‘Cashless Everywhere' Initiative Empowers Policyholders Beyond Network Hospitals

Traditionally, policyholders have been restricted to receiving cashless medical services only at hospitals within the predetermined network of their insurance provider, called 'network hospitals'. However, the 'Cashless Everywhere' initiative breaks down these barriers, offering greater flexibility and freedom of choice to individuals seeking healthcare services.

Under this initiative, policyholders are empowered to select any hospital they prefer for medical treatment, assured that a cashless facility will be available, irrespective of whether the chosen hospital is within the insurer's network. This represents a transformative shift in the landscape of health insurance, prioritising the needs and preferences of policyholders while ensuring seamless access to high-quality healthcare services.

In this article, we delve deeper into the intricacies of the 'Cashless Everywhere' initiative, exploring its implications for policyholders, healthcare providers, and the insurance industry at large. We examine the conditions under which this facility operates and the potential benefits it offers to stakeholders across the healthcare ecosystem.

The General Insurance Council (GIC) and the Insurance Regulatory and Development Authority of India (IRDAI) have teamed up to tackle a longstanding issue faced by policyholders: the limited accessibility of cashless medical services. The cashless facility was exclusively available at hospitals with which the respective insurance companies have agreements or tie-ups. However, when policyholders used to opt for treatment at a hospital outside this network, the cashless facility was not extended, necessitating a reimbursement claim and further delaying the claim process. This discrepancy has led to only 63% of customers opting for cashless claims, while the rest resort to reimbursement claims due to hospital choices beyond their insurer's network.

To address this challenge and boost insurance penetration across the country, the General Insurance Council (GIC), in collaboration with all General and Health Insurance Companies, has introduced the ground-breaking "Cashless Everywhere" initiative. This initiative aims to empower policyholders by offering them the flexibility to receive cashless treatment at any hospital of their choice, regardless of whether it is within the insurer's network. As per the guidelines from the GIC, the initiative is effective from January 25, 2024. However, certain conditions must be met to qualify for this facility:

- For elective procedures, policyholders must inform the insurance company at least 48 hours prior to admission;

- In the case of emergency treatment, notification to the insurer should occur within 48 hours of admission;

- Additionally, the claim must adhere to the terms of the policy, and the cashless facility should align with the operating guidelines of the insurance company.

Benefits of the "Cashless Everywhere" to Stakeholders:

For Policyholders:

1. Enhanced freedom of choice in choosing hospitals for treatment.

2. Reduced financial burden due to streamlined claims processes.

3. Improved access to healthcare services, even at non-network hospitals.

4. Greater convenience with cashless facility availability across a wider range of healthcare providers.

For Insurance Companies:

1. Increased customer satisfaction and loyalty.

2. Reduced administrative overhead associated with reimbursement claims.

3. Enhanced competitiveness by offering more comprehensive coverage options.

4. Potential for increased market penetration and growth in policyholder base.

For Healthcare Providers:

1. Expanded patient base from policyholders opting for treatment at non-network hospitals.

2. Streamlined payment processes, reducing administrative hassles.

3. Improved reputation and credibility by participating in a more inclusive healthcare network.

4. Potential for increased collaboration with insurers to optimise patient care.

Mr Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance and Chairman of the General Insurance Council emphasises the customer-centric nature of this initiative, stating, "It has been the constant endeavour of the GI Council to simplify the lives of policyholders and bring positive changes that benefit them." Mr Singhel underscores the significance of reducing the stress and financial burden on policyholders, as well as streamlining the claims process to enhance their overall experience. By eliminating the need for reimbursement claims in situations where policyholders opt for hospitals outside the insurer's network, "Cashless Everywhere" aims to make the entire claims journey easier, fostering greater trust in the insurance system.

Beyond enhancing customer experience, this initiative is poised to combat fraudulent activities that have plagued the insurance industry, eroding trust over time. Mr Singhel sees "Cashless Everywhere" as a pivotal step towards reducing and ultimately eliminating fraud, thereby benefiting all stakeholders involved. By offering a win-win solution for policyholders, insurers, and healthcare providers alike, this initiative indicates a transformative shift in the landscape of health insurance in India.

In conclusion:

The introduction of "Cashless Everywhere" represents a significant milestone in advancing accessibility, convenience, and trust within the health insurance sector. By prioritising the needs and preferences of policyholders, this initiative not only addresses existing challenges but also lays the groundwork for a more inclusive and transparent insurance ecosystem.

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KETKI JADHAV is a Content Writer at PersonalFN since August 2021. She is an MBA (Finance) and has over seven years of experience in Retail Banking. Ketki specialises in covering articles around banking, insurance, personal finance, and mutual funds and has been doing it for over three years now.

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