Unlocking the Common Cashless Network: Revolutionizing Health Insurance

Posted on: Apr 3, 2024 | 3 mins | Written by: HDFC ERGO Team

Unlocking the Common Cashless Network: Revolutionizing Health Insurance

Common Cashless Network: A Paradigm Shift in Health Insurance

In the ever-changing healthcare landscape, policy improvements are crucial to ensure that individuals have access to quality medical services without hampering their finances. That's where cashless health insurance plays a pivotal part. Currently, cashless settlement is available only at 63% of hospitals in India. However, the Insurance Regulatory and Development Authority of India (IRDAI) and other insurance providers have introduced new plans to make it easier for policyholders to get cashless treatment across a wider network of hospitals. This move will revolutionise how policyholders access their insurance policies, promising improved convenience and efficiency.

About the new features

The two biggest issues insurance providers face are high-priced medical bills and fraudulent claims through the reimbursement process to extort large payouts from the insurers. Health insurers frequently change their list of empanelled hospitals to combat these issues. The IRDAI and General Insurance Council (GIC) have developed two new features to ensure that policyholders don't have to face any problems to avail of cashless treatment in hospitals. The features are:

• A common network of hospitals for all health insurance policies issued by any health insurance or general insurance company nationwide.

• A 100% cashless system, where the policyholders don't have to pay anything from their pockets and their insurance policy is implemented easily.

The insurance authorities intend to develop a nationwide industry-level common network of hospitals to provide you with cashless health insurance.

The implementation process in its initial phase made a consolidated list of hospitals across all insurance providers; even individual providers can contact the hospitals on the list. In the second phase, a common network created by the General Insurance Council is at an industry-level agreement with hospitals and all licensed health insurers. Members of the GIC are also a part of this agreement. During the final phase of implementation, all insurance companies policyholders will have access to a unified integrated network and completely cashless health insurance. The GIC has already formed a committee to establish a common network of hospitals, and the implementation process has already begun on January 24, 2024. The committee has also planned to have a uniform rate at which all the hospitals will be onboarded by the insurers instead of separate agreements for different hospitals and insurance companies.

Common cashless network: How will it benefit the health insurance policyholders?

The establishment of a common cashless network brings in a plethora of benefits for health insurance policyholders. The network also enhances the coverage area, providing policyholders with a larger scope of healthcare options. Whether you reside in urban or remote regions, you will get quality medical services without worrying about network restrictions. You will have access to an integrated and comprehensive network of hospitals that will ensure that your claims process is seamless and hassle-free. The key benefits are:

• Irrespective of your insurance policy, you will have access to all cashless hospitals in the industry.

• A unified network of hospitals means more standardised and competitive pricing, which might reduce the overall cost of claims and lower premium amounts.

• It will minimise out-of-pocket expenses, which means that policyholders will face almost zero inconvenience while availing treatment at hospitals.

• Many frauds that enter the system via the reimbursement route will be eradicated, and this will mean that genuine customers will have quicker and more convenient claims process.

• There will be a complete and structured industry-level database for better analytics, which will help mitigate the impact of medical inflation on premium amounts.

How will it work?

The implementation of this network operates through a joint effort between health insurance providers and registered hospitals nationwide. Previously, if the hospital wasn't in the insurance company's network, you had to pay the complete amount and later claim reimbursement via a tedious process. Even the responsibility of collecting all the documents and bills was on you. Now, when the hospital is not in the insurance company's network, the insurer will still pay the bill at the hospital, allowing you to avail of cashless treatment. However, the non-network hospital charges will be based on the rates that the hospital charges to the existing empanelled insurers.

There are three rules mentioned in the guidelines set by the GIC that you have to keep in mind while availing the facility:

1. For elective procedures, the policyholder must inform the insurance provider at least 48 hours before the admission.

2. The customer should inform the insurer within 48 hours of admission of an emergency treatment.

3. The claim should be admissible as per the terms of the insurance policy, and the cashless hospital will be admissible under the operating guidelines of the insurance company.

Conclusion

Implementing a fully cashless medical insurance settlement system in hospitals is a revolutionary initiative that will benefit both the policyholders and insurance providers. Whether it be providing a seamless and hassle-free experience for the customers or reducing fraudulent claims through the reimbursement process. This nationwide system will help ease the claims process, lessen the insured financial burden, and ensure a stress-free experience for everyone. This will also be a huge step towards enhancing transparency and standardisation between insurance companies and hospitals. The cooperation between them signifies a commitment towards improving healthcare accessibility and ensuring a future where everyone has access to quality healthcare.

Disclaimer The above information is for illustrative purposes only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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