Health insurance rule change: Cashless treatment at all hospitals now; how to get it, charges

Health insurance rule change: Cashless treatment at all hospitals now; how to get it, charges

Health insurance policyholders can now avail of cashless facilities even at hospitals that are not in the network of the insurers. What is the new rule? How to get cashless treatment at any hospital? ET Wealth Online explains.

Cashless hospitalisation under health insurance: What is going to change?

Till now, a health insurance policyholder can get cashless treatment only at network hospitals with whom the insurance company has tied up. The insurance company settles medical expenses directly with the network hospital. If it is a non-network hospital, the policyholder has to pay the entire amount from his pocket and then go through the cumbersome claim reimbursement process.

The General Insurance Council in consultation with general and health insurance companies has launched “Cashless Everywhere” to extend the cashless treatment at all hospitals.

Cashless Everywhere: How to get cashless medical treatment at a non-network hospital?

Now, how to avail “Cashless Everywhere” facility at a non-empanelled hospital? According to the guidelines set by the General Insurance Council, there are three conditions that health insurance policyholders need to keep in mind:

1) For elective procedures, the customer should inform the insurance company at least 48 hours before the admission.
2) For emergency treatment, the customer should inform the insurance company within 48 hours of admission.

3) 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.Do keep in mind that the charges will be based on the rates of existing empanelled insurers. This cashless facility at non-network hospitals will be effective immediately, says the General Insurance Council. Hospitals with 15 beds, and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless hospitalisation now.

ET Wealth Online first reported about it on December 23, 2023.

Cashless Everywhere facility: How will it benefit health insurance customers?

Currently, 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 or third-party network.

If a customer goes to a non-network hospital for his treatment, he needs to pay first and get it reimbursed from his insurance later. In such cases, the onus of collecting documents required for an insurance claim rests solely with the customer. A significant portion of claims filed for reimbursement go through multiple query cycles due to want of critical documents for which a customer would have to coordinate with the hospital multiple times. This often makes the reimbursement process lengthy and stressful for many policyholders.

“We feel this puts a significant amount of stress on their finances and makes the process long and cumbersome. 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,” says Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance.

Cashless treatment at non-empanelled hospitals could be a win-win situation for everybody, says Parthanil Ghosh, President – of Retail Business, HDFC ERGO General Insurance Company Limited.

This initiative will also minimise fraudulent claims of health insurance during reimbursement mode and to reduce the burden of out-of-pocket expenses for the insured, say experts.

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Author: Shirley