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Frequently asked questions (FAQs) on Cashless Everywhere facility in health insurance

Posted on 31 Jan 2024
Author: Sayan Sircar

Tags: Health Insurance ; FAQ

4 mins read
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🤖 Parts of this article are AI-generated and then 100% fact-checked by a human.

This article gives you a list of common questions and their answers on the concept of “Cashless Everywhere” introduced for health insurance.

Frequently asked questions (FAQs) on Cashless Everywhere facility in health insurance

📚 Topics covered:

What is the Cashless Everywhere initiative introduced by the General Insurance Council?
How does the Cashless Everywhere facility work for policyholders at non-empanelled hospitals?
What about policy terms and exclusions?
What is the significance of this initiative in comparison to the previous system of cashless treatment only at network hospitals?
Who is eligible to avail of the Cashless Everywhere facility?
What are the guidelines for availing the Cashless Everywhere facility at non-empanelled hospitals?
What criteria determine the admissibility of a claim under the Cashless Everywhere initiative?
How does the initiative aim to reduce financial stress on policyholders during hospitalization?
What role does technology play in supporting the 100% cashless system under the Cashless Everywhere initiative?
Are there waiting periods associated with the Cashless Everywhere initiative?
How does the initiative contribute to reducing fraudulent claims in the health insurance industry?
Where is the actual press release on this topic?
What about cashless facility at excluded hospitals?
What about emergency treatment at an excluded hospital?

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What is the Cashless Everywhere initiative introduced by the General Insurance Council?

The initiative allows health insurance policyholders to access cashless treatment at any hospital, irrespective of whether it is part of the insurer’s network.

How does the Cashless Everywhere facility work for policyholders at non-empanelled hospitals?

Policyholders can choose any hospital for treatment, and the insurance company will directly settle the medical expenses with the hospital, offering a seamless cashless experience.

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What about policy terms and exclusions?

The policyholder is still bound by the general terms and conditions of their health insurance policy including exclusions, room rent limits and deductibles.

What is the significance of this initiative in comparison to the previous system of cashless treatment only at network hospitals?

The initiative eliminates out-of-pocket expenses and cumbersome claim reimbursement processes for policyholders treated at non-network hospitals.

Who is eligible to avail of the Cashless Everywhere facility?

All health insurance policyholders are eligible, provided they adhere to the specified guidelines.

What are the guidelines for availing the Cashless Everywhere facility at non-empanelled hospitals?

For elective procedures, policyholders need to inform the insurance company at least 48 hours before admission. In case of emergency treatment, notification should be within 48 hours of admission.

What criteria determine the admissibility of a claim under the Cashless Everywhere initiative?

The claim should be admissible as per the terms of the policy, and the cashless facility should comply with the insurer’s operating guidelines.

How does the initiative aim to reduce financial stress on policyholders during hospitalization?

By providing access to cashless treatment at any hospital, the initiative eliminates financial burdens associated with reimbursement hassles.

What role does technology play in supporting the 100% cashless system under the Cashless Everywhere initiative?

The cashless system is backed by a technological platform with the aid of the National Health Authority, ensuring a seamless and efficient process.

Are there waiting periods associated with the Cashless Everywhere initiative?

The waiting periods and coverage details are outlined in the policy documents. Policyholders are advised to carefully review these documents.

How does the initiative contribute to reducing fraudulent claims in the health insurance industry?

The seamless process of cashless treatment helps in reducing fraudulent claims, as compared to the reimbursement process.

Where is the actual press release on this topic?

The press release is available on GIC site here: https://www.gicouncil.in/news-media/events/press-release-launch-of-cashless-everywhere/

What about cashless facility at excluded hospitals?

Every health insurance company has a list of hospitals on their website where they do not allow claims. Policy holders looking for cashless treatment should be careful that they do not end up in such a hospital.

What about emergency treatment at an excluded hospital?

There is a good amount of chance that such a claim might be denied. Policyholders should clarify from their respective insurance companies.

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