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Health insurance rule change: Cashless treatment at any hospital from today; how to get it, charges

The General Insurance Council (GIC) in consultation with general and health insurance companies has launched the ‘Cashless Everywhere’ initiative to extend the cashless treatment at all hospitals. Health insurance policyholders can now avail of cashless facilities even at hospitals that are not in the network of the insurers.

What is the new rule? How to get cashless treatment at any hospital? ET Wealth Online explains.

Cashless hospitalization under health insurance: What is going to change?

Until now, a health insurance policyholder can get cashless treatment only at network hospitals with whom the insurance company has tied up. The insurance company settled medical expenses directly with the network hospital. If it is a non-network hospital, the policyholder has to pay the entire amount from his pocket and then go through the cumbersome claim reimbursement process.

Under the ‘Cashless Everywhere’ system, the policyholder can get treated in any hospital they choose through a cashless hospitalization facility. Even if the hospital is not in the network of the insurance company, the insurer will still settle the bill at the hospital, allowing the policyholder to avail of cashless treatment.

Cashless Everywhere: How to get cashless medical treatment at non-network hospitals?

To get ‘Cashless Everywhere’ facility at a non-empanelled hospital, according to the guidelines set by the GIC, there are three rules that health insurance policyholders need to keep in mind: 1) For elective procedures, the customer should inform the insurance company at least 48 hours before 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. Do keep in mind that the charges at the non-network hospital will be based on the rates that the hospital charges to the existing empanelled insurers.

The cashless facility at non-network hospitals will be effective immediately, says the General Insurance Council on January 24, 2024.

Hospitals with 15 beds, and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless hospitalization now.

ET Wealth Online first reported about it on December 23, 2023.

Cashless Everywhere facility: How will it benefit health insurance customers?

Currently, 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 or third-party network, according to the press release by the General Insurance Council.

Previously, if a customer went to a non-network hospital for his treatment, he needed to pay first and get it reimbursed from his insurance later. In such cases, the onus of collecting documents required for an insurance claim rests solely with the customer. A significant portion of claims filed for reimbursement went through multiple query cycles due to wanting critical documents for which a customer would have to coordinate with the hospital multiple times. This often makes the reimbursement process lengthy and stressful for many policyholders.

“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 claiming 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,” said Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance.

“The ‘Cashless Everywhere’ initiative not only curtails out-of-pocket expenses during hospitalization but also eliminates the cumbersome reimbursement process. This would also reduce the chances of reimbursement rejection, which also poses a financial burden on the policyholders. This initiative will additionally benefit individuals living in tier 2 and tier 3 regions, especially those in remote areas across the country. Such proactive measures not only foster a win-win scenario for customers and insurers but also contribute to the mitigation of fraudulent activities,” said Siddharth Singhal, Business Head – Health Insurance at Policybazaar.com.

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,” he added.

“This industry wide collaboration is not only beneficial for policyholders but also signifies a positive shift in the health insurance industry,” said Rudraraju Rajgopal, Executive Vice President & National Head – Accident & Health Claims, TATA AIG General Insurance, Company Limited.

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