The moment of truth often becomes an unpleasant shock for many policyholders when their health insurance company is unable to honour the cashless hospitalisaiton facility at a preferred hospital. However, this situation is now expected to improve significantly after IRDAI recent guidelines called ‘Standards and Benchmarks for the Hospitals in the Provider Network’.
“In order to enhance the scope for offering cashless facility across the length and breadth of the country, the insurers are now empowered to empanel the network providers that meet the standards and benchmarks criteria as specified by their respective boards. While specifying the criteria, the board of insurers shall, amongst others, consider especially the minimum manpower and healthcare infrastructure facilities,” states the IRDA circular issued on July 20, 2022.
Here is a look at what the new guidelines mean for health insurance policyholders.
How this will benefit policyholders
The insurance regulator has empowered the insurers to empanel network providers who meet the standards and benchmarks set by their respective boards. The circular also states that the board of insurers shall, among other things, consider the minimum manpower and healthcare infrastructure facilities 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 at your preferred network hospital. “This essentially means that during hospitalisation, you can receive cashless treatment – without paying anything to the hospital – at your preferred network hospital. This will help the insurers to enhance the scope of their network of cashless facilities and will
customers to take the best medical facilities near them,” says Sanjiv Bajaj, Jt. Chairman & MD, Bajaj Capital.
Expanding the scope of the most sought-after feature of the health insurance policy will increase its attractiveness. “The cashless feature allows an insured person to take advised treatment at any network hospital without worrying about paying bills by himself. The insurer will directly settle the medical bills as per their policy,” says Amit Chhabra, Health Insurance Business Head, Policybazaar.com.
Most policyholders buy a health insurance cover primarily for the wider cashless claim facility. “When it comes to hospitalisation, a cashless claim settlement process is the best option because of the convenience attached to it and you do not have to run to different places to make financial arrangements,” says Chhabra.
What was the earlier process?
Earlier the empanelment process for cashless service at hospital had many stages and it was cumbersome and time consuming. “Previously, hospitals seeking to be empaneled had to register with the Insurance Information Bureau’s Registry of Hospitals in the Network of Insurers (ROHINI). They were also required to obtain certain certifications like “NABH Entry Level (or higher) certification issued by National Accreditation Board for Hospitals & Healthcare Providers (NABH) or State Level Certificate under National Quality Assurance Standards (NOAS), issued by National Health Systems Resources Center (NHSRC),” says Bajaj.
However, the new guidelines is expected to increase health Insurance penetration, make health insurance accessible to masses and broaden the scope for providing cashless services across the country. “This will increase access to comprehensive, high-quality health care services as the insurance companies will be able to expand their network of hospitals where the insured can avail the facility of cashless treatment” says Chhabra.