General and health insurers unite for 'Cashless Everywhere' facility in hospitals

Policyholders will now be able to approach any hospital and avail of the cashless facility  for their medical expenses, irrespective of whether the medical centre is part of their insurers' cashless network or not.

General and health insurance companies, through the General Insurance Council, have come together to enable this facility — termed ‘Cashless Everywhere’ — across hospitals in order to improve the cashless coverage in the country. The facility can be availed of at hospitals registered under the Clinical Establishments Act, 2010, with a capacity of at least 15 beds.

The cashless facility does away with the need for patients to pay their hospital bills first, and then claim the same from their insurance companies. “Today, only about 63 percent of customers opt for the cashless facility. Others have to claim the reimbursement of their medical expenses as they might be admitted to hospitals that are outside their insurer’s / TPA’s (third party administrator’s) network. We feel this puts a significant amount of stress on their finances, and makes the claim process long and cumbersome,” said Tapan Singhel, MD and CEO, Bajaj Allianz General Insurance, and Chairman, General Insurance Council.

Also read: Cashless health insurance may not work in case of emergency hospitalisation

Backed by the regulator, the industry now wants to ensure 100 percent cashless settlement of claims. “We wanted to make the whole journey of claims 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 policies,” he said.

At present, policyholders can avail of cashless facilities only at hospitals that have signed agreements with their insurers and are part of their network. “If the policyholder chooses a hospital that does not have such an agreement, the cashless facility is not offered, and the customer has to go for a reimbursement claim, further delaying the claim process,’’ the GI Council said in a statement.

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Through ‘Cashless Everywhere’, policyholders can choose to get treated in any hospital, provided certain conditions are met. For elective (planned, non-emergency) procedures, policyholders will have to intimate the insurance companies at least 48 hours prior to admission.

In case of an emergency admission, they will need to inform the insurers within 48 hours. The insurer will approve the cashless payment if the claim is eligible for payment as per the policy’s terms and conditions.