Health Insurance

Health insurance that is ‘Cashless Everywhere’: Here’s how it works | HealthNews

The General Insurance Council (GIC) has announced the launch of a new “Cashless Everywhere” initiative that aims to make treatment and payments more seamless for policyholders.

Tapan Singhel, MD & CEO of Bajaj Allianz General Insurance and Chairman of the General Insurance Council, announced the initiative on Thursday, stating that the initiative would make it easier to avail treatment from medical centers outside the network of the insurance company.

How does health insurance work?

Insurance policies can be purchased through a number of private insurers, provided by employers, and for those eligible, through government agencies. In the case of a private insurer, people can choose the coverage of their choice for which premiums need to be paid to the company. The premium amount depends on various factors such as age and income, as well as the coverage and policy chosen by policyholders.

Claims, subject to the sum assured, are processed, with partial reimbursements credited directly to the insured’s bank account.

What is the Cashless Everywhere initiative?

The ‘Cashless Everywhere’ system allows policyholders the freedom to seek cashless treatment in any hospital, regardless of its network status. This initiative aims to simplify claims processing, mitigate fraud, and bolster overall industry trust.

This means policyholders can be admitted to a hospital without paying any money, and the insurance company will pay the bill upon discharge, easing the financial burden for policyholders.

How can policyholders avail the cashless system?

To access the ‘Cashless Everywhere’ system, policyholders must notify the insurer at least 48 hours before admission. Emergency cases require notification within 48 hours of admission, with admissibility contingent on policy terms and adherence to the insurer’s operating guidelines.

Is this system applicable in every hospital?

Currently, the cashless facility is only available at hospitals where the insurance companies have an agreement. Hospitals without such agreements will necessitate reimbursement claims, which could potentially elongate the claims processing timeline.

What are the benefits of a cashless system?

According to the GIC, which implements this system, the cashless facility will encourage more people to opt for health insurance. It is also a step towards combating cases of fraud, which would increase trust in the system.

Are there any other forms of cashless systems in healthcare in India?

The Haryana state government, on January 1, announced a cashless medical facility for government employees, expanding coverage to include all regular government employees. Managed by the Ayushman Bharat Haryana Health Protection Authority, this initiative also aims for cashless procedures and efficient services for beneficiaries.

In June last year, the Ministry of Health and Family Welfare announced cashless treatment facilities for Central Government Health Scheme (CGHS) beneficiaries at AIIMS New Delhi, PGIMER Chandigarh, and JIPMER Puducherry.

This also reflects the growing trend of digitization in the healthcare ecosystem.

First Published: Jan 25 2024 | 4:41 PM IST

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