Preferred Hospital Cashless Treatment Under Health Insurance Policy For Ease: Here’s Why

The moment of truth often comes as an unpleasant shock for many policyholders when their mutual is unable to honor cashless hospitalization at a hospital of their choice. However, this situation should now improve significantly after the recent IRDAI guidelines entitled “Standards and Benchmarks for the Hospitals in the Provider Network”.

“In order to broaden the reach of cashless service offerings across the country, insurers are now empowered to group together network providers who meet the standards and benchmarks specified by their respective councils. While specifying the criteria , the board of directors of insurers must, among other things, take into account in particular the minimum workforce and health infrastructure”, specifies the IRDA circular of July 20, 2022.

Here is an overview of what the new guidelines mean for health insurance policyholders.


How it will benefit policyholders

The insurance regulator has empowered insurers to form network providers that meet the standards and criteria established by their respective boards. The circular also indicates that the college of insurers must, among other things, take into account the minimum workforce and health infrastructure when defining the criteria.

With this, you can not only get quality healthcare with your health insurance policy, but you can also get cashless treatment in your preferred network hospital. “This basically means that while in hospital, you can receive cashless treatment – without paying anything to the hospital – at your preferred network hospital. This will help insurers expand the reach of their network of facilities without cash and

customers to take the best medical facilities near them,” says Sanjiv Bajaj, Jt. Chairman and Managing Director, Bajaj Capital.

Expanding the scope of the most sought-after feature of the health insurance contract will increase its attractiveness. “The cashless feature allows a policyholder to undergo advised treatment at any hospital in the network without worrying about paying their own bills. The insurer will pay medical bills directly according to their policy,” says Amit Chhabra, Health Insurance Manager at Policybazaar.com.

Most policyholders purchase health insurance coverage primarily for the broader cashless claim service. “When it comes to hospitalization, a cashless claims process is the best option because of the convenience attached to it and you don’t have to run to different places to make financial arrangements,” says Chhabra. .

What was the previous process?

Previously, the process of setting up a cashless service in the hospital had many steps and was tedious and time-consuming. “Previously, hospitals wishing to incorporate had to register with the Registry of Insurers’ Network Hospitals (ROHINI) of the Insurance Information Office. They also had to obtain certain certifications such as the “NABH Entry Level (or higher) certification issued by the National Accreditation Board for Hospitals & Healthcare Providers (NABH) or the State Level Certificate under National Quality Assurance Standards (NOAS), issued by National Health Systems Resources Center (NHSRC),” explains Bajaj.

However, the new guidelines are expected to increase health insurance penetration, make health insurance accessible to the masses, and expand the reach of cashless service provision across the country. “This will increase access to comprehensive and high-quality healthcare services as insurance companies will be able to expand their network of hospitals where policyholders can benefit from the cashless treatment facility,” Chhabra said.