1292789 SIP myths you must know!

For those getting health insurance, there was  a  some good news a few days ago. The General Insurance Council, or GIC, has made the treatment process easier.  GIC has started the ‘Cashless Everywhere’ campaign. This will benefit all the customers who wish to get treated outside the insurer’s panel of hospitals. Now, your treatment in any hospital will also be cashless, meaning you won’t have to pay from your pocket. Let’s find out the benefits of the Cashless Everywhere scheme.

Before the advent of ‘Cashless Everywhere,’ policyholders could only avail cashless treatment in hospitals that were part of the insurance company’s panel. If a policyholder sought treatment in a hospital outside the insurance company’s hospital network, then, cashless facility was not available. In such cases, all hospital expenses had to be borne out of pocket, and later, a reimbursement claim had to be filed. This took a considerable amount of time, with the fear of the claim being rejected or not fully reimbursed.

According to the General Insurance Council, currently, only 63% of customers opt for cashless claims, while the remaining 37% prefer reimbursement claims. This is because they get admitted to hospitals that are not part of the insurance company’s network, they are required  to initially pay for the treatment out of their own pockets, adding to the financial burden. To address this, ‘Cashless Everywhere’ scheme has been introduced.

Now, policyholders can get treatment in their preferred hospitals, whether or not these are in the insurance company’s network. This means that policyholders can be admitted to any hospital without  upfront payment.

The insurance company will handle the bill payment upon discharge, as long as the hospital adheres to the guidelines specified in the policy and meets the insurer’s criteria, you will face no problem. For example, hospitals with 15 beds or more and registered under the Clinical Establishment Act can offer cashless facility.

Both policyholders and insurance companies will benefit from ‘Cashless Everywhere’. Policyholders will no longer need to submit discharge summaries, medical bills, and all documents for reimbursement, the hassle of paperwork will reduce. For insurance companies, it prevents fraudulent reimbursement claims.

The cashless treatment facility in all hospitals comes with certain conditions. First,  in treatments or surgery cases, policyholders need to inform the insurance company at least 48 hours before admission. Second, in emergency treatments, the company should be notified within 48 hours of admission.

Before seeking treatment at non-network hospitals, carefully read your policy. The options, and terms  will apply under Cashless Everywhere feature as well. There are some exclusions as well.

Some diseases have a waiting period of 2 or 3 years, and coverage begins only after this period. Additionally, there are sub-limits and co-payments clause for certain medical expenses, details of which can be found in the policy.

Suppose, during policy  purchase, you have chosen the 80:20 option under co-payment. This means that the insurance company will cover 80% of the claim amount, and you will pay the remaining 20%. Whether you go to the insurance company’s network hospital or a non-network hospital, under the Cashless Everywhere option, you will still have to pay 20% of the bill.

Cashless Everywhere can be beneficial for you, but it is necessary that you have health insurance. You should get the list of hospitals from the insurance company which are not empanelled. Because in these hospitals, you won’t get the facility of cashless treatment or reimbursement. Even if you get it in some cases, only a part of it is covered by the insurance company. If any insurance company refuses to provide the Cashless Everywhere facility or denies a claim, you can first talk to the company’s senior officials. If the issue is not resolved, you can file a complaint on the Insurance Ombudsman’s website. The address is www.cioins.co.in. You can also file complaint in the consumer court.