What is ‘Cashless everywhere’ facility in health insurance?

What is cashless facility?

This facility allows a patient to be admitted to a hospital without paying any money upfront. If the hospital is in the insurer’s network, the patient can avail of cashless facility. This means that as per a predecided arrangement, the insurer will directly settle the bill with the hospital at the time of the patient’s discharge.

Till last year, one could not avail of cashless facility if the hospital selected for any medical procedure was not in the insurer’s network. So, the patient would have to pay the money upfront and then apply for reimbursement after discharge.

Also read | Why hospitals and insurance companies are clashing over suspension of cashless medical treatment: What should health insurance holders do now?

What is Cashless Everywhere?

Today, around 63% of patients avail of the cashless facility, while the remaining have to resort to reimbursements. With the objective of easing the process of bill payment for patients, the General Insurance Council (GIC) launched a new initiative, ‘Cashless Everywhere’, on 24 January 2024.

According to this facility, a patient should be able to opt for cashless service in any hospital, whether it is a part of his insurance company’s network or not. Hence, it is not essential for a tie-up to exist between the hospital and the insurer for a patient to avail of the cashless service.

The Cashless Everywhere option is subject to the following conditions.

• For elective procedures, the customer should intimate the insurance company at least 48 hours prior to admission.
• For emergency treatment, the customer needs to intimate the insurance company within 48 hours of admission.
• The claim should be admissible as per the terms of the policy and the cashless facility should be admissible as per the operating guidelines of the insurance company.

What are the roadblocks?

Since the insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI) has not issued any official notification regarding the Cashless Everywhere initiative, it is not currently under the regulatory purview.

Hence, hospitals may not be too forthcoming in adopting it and can insist on upfront payments at the time of admission.

The slow and reluctant implementation of the scheme means that even though it is available on paper, in reality, it may not be open to policyholders in all the hospitals.