Under the ‘Cashless Everywhere’ initiative, policyholders can get treated in any hospital they choose even if such a hospital is not in the network of the insurance company
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Policyholders till now searched hospitals that are under their health insurance policy for medical treatment. However, now, the General Insurance Council (GIC) has released new rules under the ‘Cashless Everywhere’ initiative, where policyholders can get treated in any hospital they choose even if such a hospital is not in the network of the insurance company. The rules have become effective from January 25, 2024.
What Are the Existing Rules on Cashless Treatment Under Health Insurance?
Under health insurance policies, in the event of hospitalisation, policyholders need not pay for treatment out of pocket with a cashless facility where insurance companies commit to covering the treatment costs at the hospital, provided the claim is admissible.
This cashless facility is currently available only at hospitals where the respective insurance company has an agreement or tie-ups. If the policyholder chooses a hospital without such an agreement, the cashless facility is not offered, and the customer has to go for a reimbursement claim, further delaying the claim process.
What Are The New Rules Under the ‘Cashless Everywhere’ Initiative?
The General Insurance Council, in consultation with all the General and Health Insurance Companies, is launching the ‘Cashless Everywhere’ initiative.
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Under Cashless Everywhere, the policyholder can get treated in any hospital they choose, and a cashless facility will be available even if such a hospital is not in the network of the insurance company.
What Are the Conditions?
The ‘Cashless Everywhere’ initiative is subject to:
1) For elective procedures, the customer should intimate the insurance company at least 48 hours prior to the admission.
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2) For emergency treatment, the customer should intimate the insurance company within 48 hours of admission.
3) The claim should be admissible as per the terms of the policy and the cashless facility should be admissible as per the operating guidelines of the Insurance Company.
