(L to R) Segar Sampathkumar, Director, Health, General Insurance Council, Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance and Neerja Kapur, CMD, New India Assurance at an event in Mumbai in Wednesday for launching “Cashless Everywhere” initiative

Under ‘Cashless Everywhere’, efforts will be made by the insurers to ensure that policyholders can get treated in any hospital they choose with a cashless facility, subject to certain conditions

Mumbai:

The General Insurance Council, the official body of general and health insurance companies, on Wednesday announced a drive aimed at making cashless hospitalisation available for policyholders even in non-empanelled hospitals.

In order to ease the burden of policyholders, who get treated in a hospital not in the network of the insurance company from whom he or she might have bought a health insurance policy, the General Insurance Council, in consultation with all the general and health insurance companies, has launched the “Cashless Everywhere” initiative from Thursday.

In health insurance with cash less facility, policyholders need not pay for treatment out of their pockets as the expenses would be directly paid by the insurance companies concerned. This is subject to the claim being admissible, as per the council.

Till now, a health insurance policyholder can get cashless treatment only at network hospitals with whom an insurance company, which has issued the policy, has a formal tie-up. If it is a non-network hospital, the policyholder has to clear the entire amount from his own pocket and then can claim reimbursement from his insurer.

Hospitals with 15 beds, and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless hospitalisation now.

Under the drive ‘Cashless Everywhere’, efforts will be made to ensure that policyholders can get treated in any hospital they choose with a cashless facility, subject to certain conditions, said the council’s chairman Tapan Singhel, who is also MD & CEO, Bajaj Allianz General Insurance.

There are over 40,000 hospitals in the country, which can now offer cash-less facilities to all the health insurance policy holders of all general and health insurance companies , numbering over 30 crore, in the new system.

In case a policy holder needs hospitalisation in a non-empanelled hospital, he or she should inform the insurance companies 48 hours before it. There will also be the option of informing the insurance company within 48 hours of hospitalisation for emergency treatment.

“The new system will encourage more customers to opt for health insurance. We also see this as a step towards reducing and in the long run, eliminating fraud, which has been plaguing the industry in a big way and reducing trust in the system. Overall, it’s a win-win for all the stakeholders,” explained Singhel.

Today only about 63 per cent of customers opt for cashless claims while the others have to apply for reimbursement claims as they might be admitted to hospitals that are outside their Insurer/TPA network, said Singhel.

Segar Sampathkumar, director, Health, General Insurance Council, said, the Council has now a host of plans that will be implemented over a period of time to bring about changes in the health insurance industry.

“We are now working on standardisation of charges by the hospitals and talking to all hospitals. We are also making efforts to put in place a grievance settlement mechanism for the hospitals,” said Sampathkumar.

Neerja Kapur, CMD, New India Assurance, said move like cashless service will create an eco-system that will ultimately bring down the health insurance premiums for the customers.

On the rising health premiums, Singhal said the high combined ratio of 120 per cent in the industry’s health insurance portfolio, indicating heavy losses incurred by the insurers, and overall inflation have been mainly pushing up the premiums in the past.

However, he assured that it may not go up further in future.