Health insurance claims gamechanger: Now access cashless facility at any hospital in India

In a significant change to health insurance rules, policyholders will now be able to access the cashless facility at any hospital in the country, irrespective of whether its a network hospital or not.

Cashless Hospitalisation

General and health insurance companies have come together with the General insurance council to introduce the 'Cashless everywhere' program, that will be available across all hospitals.
This means that patients who are being treated in a 'non-network' hospital will no longer have to settle bills and then later seek reimbursement from the insurance company, which is a long and time consuming process.

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The cashless facility is currently available only at hospitals where the respective insurance company has an agreement or tie-ups. By this, in case a  policyholder chooses a hospital that has no tie-up with the insurance company, cashless facility will not be offered. The insured has to go for a reimbursement claim, further delaying the claim process.

 “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”, said Chairman of the General Insurance Council Tapan Singhel.

With this drive in motion, all hospitals with 15 beds and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless hospitalisation. Currently, cashless facilities are available only at about 40,000 empanelled hospitals. 

Insurers who have agreed to participate in this initiative, commit to honouring claims from any hospital including those not in their network. As soon as a claim is made from a particular hospital, that hospital would automatically become part of the insurer's network.

Conditions Apply

However, the council has put forward certain conditions to avail cashless hospitalisation at hospitals that are not in the insurance company's network. As per the conditions,

• The customer should inform the Insurance Company at least 48 hours prior to admission for elective procedures 
• The customer should inform the Insurance Company within 48 hours of admission for emergency procedures
• 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.

The General Insurance Council launched 'Cashless Everywhere' drive in consultation with all the general and health insurance companies.

“The new initiative will encourage more customers to opt for health insurance. 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,” Singhel said