General Insurance Council Unveils Cashless Hospitalisation Facility to Policyholders

Starting today, the policyholders will no longer have to bear the financial burden of treatment out of their pockets as per the ‘Cashless Everywhere’ initiative.

In a significant shift, the General Insurance Council has unveiled a groundbreaking initiative aimed at extending cashless hospitalisation benefits to policyholders, even in non-empanelled hospitals. As part of the initiative titled 'Cashless Everywhere,' registered hospitals with 15 beds and compliance with state health authorities under the Clinical Establishment Act are now authorised to offer cashless hospitalisation.

Starting today, the policyholders will no longer have to bear the financial burden of treatment costs out of their pockets. Under this initiative, the expenses will be covered by the relevant insurance companies, subject to the admissibility of the claim as per the council's guidelines.

The initiative is aimed at providing policyholders with a seamless and cashless experience. It also seeks to empower the policyholders to choose any hospital for treatment with a cashless facility. Under the current regulations, the policyholders have to choose from the list of hospitals empanelled with their insurers for cashless treatment.

Tapan Singhal, chairman, General Insurance Council, emphasised that opting for a hospital without a pre-agreement for cashless facilities would no longer lead to delays and reimbursement claims. Singhal, who also serves as the chief executive of Bajaj Allianz General Insurance, highlighted that the primary goal is to alleviate the burden on policyholders receiving treatment outside the insurer's network.

How ‘Cashless Everywhere’ Initiative Will Work?

The prominent feature of the initiative is that it provides a policyholder freedom to choose a hospital or healthcare centre of his or her choice without having to worry about raising finances for the treatment, given they meet certain conditions.

Every health insurance provider has its own network of hospitals where policyholders can seek treatment with cashless benefits. However, if they choose any hospital outside the network, the policyholders have to pay for the treatment first. Later, they can reimburse it from their insurance provider.

However, this arrangement makes the claim process arduous. The ‘Cashless Everywhere’ initiative is aimed at making hospitalisation hassle-free.

Criteria to Meet

The policyholders can now opt for hospitals outside the insurance provider’s network if they meet certain criteria:

1. The policyholder should inform the respective insurance provider about the planned admission at least 48 hours before the proposed date of admission. Every insurance provider has launched a dedicated email service, where policyholders can send email intimation about planned admission.

2. For emergency admission, the insurance provider should receive the request for the cashless facility at least within 48 hours after the time of admission. A prescribed form issued by the insurer has to be filled in this case.

3. The insured person and the hospital he chose have to sign the request for a cashless facility and submit it along with necessary documentation including valid identification of the policyholder.

4. Hospitals which are outside an insurance provider’s network will have to provide a letter of consent to extend the cashless facility.

However, the insurer reserves the right to accept or reject the request for a cashless facility. In case of rejection, policyholders can opt for the reimbursement route.

Currently, cashless facilities are limited to approximately 40,000 empanelled hospitals, according to Singhal. He expressed the council's commitment to simplifying policyholders' lives and enacting positive changes that directly benefit them.

He further added that this initiative marks a paradigm shift in the insurance landscape, promising greater flexibility and convenience for policyholders seeking medical treatment.

One of the aims of the new initiative is also to reduce and in the long run, eliminate fraud, which has been plaguing the industry in a big way and reducing trust in the system, Singhal said.

Especially, in the claim reimbursement process the insurer has to investigate to detect fraud and fake claims. This can range from faking an accident, injury or damage, submitting false information to inflating damage claims than actual.

The new initiative is expected to reduce the need to opt for claim reimbursement and create a win-win situation for all stakeholders.