GIC To Create Common Empanelment Platform For Cashless Health Insurance Claims

The General Insurance Council (GIC) is taking steps towards streamlining the empanelment process for hospitals to increase the share of cashless claims in health insurance. By creating a common empanelment platform for hospitals, GIC aims to simplify the process for hospitals and policyholders while also improving the efficiency of the overall insurance claims process.

“We want to create a platform for common empanelment of hospitals. Today, there are 30 different insurance companies and 30 different platforms. Hospitals have to go through different processes and requirements of insurance companies for empanelment, which has become a pain point,” says S Prakash, GIC’s executive committee member, told media on Tuesday.

According to experts, the GIC’s initiative to create a common hospital empanelment platform can potentially revolutionize the health insurance industry. This platform aims to streamline the empanelment process for hospitals and increase the share of cashless claims in the overall insurance claims.  

The benefits of cashless health insurance are many. Firstly, it provides peace of mind to policyholders as they do not have to worry about the financial burden of hospitalization. Secondly, it helps manage medical emergencies as cashless claims are processed faster than reimbursement claims. Thirdly, it reduces the out-of-pocket expenses of policyholders as they do not have to pay upfront for medical treatment.

Says Prasun Sikdar, MD & CEO, Manipal Signa Health Insurance: “India’s healthcare system today is largely underfunded and is dependent on out-of-pocket expenses. Further, the increase in medical inflation and lifestyle diseases has put a burden on Outpatient Department (OPD) expenses. Therefore, cashless health insurance can help alleviate the financial strain of out-of-pocket expenses.”  

“To cater to the large part of out-of-pocket expenses in India, it is important to streamline the OPD segment and ensure that payers, providers, and patients have easy access to this network. To integrate primary healthcare centers, pharmacies, and diagnostic labs into the digital economy, India must link primary healthcare centres with the cashless health insurance network,” adds Sikdar.  

Benefits Of Common Empanelment Platforms

Simplify and Standardize Process: “The empanelment process for hospitals can be time-consuming and tedious. With a common empanelment platform, the process can be streamlined and more efficient. Hospitals can submit their details and required documents on the platform, which can be accessed by multiple insurance companies. This eliminates the need for hospitals to go through the same process multiple times, making the process more convenient and time-saving,” says Bajaj. 

Empanelment requirements can vary between insurance companies, leading to confusion and delays for hospitals. With a common empanelment platform, the process can be standardized, making it easier for hospitals to understand the requirements and provide the necessary information. This can result in a more efficient method for all stakeholders involved.

Increase The Pool Of Hospitals: Common empanelment platforms can help insurance companies access more empanelled hospitals. This is because the platform can be used by multiple insurance companies, allowing them to access the same set of hospitals. This can help insurance companies offer their policyholders a wider range of healthcare options, resulting in better customer satisfaction.

Increase Share Of Cashless Insurance Claims: Common empanelment platforms can also help increase the share of cashless insurance claims. This is because the platform can be used to empanel hospitals that offer cashless services. Policyholders can then avail of cashless medical treatment at these hospitals without worrying about arranging funds upfront. This can result in a better customer experience and increased customer satisfaction.

Benefits Of Cashless Health Insurance

Convenience: Cashless health insurance policies provide a high degree of convenience to policyholders. “In a cashless policy, the policyholder does not need to pay upfront for the medical treatment at a network hospital. Instead, the insurance company settles the bills directly with the hospital. This means the policyholder can focus on getting the required medical care without worrying about arranging funds. In emergency hospitalization, the policyholder may not have the time or resources to arrange the necessary funds. In such cases, cashless health insurance can be a lifesaver, offering a sense of security and peace of mind,” says Sanjiv Bajaj, joint chairman and MD, Bajaj Capital.  

Better Healthcare: Cashless health insurance policies encourage policyholders to seek timely medical treatment without worrying about the cost. This can lead to better healthcare outcomes as medical conditions can be addressed on time. Delaying medical treatment due to financial constraints can exacerbate the situation and result in a higher cost of treatment later. With cashless health insurance, policyholders are more likely to seek timely medical treatment, resulting in a better prognosis and a quicker recovery.

No Out-Of-Pocket Expenses: Cashless health insurance policies eliminate the need for policyholders to pay for medical treatment upfront. This means that the policyholder does not need to worry about arranging funds for medical treatment or borrowing from friends or family. The insurance company directly settles the bills with the hospital with a cashless policy. This ensures that the policyholder does not have to pay any out-of-pocket expenses, which can help them manage their finances better. Additionally, not having to pay upfront means that the policyholder does not have to go through the cumbersome process of claiming reimbursement from the insurance company. The cashless process is much more streamlined and efficient, resulting in a hassle-free experience for the policyholder.

However, the empanelment process for hospitals has been a major pain point for policyholders and hospitals. With the creation of a common empanelment platform, hospitals will only have to go through one process and set of requirements for all insurance companies, making the process smoother and more efficient. This will save time and resources for both hospitals and insurance companies.

Moreover, a common empanelment platform will increase the share of cashless claims in the insurance sector. At present, reimbursement claims make up a significant portion of insurance claims, which puts a financial burden on policyholders. With the introduction of a common empanelment platform, more hospitals will be empanelled, increasing the availability of cashless treatment options.  

Creating a common empanelment platform for hospitals by GIC can potentially transform the health insurance industry. The benefits of cashless health insurance are numerous, and a common empanelment platform will make the empanelment process smoother and more efficient. This will ultimately lead to an increase in the share of cashless claims in insurance, reducing the financial burden on policyholders.