General Insurance Council’s Campaign for Cashless Hospitalisation

The General Insurance Council, the representative body of non-life and health insurance companies in India, has launched a campaign called ‘Cashless Everywhere’ on January 24, 2024. The campaign aims to provide cashless hospitalisation to policyholders even in non-empanelled hospitals across the country. This is expected to ease the financial burden of policyholders, increase their choice of hospitals, and reduce fraud in the industry.

What is Cashless Everywhere?

Cashless Everywhere is an initiative that allows policyholders to get treated in any hospital they choose, regardless of whether the hospital is in the network of the insurance company or not. The only condition is that the hospital should have at least 15 beds and be registered with the respective state health authorities under the Clinical Establishment Act.

According to the General Insurance Council, there are about 40,000 empanelled hospitals in India where policyholders can avail cashless facilities. However, there are many more hospitals that are not empanelled but meet the minimum criteria for providing quality healthcare. Cashless Everywhere aims to cover these hospitals as well, thereby expanding the scope of cashless hospitalisation for policyholders.

How to avail Cashless Everywhere?

To avail Cashless Everywhere, policyholders should inform the insurance company at least 48 hours before admission in case of elective procedures. For emergency treatment, the policyholder should inform the insurer within 48 hours of admission. The claim will be admissible as per the terms of the policy and the cashless facility will be available as per the operating guidelines of the insurer.

The General Insurance Council has also set up a dedicated helpline number (1800-103-4448) and a website (www.cashlesseverywhere.in) for policyholders to get more information and assistance regarding Cashless Everywhere.

What are the benefits of Cashless Everywhere?

Cashless Everywhere is expected to benefit policyholders in several ways:

• It will eliminate the need for reimbursement claims, which are often delayed and cumbersome. Policyholders will not have to pay for treatment out of their pockets and wait for reimbursement from the insurer.
• It will increase the choice of hospitals for policyholders, especially in remote areas where network hospitals may not be available. Policyholders will have more options to select a hospital that suits their convenience and preference.
• It will reduce fraud, which has been plaguing the industry and eroding trust in the system. By verifying the credentials and bills of non-empanelled hospitals, insurers will be able to prevent fraudulent claims and overcharging.

What are the challenges of Cashless Everywhere?

Cashless Everywhere may also pose some challenges for policyholders and insurers:

• It may increase the cost of claims for insurers, as non-empanelled hospitals may charge higher rates than network hospitals. Insurers may have to negotiate with non-empanelled hospitals to ensure reasonable pricing and quality standards.
• It may create operational issues for insurers, as they will have to verify the credentials and bills of non-empanelled hospitals. Insurers may have to deploy more resources and technology to ensure smooth processing of cashless claims.
• It may lead to disputes between policyholders and insurers, as some claims may be rejected or partially paid due to exclusions or sub-limits. Policyholders may have to be aware of their policy terms and conditions and seek clarification from insurers before availing cashless facilities.