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General Insurance Council launches ‘Cashless Everywhere for Mediclaims’

The General Insurance Council has unveiled 'Cashless Everywhere for Mediclaims,' a pioneering initiative to streamline health insurance by offering a seamless, cashless system.

  • 3,420 Views | Updated on: Mar 06, 2024

Key Takeaways

  • The initiative “Cashless Everywhere for Mediclaims” simplifies and accelerates the medical expense reimbursement process by introducing a seamless, cashless system within an extensive network of healthcare providers.
  • Leveraging technology, the initiative aims to provide a more user-friendly experience, allowing policyholders to verify coverage and pre-approve medical procedures.
  • It aligns with the broader digitization trend, offering a technologically-driven solution to enhance service delivery, transparency, and efficiency in the health insurance sector.
  • It also promotes proactive healthcare measures by reducing financial barriers to medical attention and fostering a culture of preventive care among insured individuals.

In a significant move aimed at revolutionizing the health insurance field, the General Insurance Council, in collaboration with all major general and health insurance companies, has introduced the groundbreaking ‘Cashless Everywhere’ initiative. This initiative offers policyholders unprecedented flexibility and ease of access to medical services by providing a cashless facility, even in hospitals not previously affiliated with the insurance company’s network.

According to reports, in the cashless system, insurance companies will pay only up to the amount taken as a sum assured in the policy. For instance, if the sum assured is ₹5 lakh, insurers will pay the hospital up to ₹5 lakh during the year.

Benefits of Cashless Everywhere for Mediclaims

In today’s fast-paced and technologically driven world, the shift towards cashless transactions has become increasingly prevalent across various sectors. One notable area where this transition has proven particularly beneficial is in mediclaims and healthcare services. Embracing a cashless approach in mediclaims not only streamlines the entire process but also offers a multitude of advantages for both insurers and policyholders.

Expanding Treatment Options

Under the ‘Cashless Everywhere’ facility, policyholders now have the liberty to choose any hospital for their treatment, breaking away from the traditional constraint of being limited to network hospitals. This means that individuals can avail themselves of cashless services even in hospitals that do not have prior agreements with their insurance providers.

Eliminating Out-of-pocket Expenses

One of the key advantages of this initiative is the elimination of out-of-pocket expenses during hospitalization. Traditionally, policyholders were restricted to cashless services only at hospitals within the insurer’s network. With the new facility, individuals no longer need to worry about paying for treatment upfront, subject to the admissibility of the claim.

Intimation Protocols for Seamless Transactions

To ensure a smooth and seamless cashless transaction, the policyholders must inform their insurer 48 hours before elective procedures and within 48 hours post-admission in the case of emergency treatments. This proactive communication allows insurers to streamline the claims process efficiently.

Admissibility Criteria and Operating Guidelines

The ‘Cashless Everywhere’ facility is contingent upon the claim’s admissibility according to the policy terms and adherence to the insurer’s operating guidelines. This dual-check system ensures that the cashless service is provided in compliance with all regulations, fostering transparency and accountability.

Addressing Financial Stress for Policyholders

Currently, only 63% of customers opt for cashless claims, with others resorting to reimbursement claims due to hospitalization in non-network facilities. The Council recognizes the financial strain and complexity this brings to the claims process. The introduction of the ‘Cashless Everywhere’ initiative aims to alleviate this stress, making the entire claims journey more frictionless and efficient.

Enhancing Policyholder Experience and Trust

By providing a hassle-free cashless facility in any hospital of choice, the initiative seeks to enhance the overall experience for policyholders. This move is anticipated to build greater trust in the insurance system, encouraging more individuals to invest in health insurance for comprehensive coverage.

Combatting Fraud and Building Industry Trust

The ‘Cashless Everywhere’ initiative is also viewed as a strategic step toward reducing and eventually eliminating fraud in the insurance industry. Fraud has been a persistent issue eroding trust in the system. By expanding the cashless facility, the industry aims to create a win-win situation for all stakeholders, fostering a more secure and trustworthy environment.

Way Forward

The launch of ‘Cashless Everywhere for Mediclaims’ by the General Insurance Council marks a significant milestone in the evolution of health insurance services. This initiative not only aligns with the broader trends of digitization and convenience but also reinforces the industry’s dedication to prioritizing the well-being of policyholders. As more individuals experience the benefits of a streamlined and cashless mediclaim process, it is likely to set new standards for excellence and efficiency in the broader landscape of insurance services.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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