless is not available

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Pallavi below love us:

No-Spam & No Salesmen
Rated 4.9/5 on Google Reviews by 15,000+ happy customers
Backed by Zerodha
Dedicated Claim Support Team
100% Free Consultation

Confused about the right insurance? Speak to Ditto’s certified advisors for free, unbiased guidance. Book your call or chat on WhatsApp with us now!

Ditto’s Take on Cashless Health Insurance

Cashless health insurance is worth having, but it should not be the only reason you pick a plan. All insurers offer cashless health insurance because they have network tie-ups, but your experience will depend on how strong the network is in your area.

What we recommend:

Prioritize strong hospital access in your city, plus where you travel.
Avoid claim-time surprises: check room rent rules, non-payables/consumables, co-pay, deductibles, and waiting periods.
Shortlist 5 nearby hospitals and recheck the network before planned admissions.
Keep a reimbursement backup buffer for deposits and non-payables.

Our stand: Treat cashless as a convenience, not a guarantee. Choose a plan for strong coverage and clean terms, and keep reimbursement as your safety net.

Quick Note

Ditto currently partners with HDFC ERGO, Care Health, Aditya Birla Health, and Niva Bupa. Some insurers on this list are non-partners, and we’ve still included them here because the article is unbiased and based entirely on published data, not on commercial relationships.

For a detailed explanation of our process, partnership policy, and disclaimers, please see our [Editorial Policy & Disclaimers] document.

Finally, this analysis is based on publicly available information and should not be treated as personalized advice. Always read the policy brochure carefully and consult a licensed advisor before purchase.

Frequently Asked Questions

How do I check if a hospital is in my insurer’s network?

Check your insurer’s website or app and search the hospital by city or PIN code. Network tie-ups can change, so it is recommended to recheck close to admission (or call the hospital insurance desk to confirm).

What happens if my final bill is higher than the pre-authorization amount?

Ask the hospital to send a revised estimate and request an increased approval amount (an “enhancement”) while treatment is ongoing. If the insurer does not approve the full increase, you pay the difference, especially for expenses beyond approved limits or policy caps.

What if I have multiple health insurance policies?

If your policies are with different insurers, getting cashless approval from both at the same time is usually difficult. In most cases, you use one policy as cashless (primary) and claim the remaining eligible amount from the second policy via reimbursement (secondary).

Do I need to pay a deposit in a cashless claim, and will I get it back?

Many hospitals ask for a refundable security deposit (often 10% of the claim) even in cashless cases, mainly as a buffer for delays or items the policy will not cover. It is usually adjusted against the final bill, and any balance is refunded after the insurer settles its share. Some hospitals refund the deposit only after insurer settlement, so refunds may take time.

Is cashless claiming available for all treatments?

No. Cashless only works for treatments that are covered under your policy terms and not blocked by exclusions, sub-limits, or waiting periods.

Last updated on: 6 Feb, 2026

Cashless Health Insurance