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Cashless Health Insurance
Cashless health insurance lets you receive medical treatment at network hospitals without paying the bill upfront, as your insurer directly settles the medical bills with the hospital.
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It usually works best at network hospitals after pre-authorisation, and you may still need to pay for non-covered items, deductibles, co-payments, consumables, or expenses beyond the sum insured. Before hospitalisation, check whether the hospital is in your insurer’s network, whether your treatment is covered, and what documents are needed for approval.
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What is Cashless Health Insurance?
Cashless health insurance is a type of claim facility where your insurance company directly pays the hospital for your treatment, so you don’t have to arrange the full amount instantly.
If you need hospitalisation (whether planned or in an emergency), you can raise a claim under your health insurance policy to cover the expenses either through cashless or reimbursmenet (You pay the bills upfront and later get reimbursed by the insurer).
However, the cashless facility is available only at hospitals that are part of your insurer’s network (tie-up hospitals). When you get admitted, the hospital coordinates with the insurer to get a pre-approval for the treatment cost. Once approved, the insurer settles the covered expenses directly with the hospital and you only pay for non-covered costs such as deductibles, exclusions, copay, or any amount beyong sum insured.
For example: If you or a family member is ill and needs to be admitted for treatment, with cashless medical insurance you get treatment in your nearest network hospital and get proper treatment without worrying about the payment.
Meaning
Importance
How Does it Work?
Cashless Treatment at Non-Network Hospital
When to Use?
Why Choose Digit?
Covered/Not Covered
Add-Ons
Key Benefits
How to File?
Documents Required
Cashless vs Reimbursement
Which is Better for You?
Claim Rejection Reasons
Common Mistakes to Avoid
Things to Check
FAQs
Why is Cashless Health Insurance Important?
Cashless health insurance is important because it reduces immediate financial stress during hospitalisation and ensures you can focus on treatment instead of arranging funds at the last minute.
Get Timely Treatment Without Immediate Large Funds
According to The Actuary India, any small treatment can be 50K to 2 Lakhs. With cashless health insurance and claim process, you can avoid treatment delays when you don’t have instant access to such amounts.
Large Hospital Network
With cashless insurance, you get access to numerous hospitals included in the insurance network. This implies that you have choices and can select the healthcare facility that best suits your requirements.
Reduces Financial Stress During Emergencies
Instead of arranging money at short notice through savings, loans, or family support, the insurer directly handles approved expenses, letting you focus on treatment and recovery.
Simplifies the Claim Process During Critical Situations
In emergencies, managing paperwork and reimbursements can be overwhelming. Cashless claims shift most of the coordination to the hospital and insurer.
Less Uncertainty
Cashless medical insurance claims require approval before treatment, which ensures that your health insurer approves your claim. Hence, there's less uncertainty involving rejection of a health claim in the cashless process.
Simple Online Paperless Process
The key to cashless health insurance is going digital and eliminating the burden of completing paperwork and monitoring expenses. It's efficient, quick, and simple.
How Does Cashless Claim Work?
A cashless claim works through coordination between the hospital and your insurer, where the hospital requests approval, and the insurer directly settles eligible treatment costs. Here is how it works:
Step 1: Visit a Network Hospital
If you plan to undergo surgery or treatment, choose a hospital that is part of your insurer’s network for cashless claims.
Step 2: Share Policy Details
Provide your health insurance policy number/health E-card and ID proof for KYC at the hospital help desk/TPA desk.
Step 3: Pre-authorisation Request & Approval
The hospital sends your treatment details and estimated cost to the insurer for approval. The insurance company checks the details and gives final approval. As per IRDAI guidelines, insurers are expected to approve cashless treatment within 1 hour, and discharge approval is expected within 3 hours of hospital request.
Step 4: Your Insurance Pays the Bill
Depending on your policy, the hospital and insurer will cover the cost of the treatment.
Can You Get Cashless Treatment at a Non-Network Hospital?
Cashless claims work only at network hospitals because the insurer already has an agreement with the hospital. Under the wider “cashless everywhere” industry initiative, cashless treatment may also be possible at some non-network hospitals, subject to insurer approval, hospital cooperation, claim admissibility, and required timelines.
If the hospital is not in the insurer’s network or cashless approval is not available, you may need to pay first and file a reimbursement claim later. Always check on the insurer website for the Network hospital before going for treatment.
When Can You Use Cashless Treatment?
Cashless treatment can be used when your hospital and insurer are able to coordinate directly for bill settlement. However, when and how you can use it depends on the situation and the hospital type:
Note: The table is for guidance purposes only. Cashless treatment availability may vary based on the insurer’s approval, hospital policies, and specific case details.
Why Choose Cashless Health Insurance from Digit?
What’s Covered in the Health Insurance Plans Offered by Digit?
Coverages
Double Wallet Plan
Infinity Wallet Plan
Worldwide Treatment Plan
Important Features
All Hospitalisation - due to Accident, Illness, Critical Illness or COVID
This covers for all hospitalisation expenses including due to an Illness, Accident, Critical Illness or even pandemics like Covid 19. It can be used to cover for multiple hospitalisations, as long as the total expenses are up to your sum insured.
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Initial Waiting Period
You need to wait for a defined period from the first day of your policy to get covered for treatment related to any non-accidental illness. This is the Initial Waiting period.
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Wellness Program
Exclusive Wellness Benefits like Home Healthcare, Tele consultations, Yoga and Mindfullness and many more available on our App.
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Sum Insured Back Up
We provide a back-up Sum Insured which is 100% of your Sum Insured amount. How does Sum Insured Back Up work? Suppose your policy Sum Insured is Rs. 5 lac. You make a claim of Rs.50,000. Digit automatically triggers the wallet benefit. So you now have 4.5lac + 5 lac Sum Insured available for the year. However, one single claim, cannot be more than the base Sum Insured as in the above case, 5 lac. .
Once in a policy period; Related and unrelated illness; No Exhaustion Clause; Same person also covered.
Unlimited Reinstatement in a policy period; Related and unrelated illness; No Exhaustion Clause; Same person also covered.
Once in a policy period; Related and unrelated illness; No Exhaustion Clause; Same person also covered.
Cumulative Bonus
Digit Special
No claims in the Policy year? You get a bonus -an additional amount in your total sum-insured for staying healthy & claim free!
10% of Base Sum Insured for every claim free year, up to max 100%.
50% of Base Sum Insured for every claim free year, up to max 100%.
50% of Base Sum Insured for every claim free year, up to max 100%.
No Room Rent Capping
Different categories of rooms have different rents. Just like how hotel rooms have tarrifs. Digit plans give you the benefit of having no room rent cap, as long as it is below your Sum Insured..
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Day Care Procedures
Health insurance covers medical expenses only for hospitalisations exceeding 24 hours. Day care procedures refer to medical treatments undertaken in a hospital, requiring less than 24 hours due to technological advancement such as cataract, dialysis etc.
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Worldwide Coverage
Digit Special
Get a world class treatment with the Worldwide Coverage! If your doctor identifies an illness during your health examination in India and you wish to get a treatment abroad, then we’re there for you.You’re covered!
×
×
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Health Check-up
We pay for your health check-up expenses upto the amount mentioned in your Plan. No restrictions on the kind of tests! Be it ECG or Thyroid Profile. Make sure you go through your policy schedule to check the claim limit.
0.25% of Base Sum Insured, Max up to ₹ 1,000 after every two years.
0.25% of Base Sum Insured, Max up to ₹ 1,500 after every year.
0.25% of SI up to ₹ 2,000 after every year.
Emergency Air Ambulance Expenses
There may be emergency life-threatening health conditions which may require immediate transportation to hospital. We absolutely understand this and reimburse for expenses incurred for your transportation to a hospital in airplane or helicopter.
×
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Age/Zone Based Co-payment
Digit Special
Co-Payment means a cost sharing requirement under a Health Insurance Policy that provides that the Policyholder/Insured will bear a specified percentage of the admissible claims amount. It does not reduce the Sum Insured. This percentage depends on various factors like age, or sometimes also on your treatment city called zone based copayment. In our plans, there is no age based or zone based Co payment involved.
No Co-payment
No Co-payment
No Co-payment
Road Ambulance Expenses
Get reimbursed for the expenses of road ambulance, in case you are hospitalised.
1% of Base Sum Insured, Max up to ₹ 10,000.
1% of Base Sum Insured, Max up to ₹ 15,000.
1% of Base Sum Insured, Max up to ₹ 10,000.
Pre/Post Hospitalisation
This cover is for all expenses before and after hospitalisation such as for diagnosis, tests and recovery.
30/60 Days
60/180 Days
60/180 Days
Other Features
Pre-Existing Disease (PED) Waiting Period
The disease or condition that you are already suffering with and have disclosed to us before taking the policy and has been accepted by us has a waiting period as per plan opted and mentioned in your Policy Schedule.
3 Years
3 Years
3 Years
Specific Illness Waiting Period
This is the amount of time you need to wait for, until you can make a claim for a specific illness. At Digit it is 1-3 years and starts from the day of policy activation. For the full list of exclusions, read Standard Exclusions (Excl02) of your policy wordings.
1-3 Years
1-3 Years
1-3 Years
Inbuilt Personal Accident Cover
If You sustain an Accidental Bodily Injury during the Policy Period, which is the sole and direct cause of Your Death within twelve (12) months from the date of accident, then We will pay 100% of the Sum Insured as mentioned in Policy Schedule against this cover and as per plan opted.
₹ 50,000
₹ 1,00,000
₹ 1,00,000
Organ Donor Expenses
Digit Special
Your organ donor gets covered in your policy. We also take care the pre and post hospitalisation expenses of the donor. Organ donating is one of the kindest deeds ever and we thought to ourselves, why not be a part of it!
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Domiciliary Hospitalisation
Hospitals can go out of beds, or the patient’s condition may be rough to get admitted in a hospital. Don’t panic! We cover you for the medical expenses even if you get treatment at home.
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Bariatric Surgery
Obesity may be the root cause of so many health issues. We absolutely understand this, and cover for Bariatric Surgery when it is medically necessary and advised by your doctor. However, we DONOT cover if hospitalisation for this treatment is for cosmetic reasons.
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Psychiatric Illness
If due to a trauma, a member has to be hospitalised for a psychiatric treatment, it will be covered under this benefit, upto INR 1,00,000. However, OPD consultations are not covered under this. The waiting period for Psychiatric Illness Cover is same as Specific Illness waiting period.
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Consumables Cover
Before, during & after hospitalisation, there are many other medical aids & expenditures such as walking aids, crepe bandages, belts, etc.,which need your pocket’s attention.This cover takes care of these expenses that are otherwise excluded from the policy.
Available as an Add-On
Available as an Add-On
Available as an Add-On
What’s Not Covered in Health Insurance Plans Offered by Digit?
Pre-Natal & Post-Natal Expenses
Pre-natal and post-natal medical expenses are not covered, unless they lead to hospitalisation.
PED Before Waiting Period
In case of a pre-existing disease, unless the waiting period is over, the claim for that disease or illness cannot be made.
Hospitalisation without Doctor’s Recommendation
Any condition you get hospitalised for that doesn’t match the doctor’s prescription is not covered.
Add-on Options for Cashless Health Insurance with Digit
Enhance your cashless health insurance policy with add-ons at Digit. These add-ons are subject to underwriting approval and your eligibility at the time of purchase or renewal. Here’s a list of add-ons available that provide additional layers of protection beyond the basic coverage of your policy:
Consumable Cover
Pay 10% extra premium and we will also cover your non-medical expenses once your base claim is approved.
Pre-existing Disease/Specific Disease/Initial Waiting Period Modification
You can reduce your pre-existing disease waiting period to up to 2 years.
Network Hospital Discount
Opt for treatment at one of our network hospitals and receive a 10% discount on your premium with this add-on cover. However, a co-payment will be applicable if you get hospitalised in a non-network hospital.
Key Benefits of Cashless Health Insurance by Digit
Your health insurance plan with Digit extends several exclusive benefits that enhance your coverage. Here are the key benefits:
* These add-ons are subject to underwriting approval and your eligibility at the time of purchase or renewal
What Our Customers Have to Say about Us
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How to File a Cashless Claim with Digit?
Filing a cashless claim with Digit involves coordinating with a network hospital, where the hospital requests approval from Digit and the eligible treatment costs are directly settled.
For Planned Hospitalisation
For Emergency Hospitalisation
Step 1: Choose a Digit Network Hospital
When you need to make a claim, select any of Digit’s 9000+ network hospitals.
Step 2: Inform Digit & Share Document at Hospital
Inform Digit at least 48 – 72 hours before admission to your chosen hospital. At the time of admission, provide your health e-card and KYC documents to the hospital and get a pre-authorisation form.
Step 3: Submit Pre-authorisation Request
Fill and sign the form, and ensure the hospital submits it to the Third-Party Administrator (TPA), who coordinates between the hospital and Digit.
Step 4: Claim Review & Approval
Digit reviews your request by checking coverage, policy terms, and medical necessity, and communicates the approval to the hospital. Once approved, your treatment will start and Digit directly settles the hospital bill.
Note: You can contact Digit at 7709996079 for guidance on the cashless claim process and required steps.
What are the Documents Required for Cashless Claim Approval?
You must have a few important documents when visiting a cashless hospital in India. With no upfront fees, this procedure makes your hospital stay easy and hassle-free. The documents include:
Claim Documents
KYC Document
Digit's Network Hospitals for Cashless Hospitals
Get Cashless Treatment at 9000+ Hospitals across India
What to Do if No Cashless Hospitals are Nearby?
If there are no network hospitals nearby, you can still get treated at any hospital and later claim the expenses through the reimbursement process. Here's how to submit a claim for reimbursement:
- In case of emergency or urgency, prioritise treatment at the closest hospital, even if it is not in your insurer’s network.
- If it is planned hospitalisation, notify us about your treatment within 48 hours after the date of hospitalisation.
- Avail your treatment and settlement bills that you have done out of your pocket.
- Submit and upload all the necessary documents on your company’s portal to get the reimbursement.
- The insurance company will verify all the documents and settle your claim after verifying.
What is the Difference Between Cashless Claim and Reimbursement Claim?
There are two types of processes you can opt for during claims in health insurance. A cashless claim or a reimbursement claim. Here’s a quick table to help you understand the key differences between the two:
In simple terms, in a cashless claim, the insurance company pays the medical bill directly to the hospital and in reimbursement claim, you pay the medical bill to the hospital and later the insurer pays you.
Cashless vs Reimbursement Claim: Which is Better for You?
Both cashless and reimbursement claims serve the same purpose, but the better option depends on your situation, hospital choice, and financial preparedness.
What are the Common Reasons for Claim Rejection in a Cashless Medical Insurance?
While cashless health insurance reduces upfront financial burden, claims can still be rejected if policy conditions or approval requirements are not met. Here are the most common reasons for cashless claim rejections.
- Incomplete Waiting Period: There is a waiting period for specific conditions under every policy. You risk getting your claim denied if you file for a condition during this waiting time. To avoid, always check your policy waiting periods before planning treatment or hospitalisation.
- Non-Disclosure of Information: Your claim may be denied if you hide any information regarding your health or any pertinent health information. To avoid claim rejection, always fill out your policy application accurately and truthfully.
- False Information: The claim form may be rejected if it contains any false information. To prevent such issues, double-check all the information before filing the claim.
- Pre-authorisation Request Not Approved: Cashless claims require insurer approval before or during hospitalisation. If this is denied, cashless facilities will not be available. To avoid, ensure the hospital submits correct documents and responds quickly to any insurer queries.
- Treatment Not Covered Under Policy: If the procedure is listed under policy exclusions or not covered, the claim will be rejected. Always review inclusions/exclusions carefully, especially for planned treatments to avoid rejections.
- Insufficient Documents: Failure to provide all required documentation is one of the primary causes of health claim rejection. Ensure that you provide the insurance company with all your medical documents, bills, and reports as requested to avoid rejections.
- Pre-existing Conditions: Your claim may be denied if you haven't disclosed any pre-existing medical conditions when applying for insurance. Always provide your whole medical history to prevent your claim from being denied.
- Timeframe Crossed: If you fail to notify your insurance company of your hospital stay within the predetermined time window, your claim can be rejected.
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What are the Common Mistakes to Avoid in Cashless Health Insurance Claims?
Even though cashless claims are designed to be simple, small mistakes during the process can lead to delays, partial approvals, or even rejection:
Digit’s Health Insurance Claim Numbers for FY 2024-25
75% of Cashless Health Claims Approved in Just 30 Minutes at Digit
At Digit, in the second half of FY25, the average turnaround time (TAT) for pre-authorisation of health insurance cashless claims was a speedy 26.93 minutes. Even better? Over 75% of requests were approved within 30 minutes, making the process feel almost instantaneous.
Of course, some requests, around 3.3% took a little longer (over 60 minutes), mainly because they needed extra info or clarification from hospitals or customers.
65% Cashless Discharge Approved in Just 60 Minutes at Digit
At Digit, in the second half of FY 2024-25, the average turnaround time (TAT) for hospital discharge approval in our health insurance was 58.95 minutes. Notably, 65% of discharge requests were completed within 60 minutes, ensuring patients aren’t left waiting once their treatment is finished.
While only 1.3% of cases extended beyond three hours, typically due to complex queries or pending clarifications.
Almost 70% of Reimbursement Claims Settled in Just 2 Days
Not every hospital is part of a cashless network, and that’s where reimbursement claims come into play. Once all documents are submitted, the average turnaround time for processing a reimbursement claim at Digit in FY 2024-25 was just 2.43 days.
Nearly 70% of claims were settled within two days, providing quick relief to policyholders who initially had to pay out of pocket. While about 4.5% of claims took over a week to settle, usually due to missing documents or follow-up queries, the process is largely smooth and customer-centric.
1.1 Lakh+ Claims Registered Quickly with Smart Health Claim Bots in FY 2024-25
At the heart of smooth insurance experiences lies something you never see!! 😁
At Digit, our Health Claims Bots and Bulk Policy Issuance are quietly reshaping the way claims get processed. These smart systems fetch real-time data directly from the partner, eliminating manual uploads, reducing errors, and speeding up approvals for claims. In FY 2025 alone, they registered over 1.1 lakh claims, cutting down processing time.
No breaks and no delays. Fewer forms and faster care! ☺️
Digit Settled 9.16 Lakh Claims in FY 2024-25
The data below is for all the products as given in the table below:
9.16 Lakh Claims Settled
Digit settled 9.16 lakh claims in FY 2024–25. Of the total, 2,18,082 were health-related claims, including travel and personal accident, each one settled with care, not delay. Behind each of those claims was an unexpected moment, an accident, an illness, a trip gone wrong, and every time, we showed up.
Because when life takes a sudden turn, your insurance should move forward, not hold you back.
₹4,622 Crore Paid in Claims
At Digit, protection isn’t a promise; it’s an action. In FY 2024–25, we settled claims worth ₹4,622 crore, stepping in when our customers needed us most. Out of the total, ₹1,374 crore was paid towards health insurance claims alone, proof that when it comes to care, we are always there.
Quick settlements, zero confusion, and absolute peace of mind.
Everywhere Cashless by GIC: Treatment Anytime, Anywhere!
The General Insurance Council (GIC) started the 'Cashless Everywhere' program to recreate the Indian health insurance market. By altering the traditional methods of filing health insurance claims, this program gives policyholders greater ease and versatility.
In the past, policyholders who wanted cashless treatment had to choose a network hospital. If they sought medical attention outside of these networks, they had to pay the full hospital fee before filing a reimbursement claim. However, the Cashless Everywhere Hospitals campaign lifted these limitations, enabling policyholders to get cashless care at hospitals, independent of network ties.
This is how Everywhere Cashless works:
- Check if your hospital is on the list of everywhere cashless hospitals.
- Confirm with the hospital if they accept Anywhere Cashless.
- Inform your insurance company before the 48-hour planned hospitalization or within 48 hours of admission during medical emergencies like accidents.
- You have to fill out your claim form and ask your hospital to mail it to your insurance company.
What Should You Check Before Claiming for Cashless Hospitalisation?
Before opting for cashless hospitalisation, a few quick checks can help you avoid delays, rejections, or last-minute out-of-pocket payments:
- Check your insurer’s hospital list to ensure whether the hospital is available in the network hospital.
- Ensure your policy is valid and premiums are paid. An inactive policy can lead to immediate claim rejection.
- Make sure the treatment you need is covered, and your sum insured is sufficient to cover the treatment.
- Check if your illness or treatment falls under any waiting period (e.g., pre-existing diseases) as claims during waiting periods may not be approved.
- Look for restrictions like room rent limits, co-payment requirements, disease-specific caps, etc. These can increase your out-of-pocket expenses even in cashless claims.
- Inform the insurer on time, at least 48-72 hours before hospitalisation and within 24 hours for emergency situations.
- Ensure the hospital has initiated the pre-authorisation request with your insurer/TPA.
To sum up, cashless health insurance allows you to receive treatment at network hospitals without paying the full bill upfront, as your insurer directly settles approved expenses with the hospital. This makes it especially useful during emergencies or high-cost treatments where arranging immediate funds can be difficult. The process is faster and more convenient than reimbursement claims, but they are limited to network hospitals and require timely approval.
FAQs about Cashless Health Insurance
What is a Network Hospital?
A medical facility that partners with an insurance company is known as a network hospital. In a medical emergency, policyholders can visit the network hospital and use the cashless health insurance claim.
Is cashless facility available in all health insurance plans?
No, cashless facility is not available in all hospitals for every plan. It is only available if your insurer has a tie-up with the hospital (network hospital). Most health insurance plans offer cashless benefits, but it depends on the hospital network of the insurer.
What is the time limit to inform the insurer for a cashless claim?
You must inform your insurer at least 48-72 hours before planned hospitalisation and within 24 hours in case of emergency hospitalisation to avail cashless treatment without delays.
Do I have to pay anything from my pocket during a cashless claim?
This depends on whether your health insurance comes with a copayment or not. If it comes with a percentage of copayment, then at the time of claim, you will have to pay a small amount from your pocket depending on your hospital bill.
Does cashless claim mean 100% of the bill is covered?
No, the insurer will pay only as per your policy coverage. Any exclusions, limits, or non-medical expenses will have to be paid by you.
Can I convert a cashless claim into a reimbursement claim?
Yes, if your cashless claim is not approved or partially approved, you can still proceed with the treatment and later apply for reimbursement by submitting all required documents.
How to choose the best health insurance in India for cashless treatment?
One of the primary reasons people buy health insurance is because of the benefit of cashless claims. To choose the best cashless medical insurance, always look for features such as:
- Claim settlement process: Get an idea of how efficient your insurer is with cashless claims).
- Number of network hospitals: Check if there are network hospital near your location.
- Processes: Understand if the claim process is simple or complicated.
- Copayment: See whether your claims will be completely cashless or whether you have to pay a percentage of the bill or not.
- Check for Reviews: Know the brand’s overall reviews and reputation and you’ll be able to make the right choice.
Do I need to inform my insurer before cashless hospitalisation?
Yes, discuss your hospital stay with your health insurance company. According to most policies, you must notify your health insurance company of your anticipated hospitalisation at least 48-72 hours before being admitted to the network hospital.
How long does a cashless claim approval take?
Cashless claim approval typically happens within minutes to a few hours, depending on the insurer and hospital. At Digit, over 75% of claims are approved within 30 minutes.
Is a cashless claim better than a reimbursement claim?
In general, yes. A cashless claim procedure is preferable to a reimbursement claim procedure under health insurance due to its convenience, quickness, and hassle-free nature.
Is OPD covered in cashless health insurance?
Yes, OPD is covered in cashless health insurance at Digit. However, it depends on your chosen health insurance policy since some health insurers provide OPD benefits while others don’t. Read the policy wording before opting for health insurance to learn about OPD coverage.
Does cashless health insurance allow me to receive tax benefits?
Yes, you can avail medical insurance tax benefit according to Section 80D of the Income Tax Act. You can avail yourself of tax benefits of up to 25,000 if you are below 60 years of age.
How many claims are permitted annually under cashless health insurance coverage?
You can claim health insurance multiple times until your sum insured is exhausted.
Who is a TPA?
TPA stands for Third Party Administrator. The health insurance company's agent is TPA. It serves as a go-between for the insured person and the insurance company. Its main responsibility is to handle all insurance and cashless claims regarding hospital stays and medical bills.