Health Insurance: You can now avail cashless treatment at any hospital; check new rules

Policyholders till now used to search for hospitals for medical treatment which are under their health insurance policy. However, now, the General Insurance Council (GIC) has issued new rules under the ‘Cashless Everywhere’ initiative, where policyholders can get treatment at any hospital of their choice, even if such hospital is not in the network of the insurance company. The rules have become effective from January 25, 2024.

What are the current rules on cashless treatment under health insurance?

Under health insurance policies, in case of hospitalization, policyholders do not need to pay from their own pocket for the treatment with cashless facility, where insurance companies commit to cover the cost of the hospital treatment , provided the claim is admissible.

This cashless facility is currently available only in those hospitals where there is an agreement or tie-up with the respective insurance company. If the policyholder chooses a hospital without any such agreement, the cashless facility is not offered, and the customer has to go for a reimbursement claim, thereby further delaying the claim process.

What are the new rules under the ‘Cashless Everywhere’ initiative?

The General Insurance Council, in consultation with all general and health insurance companies, is launching the ‘Cashless Everywhere’ initiative.

Under Cashless Everywhere, the policyholder can get treatment in any hospital of his choice and even if such hospital is not in the network of the insurance company, cashless facility will be available.

What are the conditions?

The theme of ‘Cashless Everywhere’ initiative is:

1) For elective procedures, the customer must inform the insurance company at least 48 hours before admission.

2) For emergency treatment, the customer must inform the insurance company within 48 hours of admission.

3) The claim should be admissible as per the policy terms and the cashless facility should be admissible as per the operational guidelines of the insurance company.