What is Core & Satellite strategy?

A small step for the health insurance industry, a major step for patient benefit. The “Cashless Everywhere” step announced by the General Insurance Council (GIC) on January 24 will allow policyholders to heave a sigh of relief since they would have the liberty of choosing any hospital for their treatment without having to pay out lumpsum amounts from their pockets and recover costs later. Additionally, the cashless facility would be extended to hospitals that are necessarily not part of the insurance company’s network.

Hospitals that have 15 beds, and registered with the respective state health authorities under the Clinical Establishment Act can offer cashless services now.

With treatment costs zooming, health insurance is increasingly becoming a must-have for citizens. But often policyholders are constrained by the fact that the hospital near their home or where their consultants are attached are not listed for cashless service for that particular insurer.

In such situations, in the event of hospitalisation, citizens covered under the insurance need not pay for treatment out of pocket at a hospital that offers cashless facility, provided the claim is admissible. However, the patient can utilise the cashless benefit only if the hospital in question has such an agreement with the insurer in question.

In case the policyholder if forced to get himself treated at a hospital that does not have an agreement with his insurance company, customer has to pay from his pocket and claim reimbursements. It not only puts him in upfront financial strain but also delays the claim.

The latest step will ease the burden of policyholders, who would not face such constraints.

Significantly, the “Cashless Everywhere” initiative is contingent upon fulfilling a few conditions by the patient party. They are:

For elective procedures (typically planned surgery), the customer should inform the Insurance Company at least 48 hours before the admission in the case of a non-empanelled hospital.
The claim should be admissible as per the terms of the policy. The cashless facility should be admissible as per the operating guidelines of the insurer.

Tapan Singhel, MD and CEO of Bajaj Allianz General Insurance and Chairman of the General Insurance Council, has said in a statement that GI Council always wanted to increase comfort of policyholders. “With this in mind, we are announcing “Cashless Everywhere” to make customers’ lives easier,” he told the media.

“Today if you see only about 63% of customers opt for cashless claims while the others have to apply for reimbursement claims as they might be admitted to hospitals that are outside their Insurer/TPA network. We feel this puts a significant amount of stress on their finances and makes the process long and cumbersome. We wanted to make the whole journey of claims a frictionless process, which will not just improve the policyholder’s experience but will build greater trust in the system. This, we feel, will encourage more customers to opt for health insurance,” said Singhel.

He also said that this measure would help reduce instances of fraud plaguing the industry.