Cashless Health Insurance: Claim Process and Timelines

Quick Overview

Cashless health insurance allows the insurer to pay the hospital directly, so you don’t have to arrange the amount upfront. It works across network hospitals and needs a pre-authorization request (before admission for planned care, soon after admission in emergencies). Even with a cashless option, hospitals may ask for a refundable ₹5,000–₹50,000 security deposit to cover non-payables or approval/payment delays, which is adjusted/refunded at discharge.

It can be higher if the insurer-hospital relations are strained. If cashless is rejected, fix documents, switch to reimbursement, or escalate with the insurer and IRDAI.

Even if you have health insurance, the hospital can ask for a ₹2 lakh deposit at admission. At that moment, the question is: what does cashless really mean?

Cashless health insurance means the insurer pays the eligible hospital bill directly to the hospital, usually at a network hospital after pre authorization. It reduces the need to arrange the full amount upfront, but it does not mean you will pay nothing.

You may still spend out-of-pocket for non covered items, deductibles, co-pay, and any costs beyond your policy limits.

In this article, we break down how cashless claims work, what is covered and what is not, and what to do if they are rejected.

How do Cashless Claims Work?

Step 1: Go to Network Hospital

Planned Hospitalization: Ask the hospital to send the pre-authorization request with an estimate at least 48 hours before admission
Emergency Hospitalization: Get admitted first, then the hospital raises pre-authorization. Inform the insurer within 24 hours
Common Delay: Hospitals may send pre-authorization late, sometimes on discharge day. Ask for the pre-authorization reference number on admission day

Step 2: If Approved, Insurer Pays the Hospital

You pay: Non-covered items, deductibles, and co-pay, if any
Do this: Track the request and reply fast to insurer queries
Ask the desk: Any pending document, consultation note, investigation report, or KYC

Step 3: Enhancement and Final Approval

Enhancement: If costs rise, the hospital sends an enhancement request. If insurer approval is lower than the revised estimate, you pay the gap as an extra deposit
Late denial risk: Even after initial approval, cashless can be denied at discharge if final records indicate an exclusion or pre-existing disease concern

Note: IRDAI requires insurers to decide cashless authorization within 1 hour of receiving the request, and issue discharge authorization within 3 hours. If discharge approval crosses 3 hours, any extra amount charged by the hospital for the delay must be borne by the insurer. Timelines can slip due to queries or document gaps. Hence, ask what is pending and share it quickly.

What is Covered and Not Covered in Cashless?

Covered (Inclusions)	Not covered (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.

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Best Cashless Health Insurance Plans in India

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

Policy Terms: Room rent rules, co-pay, consumables coverage, and waiting periods
Insurer Metrics: Hospital network strength and claims service track record
Premium Value: Whether the price is fair for what the plan actually offers

Based on the same framework, here are our top cashless health insurance picks.

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.

What to do if a Cashless Claim is Rejected?

Rejection Reason

Ask the insurer for the rejection reason in writing and the exact policy clause. Common reasons include doubting medical necessity, waiting periods or exclusions, non-network hospitals, sum insured limits, missing documents, early high-value claims, or non-disclosure.

Documentation

If the rejection is due to paperwork, submit the missing or corrected documents and ask the hospital desk to resend the request for review. Keep copies of everything you share.

Try Reimbursement

If cashless does not go through, pay the bill and file a reimbursement claim with all hospital documents. Keep in mind that reimbursement is still subject to your policy terms, so the insurer may not pay for exclusions or non-payables.

Escalate Claim

If you still disagree, raise a written grievance with the insurer’s Grievance Redressal Officer. Insurers are expected to resolve complaints within 15 days. If it is still unresolved or you are unhappy with the response, escalate it on IRDAI’s Bima Bharosa portal and, if needed, approach the Insurance Ombudsman.

Pro Tip: Sometimes, cashless is unavailable because the hospital has temporarily stopped offering cashless for a specific insurer due to operational or payment disputes. Keep a Plan B like a credit card or emergency fund buffer.

Cashless vs Reimbursement: What’s the Difference?

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 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

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.

Check network strength: Prefer insurers with strong network coverage across cities you travel to, not just your home city.
Rule of 5: Shortlist 5 nearby network hospitals for home, parents, and work, including multispecialty, maternity, and pediatric options.
Review regularly: Recheck the network list before renewals and any planned hospitalization since hospital tie ups can change.
Avoid blacklisted hospitals: If a hospital is blacklisted, claims may not be payable at all, cashless or reimbursement, so check the list before admission.

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.

Can a hospital refuse cashless even if it is a network hospital?

Yes, it can happen if the hospital is temporarily not honoring cashless for an insurer due to disputes, or if it has been removed or blacklisted from the network. The safest approach is to confirm cashless at the hospital desk before admission and keep reimbursement as a backup.

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

We truly believe financial information should be made accessible to people free of cost. And we will go to extreme lengths to make that dream a reality.

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.

Last updated on: 17 Jan, 2026