Health insurance claim reform: Cashless treatment at any hospital may be a reality next year; how it will help
cashless hospital network that will include both empanelled and non-empanelled hospitals, two major industry players told ET Wealth Online. So, health insurance policyholders can soon avail of cashless treatment in hospitals, even if they are not empanelled with their insurance companies.
What it means for you and how it is going to help you? Read here to find out.
Cashless hospitalisation under health insurance: What is the existing rule?
Till now, a health insurance policyholder can avail of cashless treatment only at network hospitals with whom the insurance company has tied up.
The insurance company settles medical expenses directly with the network hospital, thus, allowing policyholders the advantage of receiving medical treatment without worrying about sudden outflow of funds due to medical expenses.
Each insurance company has an independent network of medical service providers that they have a tie-up with.
At present, cashless settlement is available only in 49% of the hospitals in India. «While this network includes all the large tertiary care hospitals, the spread of the network of hospitals was dependent on the density of customers in a particular geography.
Therefore, invariably some customers would take treatment at hospitals that their insurer does not have a tie-up with,» an official from one of the prominent insurers told ET Wealth Online, speaking on condition of anonymity
100% cashless network: Cashless treatment in non-empanelled hospitals — what is going to change?
The insurance regulator, along with the General Insurance Council (GIC) has proposed to introduce a 100% cashless network. «In the process of doing so, the regulator may consider cashless treatments from non-empanelled hospitals as well,»
