Suppose some restaurant is enlisted on Swiggy and not on Zomato. But I tell you that you can still use Zomato and order food from this restaurant. Isn’t that great? 

Something similar is happening in the health insurance sector now.

The General Insurance Council in India recently announced an innovative initiative called “Cashless Everywhere”. This initiative allows policyholders to avail cashless treatment in any hospital, regardless of whether the hospital is in the network of the insurance company or not. 

This initiative is seen as a significant step towards simplifying claims processing, mitigating fraud, and bolstering overall industry trust.

How Cashless Everywhere helps health insurance industry

For the health insurance industry, the Cashless Everywhere initiative brings several benefits. Some of them are listed below: 

1. It simplifies the claim process by eliminating the need for policyholders to apply for reimbursement claims if they are admitted to hospitals outside their insurer’s network. 
2. This initiative can also increase insurance penetration by making the claim process frictionless. It helps building greater trust in the system and encouraging more customers to opt for health insurance. Imagine how tension free you can be while going for any medical treatment as cash is no more an issue.
3. Furthermore, it is seen as a step towards reducing and, in the long run, eliminating fraud, which has been plaguing the industry. We all have come across several incidents of hospitals overcharging, haven’t we?

What about consumer benefits?

Consumers also stand to gain significantly from this initiative. 

1. It gives policyholders the freedom to get treated in any hospital they choose, with a cashless facility available even if such a hospital is not in the network of the insurance company. 
2. It also eliminates the need for policyholders to apply for reimbursement claims, which can be a long and cumbersome process. 
3. Moreover, as I pointed out earlier, it reduces the financial stress on policyholders, especially during emergencies. 
4. The initiative also promotes accessibility and convenience in healthcare services by accommodating even hospitals in remote locations with limited access to technology.

Evaluating Cashless Everywhere

The success of this initiative depends on several factors, including consumer awareness, standardisation of rates for treatment and medical procedures and the ability of healthcare facilities to quickly implement the new initiative. 

There are some practical issues as well. For example, hospitals do face different costs themselves depending upon the location and other facilities in their area. Expecting uniform rates across all hospitals is a bit ambitious goal.

So how do you, as a consumer, can make use of Cashless Everywhere in future?

As per the GIC guidelines, it is expected that:

1. For elective procedures, the customer should intimate the insurance company at least 48 hours prior to the admission. 
2. For emergency treatment, the customer should intimate the insurance company within 48 hours of admission.

To check if a hospital is part of the Cashless Everywhere initiative, policyholders can contact their health insurance provider or the hospital directly. 

It’s also important to note that for hospitals to offer cashless treatment, they should satisfy certain criteria, including having at least 15 beds. Per the rules, hospitals should be registered under clinical establishment act with their state authorities.

Final words

The Cashless Everywhere initiative is a promising step towards revolutionizing the health insurance industry in India, offering numerous benefits to both the industry and consumers. 

However, substantial work in this area is still needed. Its success will depend on synergies between insurers and hospital authorities, effective implementation and widespread awareness among consumers.

It is going to be an interesting decade for the Indian health insurance industry. Watch out this space for the upcoming developments!

Disclaimer: The above content is for informational purposes only. Not advice. Please consult your financial advisor to find out which health insurance policy is good for you.