Until now, individuals holding health insurance policies were limited to obtaining cashless treatment exclusively at network hospitals affiliated with the insurance provider. In cases involving non-network hospitals, policyholders were required to bear the entire expense upfront and navigate the intricate process of claim reimbursement. To address this, the General Insurance Council, in collaboration with general and health insurance companies, has introduced ‘Cashless Everywhere‘ to broaden the scope of cashless treatment to include all hospitals. Discover the details of this New Health Insurance Rule and the procedure for accessing cashless treatment at any hospital.
In collaboration with general and health insurance companies, the General Insurance Council (GIC) has initiated the ‘Cashless Everywhere’ program. This initiative aims to expand the availability of cashless treatment to all hospitals, enabling health insurance policyholders to access cashless facilities even at hospitals outside the insurers’ networks.
The ‘Cashless Everywhere’ system enables policyholders to receive cashless hospitalization at any hospital of their choice, even if it is not part of the insurance company’s network. The insurer will settle the bill directly with the hospital, providing policyholders with the convenience of cashless treatment.
To avail the ‘Cashless Everywhere’ facility at a non-network hospital, health insurance policyholders must adhere to the following guidelines established by the General Insurance Council (GIC):
1) For elective procedures, customers should notify the insurance company at least 48 hours before admission.
2) In the case of emergency treatment, customers must inform the insurance company within 48 hours of admission.
3) The claim should meet the policy terms, and the cashless facility should align with the operating guidelines of the insurance company.
It’s important to note that charges at non-network hospitals will be based on the rates these hospitals charge existing empanelled insurers. The implementation of the cashless facility at non-network hospitals is effective immediately, as announced by the General Insurance Council on January 24, 2024.
Furthermore, hospitals with 15 beds, registered with the respective state health authorities under the Clinical Establishment Act, can now offer cashless hospitalization.
Benefits of ‘Cashless Everywhere’ Facility for Health Insurance Customers
The ‘Cashless Everywhere’ facility brings significant benefits to health insurance customers by addressing existing challenges. Currently, 63% of customers opt for cashless claims, while others resort to reimbursement claims when seeking treatment outside their insurer or third-party network, as highlighted in the General Insurance Council’s press release.
Previously, if a customer received treatment at a non-network hospital, they had to make upfront payments and then go through the reimbursement process with their insurance provider. In such cases, the responsibility of collecting necessary documents for an insurance claim rested solely on the customer. A substantial number of reimbursement claims underwent multiple query cycles due to the lack of critical documents, requiring customers to coordinate with the hospital multiple times. This often resulted in a lengthy and stressful reimbursement process for many policyholders.
