Big change in health insurance: Now get cashless treatment at any hospital!

In a groundbreaking move that will benefit millions of health insurance policyholders in India, the General Insurance Council (GIC) has extended the scope of cashless treatment to all hospitals. Let’s break down what it means for a policyholder and how this benefit can be availed.

What is going to change?

Until now, a health insurance policyholder was entitled to receive cashless treatment only at hospitals which were empanelled with the insurance company (also known as network hospitals). If the policyholder chose a non-network hospital, they would have to pay all expenses out of pocket, before claiming reimbursement from the insurer. This process was lengthy and cumbersome.

The General Insurance Council has taken note of this and decided to empower policyholders by extending the cashless treatment to all hospitals.

So, what’s the new rule?

After consulting with general and health insurance companies, the General Insurance Council has launched the "Cashless Everywhere" initiative:

As a health insurance policyholder, you can now avail cashless treatment at any hospital, regardless of whether or not it is part of the insurer's network. The insurance company will settle your bills directly with the hospital, eliminating the need for reimbursement.

Great, does it come with any conditions?

Yes, there are three things to keep in mind if you want to get cashless treatment at non-network hospitals:

• For elective procedures, the customer should inform the insurance company at least 48 hours before admission.

• For emergency treatment, the customer should inform the insurance company within 48 hours of admission.

• The claim should be admissible as per the terms of the policy and the cashless facility should be permissible according to the operating guidelines of the insurance company.

When is it coming into effect?

It is already in place. The General Insurance Council stated that the cashless facility at non-network hospitals became effective immediately on January 24, 2024.

Okay, but why was this change needed?

According to the General Insurance Council, only 63% of health insurance customers opt for cashless claims, while others have to apply for reimbursement claims if they are admitted to hospitals outside their insurer/TPA network. This could significantly stress their finances and make the process long and cumbersome. With the Cashless Everywhere initiative, the GIC aims to make the claims journey “a frictionless process,” improving the policyholder’s experience and building greater trust in the system.