June 14, 2024

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Network restrictions lifted: Now access any hospital for seamless treatment under your health insurance policy

3 min read

The General Insurance Council (GIC) on Wednesday launched “Cashless Everywhere” initiative under which policyholders will have the freedom to choose any hospital for their treatment. Furthermore, the cashless facility will be extended to hospitals that may not be part of the insurance company’s network.

General and health insurance companies provide coverage to millions of citizens through health insurance policies. In the event of hospitalisation, policyholders need not pay for treatment out of pocket with a cashless facility where insurance companies commit to covering the treatment costs at the hospital, provided the claim is admissible. 

Also read: Here’s how you can buy health insurance for your parents and claim tax-saving benefits at work

This cashless facility is currently available only at hospitals where the respective insurance company has an agreement or tie-ups. If the policyholder chooses a hospital without such an agreement, the cashless facility is not offered, and the customer has to go for a reimbursement claim, further delaying the claim process.

In order to ease the burden of policyholders who get treated in a hospital not in the network of the Insurance Company, the GIC, in consultation with all the General and Health Insurance Companies, is launching the “Cashless Everywhere” initiative.

Also read: Porting your health insurance policy? Here are few tips to avoid claim rejection in future

Under Cashless Everywhere, the policyholder can get treated in any hospital they choose, and a cashless facility will be available even if such a hospital is not in the insurance company’s network. This Cashless Everywhere is subject to:

1. For elective procedures, the customer should inform the Insurance Company at least 48 hours prior to admission.

2. For emergency treatment, the customer should inform the Insurance Company within 48 hours of admission.

3. The claim should be admissible as per the terms of the policy, and the cashless facility should be admissible as per the operating guidelines of the Insurance Company.

Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance and Chairman of the General Insurance Council, said that it had been the constant endeavour of the GI Council to simplify the lives of policyholders and bring positive changes that benefit them. “With this in mind, we are announcing “Cashless Everywhere” to make customers’ lives easier.”

“Today if you see only about 63% of customers opt for cashless claims while the others have to apply for reimbursement claims as they might be admitted to hospitals that are outside their Insurer/TPA network. We feel this puts a significant amount of stress on their finances and makes the process long and cumbersome. We wanted to make the whole journey of claims a frictionless process, which will not just improve the policyholder’s experience but will build greater trust in the system. This, we feel, will encourage more customers to opt for health insurance,” he said.

“We also see this as a step towards reducing and in the long run, eliminating fraud, which has been plaguing the industry in a big way and reducing trust in the system. Overall, it’s a win-win for all the stakeholders,” added Singhel.

Siddharth Singhal, Business Head – Health Insurance at Policybazaar.com, said, “The Cashless Everywhere initiative stands as a groundbreaking measure within the health insurance industry by the regulatory body. It empowers policyholders to access treatment in any of the approximately 40,000 hospitals nationwide, providing a cashless facility, even outside the insurance network. Currently, 63% of customers use the cashless feature, and the remaining 37% are poised to benefit from this initiative.”

“The “Cashless Everywhere” initiative not only curtails out-of-pocket expenses during hospitalisation but also eliminates the cumbersome reimbursement process.  This would also reduce the chances of reimbursement rejection, which, too, poses a financial burden on the policyholders. This initiative will also benefit individuals residing in tier 2 and tier 3 regions, especially those in remote areas nationwide. Such proactive measures not only foster a win-win scenario for customers and insurers but also contribute to mitigating fraudulent activities,” added Singhal.


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