A shot in the arm for all policyholders

A cashless treatment doesn’t require the insured to make any payment to the hospital, up to the limit prescribed under the policy, to avail the treatment. If the treatment is availed under a non-network hospital, then the policyholder could place for a reimbursement after the treatment

Health insurance is very important forevery individual’s financial plan. A health emergency not only hinders a person’s life but also adversely impacts their family members. Ill-health impacts not just their lifestyle (they might have to adjust to the new reality) but could have adverse bearing on their personal finances as this unplanned expense hurts the planned goals. Of course, any insurance is offered when the individuals are healthy, at standard rates. Hence, it is imperative to opt for a health insurance when healthy and not when one feels wealth. Generally, a health insurance is provided by an insurance company upon paying a premium. The necessary details about personal health and income are to be disclosed so that there are no hiccups at the time of a claim. The insurance company guarantees within the agreed upon terms to pay the hospitalisation costs, usually the case, but certain plans do have the option to claim the out-patient costs. Many of the procedures, nomenclature as day-care treatments where no hospitalisation is required are also covered under these policies. Usually, a health card or an identity is provided by the insurer and upon hospitalisation, is intimated for initiation of treatment costs. The hospital, if under their empaneled network (affiliated to the insurer) will allow for a cashless treatment. A cashless treatment doesn’t require the insured to make any payment to the hospital, up to the limit prescribed under the policy, to avail the treatment.

If the treatment is availed under a non-network hospital, then the policyholder could place for a reimbursement after the treatment.The policyholder in such cases must submit all the necessary documents in original or upload through the insurer’s web-application to claim the reimbursement. The policyholder have to then await for the claim process to complete to just received the money they had already spent for the treatment, putting a significant stress on their finances.

There’s good news for all the health insurance policyholders from the GIC, General Insurance Council, a body which is formulated by law under the IRDAI (Insurance Regulatory and Development Authority of India) acting as a link between the regulator and the general insurance industry.

It launched ‘Cashless Everywhere’ that took-off on January 24. It allows cashless treatment at all hospitals irrespective of the network of the insurers. With the new initiative, the policyholder can get treated through cashless facility in any hospital of their choice irrespective of the hospital within the network of the insurer or not. However, to enjoy the ‘Cashless Everywhere’ facility at a non-empaneled hospital, GIC has laid out three rules to be kept in mind by the policyholder; For elective procedures, the policyholder should intimate the insurance company at least 48 hours prior to the admission; for emergency procedures, the policyholder should intimate the insurance company within 48 hours of admission and the claim should be admissible as per the terms of the policy and the cashless facility should be admissible as pre the operating guidelines of the insurance company.

Despite a very promising initiative, there could be some tethering issues in its implementation. Nevertheless, it is a welcome move by the council in the interests of the policyholders. As per the council, only 63 per cent of the 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 issuer/TPA (Third Party Administrator) network. The council’s new initiative could bring a frictionless claim process to the policyholders. It also believes that this initiative could eliminate the plaguing frauds in the long term and enhance the trust in the system.

(The writer is co-founder of ‘Wealocity’, a wealth management firm)