The 'Anywhere Cashless' initiative launched by insurers is a win-win facility

Until now, a health insurance policyholder could get cashless treatment only at network hospitals with whom an insurance company, which has issued the policy, has a formal tie-up. If it is a non-network hospital, the policyholder has to clear the entire amount from his own pocket and then can claim reimbursement from his insurer

The General Insurance Council, the official body of general and health insurance companies, on Wednesday announced a drive aimed at making cashless hospitalisation available for policyholders even in non-empanelled hospitals.

ICICI Lombard has been offering the 'Anywhere Cashless' feature since last March. This feature empowers the customers to access cashless facilities at any hospital, regardless of its inclusion in our current network.

In order to ease the burden of policyholders, who get treated in a hospital not in the network of the insurance company from whom he or she might have taken a health insurance policy, the General Insurance Council, in consultation with all the general and health insurance companies, has launched the “Cashless Everywhere” initiative from January 24.

Talking to Bizz Buzz, Segar Sampathkumar, director, Health, General Insurance Council, says, “Cashless Everywhere is an initiative by the council to provide cashless to any hospital even if it is not in the network of the insurance company.”

In health insurance with cash less facility, policyholders need not pay for treatment out of their pockets as the expenses would be directly paid by the insurance companies concerned. This is subject to the claim being admissible, as per the council.

Until now, a health insurance policyholder could get cashless treatment only at network hospitals with whom an insurance company, which has issued the policy, has a formal tie-up. If it is a non-network hospital, the policyholder has to clear the entire amount from his own pocket and then can claim reimbursement from his insurer.

Hospitals with 15 beds, and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless hospitalisation now.

Under the drive ‘Cashless Everywhere’, efforts will be made to ensure that policyholders can get treated in any hospital they choose with a cashless facility, subject to certain conditions, said the council’s chairman Tapan Singhel, who is also MD & CEO of Bajaj Allianz General Insurance.

There are over 40,000 hospitals in the country, which can now offer cash-less facilities to all the health insurance policy holders of all general and health insurance companies , numbering over 30 crore, in the new system.

In case a policy holder needs hospitalisation in a non-empanelled hospital, he or she should inform the insurance companies at least 48 hours earlier. There will also be the option of informing the insurance company within 48 hours of hospitalisation for emergency treatment.

“The new system will encourage more customers to opt for health insurance. We also see this as a step towards reducing and in the long run, eliminating fraud, which has been plaguing the industry in a big way and reducing trust in the system. Overall, it’s a win-win for all the stakeholders,” Singhel.

Today only about 63 per cent 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/TPA network, said Singhel.

Neerja Kapur, CMD, New India Assurance, said that a move like cashless service will create an eco-system that will ultimately bring down health insurance premiums for customers.

Ritesh Kumar, MD & CEO of HDFC Ergo, said, “The idea is to make it convenient for policyholders. The entire initiative is achieve 100 per cent cashless treatment.”

Dr. S. Prakash, head of health committee of the council said that 100 per cent cashless will be made available for up to 50,000 hospitals in India.