Common use of Cashless Facility Clause in Contracts

Cashless Facility. i. Wherever Cashless Facility is available, the You/Insured Person shall contact Us or Our Assistance Service Provider as soon as possible, but in any event, before completion of the treatment or services availed. Where any service under an Benefit/Cover Option is only covered on a Cashless Facility basis, it shall not be covered by this Policy unless You/Insured Person consults with Us or Our Assistance Service Provider and the cost for such services are authorized in advance by Us or Our Assistance Service Provider. ii. To avail of Cashless facility at any Medical Practitioner, Hospital, or other service provider, the Insured Person’s health card along with a valid photo ID proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by Us) should be provided, or a pre-authorization may be sought from Us or Our Assistance Service Provider by providing the Certificate of Insurance number and a valid photo ID proof to the service provider, who can co-ordinate with Us to provide Cashless facility for the Insured Person’s treatment or services. iii. We or Our Assistance Service Provider shall process the request for pre-authorization after having obtained accurate and complete information in respect of the claim for which Cashless Facility is sought to be availed. We or Our Assistance Service Provider shall confirm in writing authorization or rejection of authorization to avail Cashless Facility. iv. Where such pre-authorization is confirmed, We or Our Assistance Service Provider shall contact the service provider for communicating the confirmation and extent of such coverage. If pre-authorization as per Cashless Facility is denied by Us, or is unavailable at such service provider, then You/Insured Person may still subsequently write to Us seeking reimbursement of the expenses covered under the Policy. v. Cashless facility is only available at specific service providers and geographies, and updated list of which shall be available at Our website or can be confirmed through a phone call made to Us or Our Assistance Service Provider.

Cashless Facility. i. Wherever Cashless Facility is available, the You/available only at Network Providers for In-patient Care under Benefit 1(refer clause 2. 1.1) The Insured Person shall contact Us or Our Assistance Service Provider as soon as possible, but in any event, before completion can avail of the treatment or services availed. Where any service under an Benefit/Cover Option is only covered on a this Cashless Facility basisat the time of admission into a Network Provider, it shall not be covered by this Policy unless You/completing the following procedure: a) Pre-authorization : The Policyholder or Insured Person consults with Us or Our Assistance Service Provider and must call the cost for such services are authorized in advance by Us or Our Company’s / Assistance Service Provider. ii. To avail ’s call center as specified in the Policy Schedule and request authorization for the proposed treatment by way of Cashless facility at any Medical Practitioner, Hospital, or other service provider, the Insured Person’s health card along with submission of a valid photo ID proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by Us) should be provided, or a completed pre-authorization may be sought from Us or Our Assistance Service Provider by providing form at least within 24 hours of admission to Hospital, if the Certificate of Insurance number and a valid photo ID proof to the service provider, who can co-ordinate with Us to provide Cashless facility for the Insured Person’s treatment or servicesHospitalization is required. iii. We or Our Assistance Service Provider shall b) The Company will process the request for pre-authorization after having obtained accurate and complete information in respect of the claim Illness or Injury for which Cashless Facility is sought to be availed. We The Company or Our the Assistance Service Provider shall will confirm in writing authorization or rejection of authorization to avail Cashless FacilityFacility for the Insured Person’s Hospitalization. ivc) If the request for availing Cashless Facility is authorized by the Company or the Assistance Service Provider, then payment for the Medical Expenses incurred in respect of the Insured Person shall not have to be made to the extent that such Medical Expenses are covered under this Policy and fall within the amount authorized in writing by the Company for availing Cashless Facility. Where such prePayment in respect of all Deductible or Co-authorization is confirmed, We Payment and amount exceeding the sub-limits as applicable shall be made directly by the Policyholder or Our Insured Person to the Network Provider. d) If the Company or the Assistance Service Provider shall contact does not authorize the service provider for communicating the confirmation and extent of such coverage. If pre-authorization as per Cashless Facility due to insufficient Sum Insured or insufficient information provided to the Company or the Assistance Service Provider to determine the admissibility of the Claim or if the treatment is denied not taken at a Network Provider, payment for the treatment will have to be made by Us, the Policyholder or is unavailable at such service provider, then You/Insured Person to the Network Provider, following which a Claim for reimbursement may still subsequently write be made to Us seeking reimbursement of the expenses covered Company which will be considered by the Company subject to the terms, conditions and exclusions under the Policy. v. e) It is agreed and understood that in all cases where availing of Cashless facility is only available at specific service providers and geographies, and updated list of which shall be available at Our website Facility has been authorized in writing by the Company or can be confirmed through a phone call made to Us or Our the Assistance Service Provider, all the information and documents as specified for the Benefit shall be submitted to the Company or the Assistance Service Provider immediately and in any event before the Insured Person’s discharge from Network Provider. It is agreed and understood that the Company may, in its sole discretion, modify or add to the list of Network Providers or modify or restrict the extent of Cashless Facilities that may be availed at any particular Network Provider. Before availing the Cashless Facility, Policyholder or the Insured Person is required to check the applicable list of Network Providers for the area where he intends to avail the Cashless Facility through the ASP’s call center number as provided in the Policy Schedule or by visiting the ASP’s website or Company’s website.