Cashless Insurance – System Unleashed by General Insurance Council 2024

Cashless Insurance

In a groundbreaking move, the General Insurance Council (GIC) has ushered in a new era for health insurance policyholders. The recently introduced Cashless Insurance – ‘Cashless Everywhere’ system is set to transform the landscape of healthcare financing, providing individuals the flexibility to access Cashless Insurance treatment facilities across all hospitals. This is a departure from the previous norm, where such services were confined to network hospitals affiliated with insurance companies.

Historical Perspective: Limitations of Network Hospitals

Traditionally, policyholders could only avail cashless treatment in hospitals that were part of the network established by insurance companies. In such instances, the insurer would directly settle medical expenses with the hospital. However, those seeking treatment in non-network hospitals faced the cumbersome task of paying the entire bill upfront and subsequently initiating a reimbursement claim. This process involved extensive documentation, inquiries, and approvals, resulting in delays in reimbursement.

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The Game-Changer: ‘Cashless Everywhere’ System

The primary change introduced by the Cashless Insurance – ‘Cashless Everywhere’ system is its universality. Policyholders can now access cashless treatment not only in network hospitals but in any hospital of their choice. This implies that even non-network hospitals will see the insurance company directly settling the medical bills, a departure from the previous reimbursement-oriented approach.

Procedure for Cashless Treatment in Non-Network Hospitals

Elective Procedures:

For planned procedures, policyholders must inform the insurance company a minimum of 48 hours before admission to the hospital.

Emergency Treatments:

In the case of emergencies, it is imperative to notify the insurance company within 48 hours of hospital admission.

Claim Processing:

Claims will be processed in adherence to policy conditions, and the cashless facility will be granted in accordance with the operating guidelines of the insurance company. Charges in non-network hospitals will be subject to prevailing empaneled insurance company rates.

Policy Implementation and Institutional Criteria

The General Insurance Council, in its announcement on January 24, revealed that the implementation of cashless facilities in non-network hospitals is imminent. Notably, hospitals with a minimum of 15 beds registered with the respective state health authority are now eligible to offer cashless facilities under the provisions of the Clinical Establishment Act.

In essence, the ‘Cashless Everywhere’ system marks a pivotal moment in the evolution of health insurance, fostering greater accessibility and streamlining processes for policyholders. This progressive initiative by the General Insurance Council is poised to enhance the overall efficiency and convenience of healthcare financing, ensuring that individuals can receive quality medical care without the burden of immediate financial outlay.

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