Revolutionizing Health Insurance: The ‘Cashless Everywhere’ in India
The General Insurance Council recently introduced the ‘Cashless Everywhere’ initiative, revolutionizing the landscape of health insurance in India. This initiative enables health insurance policyholders to access cashless treatment even in non-network hospitals. Upon receiving a claim, participating insurers will promptly include non-network hospitals in their network, expanding the choices available to policyholders, reducing costs and disputes, and mitigating fraud risks. Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance and GIC chairman, emphasized the importance of prioritizing customer awareness and swiftly establishing agreements with hospitals when policyholders are admitted to non-network hospitals.
This groundbreaking initiative, set to commence nationwide from January 25, was initiated by the Insurance Regulatory and Development Authority of India (IRDAI). Its primary objective is to enhance insurance penetration, streamline the claim process for policyholders and hospitals, and eliminate the delays and disputes often associated with reimbursement procedures.
How Will the Cashless Scheme Work in Hospitals?
Under the ‘Cashless Everywhere’ system, policyholders can be admitted to a hospital without upfront payment, with the insurance company settling the bill upon discharge. To avail themselves of this facility, policyholders must notify the insurer at least 48 hours before admission, with emergency cases requiring notification within 48 hours of admission, subject to policy terms and insurer guidelines. Currently, cashless facility is limited to hospitals with agreements with insurance companies, while hospitals without such agreements necessitate reimbursement claims, potentially prolonging the claims processing timeline.
Present Situation for Cashless Scheme in Hospitals
According to the IRDAI Annual Report for the fiscal year 2022-23, 56% of health claims were settled through the cashless route. However, this facility is presently limited to hospitals with agreements with respective insurance companies. Despite settling 2.36 crore health insurance claims during this period, Tapan Singhel noted that only 63% of customers opt for cashless claims, with the rest opting for reimbursement claims, particularly in rural and semi-rural areas where access to network hospitals may be challenging. Currently, if a policyholder chooses a hospital without an agreement with the insurance company, a cashless facility is not available, further delaying the claims process.
Benefits of the Cashless Everywhere System in India
This initiative offers policyholders the freedom to receive treatment at any hospital of their choice, irrespective of network affiliation. This flexibility minimizes the need for reimbursement, streamlining the claims process and enhancing the overall policyholder experience. Additionally, hospitals with at least 15 beds registered with state health authorities can offer cashless hospitalization, expanding the network to approximately 40,000 hospitals across India. Various government initiatives, such as the cashless medical facility for government employees in Haryana and cashless treatment facilities for CGHS beneficiaries, further contribute to the digitization and accessibility of healthcare services.
Problems in the Cashless System in India
Challenges persist in raising awareness among customers about the cashless facility and encouraging hospitals to adopt it. Disagreements between hospitals and insurers regarding treatment rates may hinder the availability of cashless treatment. Additionally, difficulties in identifying network hospitals and the subsequent need for reimbursement can lead to financial strain and delays for policyholders.
Conclusion
The introduction of the ‘Cashless Everywhere’ system by GIC in India signifies a monumental advancement in the health insurance sector. By enabling policyholders to access cashless treatment at any hospital, this initiative is poised to simplify the claim process, enhance insurance coverage, and foster trust within the system. Despite initial challenges, the success of this system has the potential to redefine standards in health insurance, benefiting policyholders, hospitals, and insurers alike.
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