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Revolutionising Health Insurance – Cashless Hospital Treatment Everywhere

Revolutionising Health Insurance - Cashless Hospital Treatment Everywhere

When you choose a health insurance plan, it is often suggested that you choose an insurer that allows you the cashless treatment advantage in a wide network of hospitals. For instance, you have shortlisted two health insurance plans that look equally appealing. However, one comes with a network of 5,000 hospitals, while the other has 21,000, so you may be more inclined towards the latter.

While it is a smart choice to opt for a wider network, what if there are no network hospitals in your vicinity? Or what if your preferred doctor or hospital is not empanelled with your health insurance provider? Or what if you had to undergo an emergency treatment in a non-network hospital?

Cashless Everywhere – Good News for Everyone

Well, we bring you good news! In a groundbreaking move, the General Insurance Council has introduced the ‘Cashless Everywhere’ initiative. Under this transformative initiative, an effort will be made to see that policyholders can get a cashless hospitalisation facility at any hospital of their choice. Yes, you heard that right!

Cashless Hospitalisation So Far

Cashless hospitalisation has always been considered one of the biggest benefits offered by health insurance. It saves the insured from the worry of running around arranging funds for a treatment. In case hospitalisation is required, with the cashless facility, you do not have to pay for the medical bills from your pocket. That’s not all. The uncomplicated and hassle-free claim settlement makes things simpler and easier for the policyholder as well as the insurance company.

The meaning of cashless hospitalisation will remain the same. So, what’s new? What’s new is the cashless ‘everywhere’ part. Earlier, cashless hospitalisation was provided only in the network hospitals of your particular health insurance company. So far, if you went to a non-network or non-empanelled hospital, you had to pay the bills upfront, from your pocket. It was only after your discharge that you could raise a request for a reimbursement. The reimbursement process included careful submission of all medical bills and receipts. Typically, insurance companies take about 7 to 10 working days to verify the documents and release the payment.

Despite this, only 63% of the health insurance policyholders opt for cashless treatment, the remaining go for reimbursement. The major reason is the lack of network hospitals in their areas. The long and detailed procedure of reimbursement claim settlement can often come with financial stress.

This remarkable step by the IRDAI, the regulatory body, has brought together all the health insurance companies. With cashless everywhere, it can be ensured that a policyholder can seek treatment at any hospital of their choice. While the announcement is being welcomed by policyholders all across the country, this initiative will be all the more beneficial for policyholders living in tier 2 and tier 3 regions. Finding a network hospital of their choice has often been a challenge for people living in smaller cities.

Things to Note about the ‘Cashless Everywhere’ Feature

Yes, cashless everywhere is indeed a remarkable step that will help not just the policyholder but also the insurance providers and the hospitals. However, as an insurance policyholder, you need to be careful about the following:

  1. If your doctor has prescribed hospitalisation, you need to inform your health insurance provider at least 48 hours before the hospitalisation.
  2. If it is an emergency, inform the insurer within 48 hours of hospitalisation.
  3. In case you do not complete this pre-agreement, you will have to file for a reimbursement claim.
  4. Currently, the cashless everywhere benefit will be available at 40,000 hospitals that are commonly empanelled.
  5. The hospital you choose should be registered with the state authorities in accordance with the Clinical Establishment Act. Also, bear in mind that the hospital should have a minimum of 15 beds.
  6. The claim that you make has to be in accordance with the health insurance policy that you have.

Summing Up

A change in the positive direction, cashless Everywhere is an initiative towards a 100% cashless system. It will be backed by digital platforms, with support from the National Health Authority. It will also bring standardisation of rates and services. It has been the GIC’s (General Insurance Council) constant endeavour to make health insurance simpler and easier for the common people. With this step too, the council aims to benefit all parties in the health insurance industries. Beyond serving as a customer-centric initiative, Cashless Everywhere will focus on enhancing convenience and experience.

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