Cashless Health Insurance: What Rule Is Going To Change And How To Get Cashless Treatment At Non-Network Hospitals?

Earlier, health insurance holders could only receive cashless treatment at hospitals within the insurer's network. The insurer would directly settle medical expenses with these network hospitals. If the hospital was outside the network, the policyholder had to pay upfront and then undergo a tedious reimbursement process. With the new 'Cashless Everywhere' system, policyholders can now receive cashless treatment at any hospital of their choice. Even if the hospital isn't part of the insurer's network, the insurer will still settle the bill, enabling the policyholder to avail of cashless treatment.

The General Insurance Council (GIC) worked with general and health insurance companies to introduce the 'Cashless Everywhere' initiative. This allows health insurance holders to get cashless treatment at any hospital, even if it's not part of the insurer's network.

Here are the guidelines for accessing cashless medical treatment at non-network hospitals under the 'Cashless Everywhere' initiative, as outlined by the GIC:

• Notify the insurance company at least 48 hours before admission for planned procedures.

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

• Ensure that the claim meets policy terms and that the cashless facility is in line with the insurer's operating guidelines.

Please note that charges at non-network hospitals will be based on rates charged to existing empanelled insurers. The cashless facility at non-network hospitals is effective immediately, according to the General Insurance Council's announcement on January 24, 2024. Hospitals with up to 15 beds, registered under the Clinical Establishment Act with respective state health authorities, can now offer cashless hospitalization.

The Cashless Everywhere facility offers several benefits to health insurance customers:

Increased Flexibility: Customers can receive cashless medical treatment at any hospital of their choice, regardless of whether it's within the insurer's network.

Convenience: Policyholders no longer need to worry about paying upfront and going through a reimbursement process when receiving treatment at non-network hospitals.

Reduced Financial Burden: By allowing cashless treatment at non-network hospitals, customers can avoid the immediate out-of-pocket expenses associated with healthcare.

Expanded Access To Healthcare: This initiative broadens access to quality healthcare services by enabling policyholders to seek treatment at a wider range of hospitals.

Simplified Procedures: With streamlined guidelines for accessing cashless treatment at non-network hospitals, customers can navigate the process more easily and efficiently.