Health Insurance: Policyholders Can Opt For Cashless Claims At All Hospitals From Jan. 25

The General Insurance Council announced the "Cashless Everywhere" initiative, which would allow policyholders to obtain cashless redressal of claims at all hospitals—irrespective of whether the hospital is covered under the network of the insurance provider.

Currently, only about 63% of customers opt for cashless claims, while others have to apply for reimbursement claims as they might be admitted to hospitals that are outside their insurer/TPA network, said Tapan Singhel, GIC chairperson as well as managing director and chief executive officer of Bajaj Allianz General Insurance Co.

This puts a significant amount of stress on their finances and makes the process long and cumbersome, he said.

"This, we feel, will encourage more customers to opt for health insurance," Singhel said.

The initiative will open up the opportunity for customers to approach any hospital across India—around 40,000 plus—without being limited to the ones empanelled by their particular insurers, which are typically around 1,000 to 5,000 hospitals.

The procedure for availing cashless claims are as follows:

• For elective procedures, the customer should intimate the insurance company at least 48 hours prior to admission.

• For emergency treatment, the customer should intimate the insurance company within 48 hours of admission.

The hospital will then submit the preauthorisation form to the insurance company, in case of an elective surgery, for the insurer to verify admissibility. After that, the hospital will sign an MoU and the insurer would grant the preauthorisation.

The customer would then only require to pay for items not covered under the insurance policy. The hospital will submit the bill and the insurer will honour it, as per the terms of the policy.

Currently, around 83% surgeries are elective, and this initiative is expected to aid customers to have a seamless process of claims.

It will come into force from Jan. 25, which means a customer looking to opt for an elective surgery from Jan. 27 can intimate their insurer to avail the benefit.

"The health insurance industry boasts of 7 crore claims, against 30 crore policies issued in a year, with a grievance rate of 0.03% and only 32,000-33,000 issues raised with the insurance ombudsman," said Ritesh Kumar, managing director of HDFC Ergo General Insurance Co.

This initiative is expected to reduce fraudulent claims and eventually bring down health premium for the industry by increasing trust.