Cashless pre-approval: how it works

1. 1
   Check the hospital is in your insurer's network. Ask your insurer, your TPA or the hospital's insurance desk. Cashless treatment is available only at network hospitals.
2. 2
   Tell your insurer early. Many policies ask for 48 or 72 hours' notice before a planned admission. Under IRDAI's rules a claim cannot be rejected only because notice was late, but early notice avoids delays.
3. 3
   Go to the hospital's insurance (TPA) desk. Take your policy or e-card and photo ID. The desk completes the cashless request form with your doctor and sends it to the insurer or TPA.
4. 4
   The insurer decides within one hour. IRDAI requires insurers to decide on a cashless request immediately, and within one hour of receiving it.
5. 5
   Final approval at discharge within three hours. The insurer must give final authorisation within three hours of the hospital's discharge request. If it takes longer, any extra amount the hospital charges is paid by the insurer, not by you.
6. 6
   Pay your share at discharge. You sign the discharge papers and pay for items the policy doesn't cover, plus any co-payment, deductible or amount above your limits. Estimate your share before admission.

IRDAI's rules say insurers and TPAs must collect the documents they need from the hospital, so you should not have to submit them yourself. At the insurance desk you usually need:

• your policy document or health card (e-card)
• photo ID of the patient
• your doctor's advice for admission

Keep the policy number and your insurer's or TPA's helpline number with you. If the hospital asks for documents for a reimbursement claim later, keep copies of the bills, discharge summary and reports.

In an emergency, go to the nearest hospital with an emergency department, or call 108 for an ambulance or 112. Don't delay treatment to arrange cashless approval. Tell your insurer as soon as you can; many policies ask for notice within 24 hours of an emergency admission or before discharge. If the hospital is not in your insurer's network, you can usually pay and claim reimbursement.

If the bill grows beyond the amount first approved, the hospital sends an enhancement request to the insurer or TPA. IRDAI's published limits are one hour for cashless requests and three hours for final discharge authorisation. Ask your insurer whether the one-hour limit also applies to enhancements.

1. 1
   Pay and claim reimbursement. If cashless is refused, you can continue treatment and claim the amount back. Insurers must settle a reimbursement claim within 15 days of receiving it, and pay interest at the bank rate plus 2% if they are late. A refusal must name the policy terms it relies on.
2. 2
   Complain to your insurer. Use its website, email, call centre or branch. The insurer must acknowledge your complaint at once and reply within 14 days.
3. 3
   Complain to IRDAI. Register a complaint on Bima Bharosa, or call IRDAI's grievance call centre on 155255 or 1800 425 4732, 8 am to 8 pm, Monday to Saturday.
4. 4
   Go to the Insurance Ombudsman. If the insurer rejects your complaint or doesn't reply within 30 days, you can complain to the Insurance Ombudsman free of charge, within one year of the insurer's rejection, for claims up to ₹50 lakh. The Kochi office covers Kerala: oio.ernakulam@cioins.co.in, 0484 2358759.

These schemes pay fixed package rates at empanelled hospitals. Each hospital has a scheme desk that checks your eligibility and arranges approval.

KASP / PMJAY

Karunya Arogya Suraksha Padhathi (KASP), run with Ayushman Bharat PM-JAY, gives eligible families a cover of ₹5 lakh per family per year on a family floater basis, with no limit on family size or age, and pre-existing conditions covered from the first day. Treatment is cashless at the hospital and includes up to 3 days of expenses before admission and 15 days after.

Present your card at the hospital's KASP counter. To add a family member, take Aadhaar and the ration card to an empanelled hospital. See the hospitals on the KASP / PMJAY list, or contact State Health Agency Kerala on 0471 4063121.

MEDISEP

MEDISEP covers Kerala government employees, pensioners and their families. Its second phase began on 1 February 2026. In June 2026 the government told the Legislative Assembly that 712 hospitals are empanelled: 564 private hospitals in Kerala, 5 outside Kerala and 143 government hospitals. Phase II covers 2,516 procedures in 41 specialties, with extra packages for 10 critical illnesses and organ transplants, and pays package rates for 13 kinds of emergency treatment at hospitals that are not empanelled. The basic cover is ₹5 lakh a year on a family floater basis, according to the Phase II guidelines (G.O.(P) No. 5/2026/Fin of 20 January 2026), which we could read only in an unofficial copy. Treatment is cashless at hospitals empanelled under MEDISEP: show your MEDISEP ID card at the hospital's MEDISEP desk, which sends the pre-authorisation request. The district-wise list of hospitals is on the MEDISEP portal, which could not be reached for this directory, so confirm empanelment with the hospital.

CGHS

Under the CGHS orders of November 2017 and January 2018, empanelled private hospitals treat pensioners and other CGHS beneficiaries eligible for credit on a cashless basis, for procedures listed in the CGHS rate list and advised by a government specialist or a CGHS medical officer. No separate referral letter is needed, and the advice is valid for three months unless it says otherwise. Serving central government employees pay and claim reimbursement through their department. See the hospitals on the CGHS Thiruvananthapuram list, and check current rules with your CGHS wellness centre.

ECHS and ESI

For ECHS, treatment at an empanelled hospital is arranged through your ECHS polyclinic; see the hospitals on the ECHS list. For ESI, treatment is through ESI dispensaries and hospitals, which refer patients to tie-up hospitals when needed. Ask your polyclinic or ESI dispensary before a planned admission.

If you are not sure where to start, send us the details and we will tell you which insurance desk to contact. The help is free: no hospital, insurer or TPA pays Adserr for enquiries or admissions, and Adserr never recommends a hospital, insurer or policy. Adserr is a healthcare marketing agency, not an insurer, TPA or insurance intermediary, and cannot approve claims.

• IRDAI, Master Circular on Health Insurance Business, 29 May 2024: one-hour and three-hour limits, documents collected from the hospital.
• IRDAI, Master Circular on Protection of Policyholders' Interests, 2024, 5 September 2024: notice, reimbursement, complaints and the Ombudsman.
• IRDAI, Health department page and grievance cell.
• Council for Insurance Ombudsmen, how to complain and office list.
• State Health Agency Kerala, KASP and KASP FAQ.
• Kerala Legislative Assembly, answer to question 44 on MEDISEP, 22 June 2026.
• Ministry of Defence, list of ECHS-empanelled hospitals in Kerala, Rajya Sabha unstarred question 1640, 15 December 2025.
• Ministry of Health and Family Welfare, CGHS office memoranda of 9 November 2017 and 15 January 2018.

All checked on 12 October 2026.

How long does cashless approval take?

IRDAI requires insurers to decide on a cashless request immediately, and within one hour of receiving it from the hospital. Final authorisation at discharge must come within three hours of the hospital's request.

What happens if discharge approval takes more than three hours?

You should not be made to wait. If the insurer takes longer than three hours, any extra amount the hospital charges for the delay is paid by the insurer, not by you.

Can my claim be rejected because I told the insurer late?

IRDAI's rules say no claim may be rejected only because documents were missing or the claim was notified late. Tell your insurer as early as you can anyway, to avoid delays.

Can Adserr approve my cashless request?

No. Your insurer or its TPA decides, working with the hospital. Adserr can tell you which insurance desk to contact, but it is not an insurer, TPA or insurance intermediary.

Can people aged 70 and above get the Ayushman Vay Vandana card in Kerala?

In 2024 the central government extended PM-JAY to everyone aged 70 and above, with an Ayushman Vay Vandana card. News reports in 2025 said Kerala had not implemented it, and we found no newer official update. Check with State Health Agency Kerala on 0471 4063121.