DNA: In the coming time, you will now get cashless medical services in every hospital. Soon the entire system of Re-Imbursement Claim is going to end. IRDAI and General Insurance Council held several rounds of meetings on this issue.
DNA Analysis: At present, insurance is necessary for every person. Be it life insurance or health insurance. Since the Corona epidemic, people have become aware of health insurance. New diseases and the cost of their treatment leave even well-to-do families in trouble. That is why now the Central Government and many state governments also provide health insurance to the public at different levels.
24 life insurance companies and 34 general insurance companies
Insurance secures the future of the people of the country, that is why there are 24 life insurance companies and 34 general insurance companies running in India which are providing different types of services. Those who have taken life insurance know that their family gets the claim i.e. the insurance amount from the company with which their insurance policy is running.
You must also know about life insurance that after the death of a person who has life insurance, his family gets a claim, but this is not the case with health insurance, the person or family who has health insurance. If he falls ill, the cost of treatment is borne by the health insurance company.
In case of health insurance, companies bear the cost of treatment in two ways. First- CASHLESS and second Re-Imbursement Claim.
Who will bear the hospital expenses?
CASHLESS Plan means that when the person taking health insurance falls ill and is admitted to the hospital, then through the card received from the insurance company, he bears the hospital expenses. He does not have to pay anything from his own pocket. This does not happen in the case of Re-imbursement Claim.
In this, the person bears the entire hospital expenses from his own pocket. After that the hospital gives the original bill to the insurance company. After which the insurance company returns the spent money to the person taking the insurance.
The company pays the treatment expenses
Till now, insurance companies have been paying the treatment expenses of their customers through these two methods only. You must have noticed that a cashless plan is easier than a plan with re-imbursement claim. In this, the person taking health insurance does not have to worry. He doesn’t have to manage money.
Treatment starts as soon as the card is given
Suppose you fall ill. As soon as you fell ill, you went to the hospital. As soon as you reach there, you tell the hospital that you have health insurance. You took out the health insurance card and gave it to the hospital. Your treatment started as soon as you gave this card. This is called a cashless plan, till now the facility of cashless settlement is available only if your health insurance company is in the panel of that hospital.
fell ill and went to the hospital
The second situation is that you fall ill and go to the hospital. There you told that you have health insurance, but you do not have a cashless plan, because the hospital you went to is not in the panel of your health insurance company. In such a situation, you will have to pay the cost of your treatment from your own pocket. After that you will get the bill for the treatment expenses from the hospital. Then after this you will give the bill to the insurance company. The insurance company will audit this bill, then after this, it will refund you the out-of-pocket expenses.
Now know this also
Many of you must have faced a different situation. In which you would have first borne the cost of treatment from your own pocket, then taken back the reimbursement claim for this expense from the insurance company. In this entire process, the sick person and his family have to face a lot of trouble. Surely you too would not want to get into this trouble.
Health insurance companies in the country are currently providing services in more than 75 thousand hospitals. You will be surprised to know that not every company provides services in every hospital. Even the largest insurance company is registered in only 13 thousand hospitals. That means, in every situation, one has to get stuck in this situation sometimes.
This system is about to end
In the coming time, you will now get cashless medical services in every hospital. Soon the entire system of Re-Imbursement Claim is going to end. The name of the government organization that keeps an eye on any type of insurance in the country is IRDAI i.e. Insurance Regulatory and Development Authority of India.
The decision was taken after several rounds of meetings
IRDAI and General Insurance Council held several rounds of meetings on this issue. After the meetings, it has now been decided that a scheme named Unified Hospital Network will be started in India from the beginning of next year. Under this, if a person has health insurance of any company, then that person can get treatment through cashless plan in any hospital certified by NABH.
That means, no matter which company’s health insurance you have, you can avail the benefit of cashless treatment in any empaneled or non-empaneled hospital. In the next few days, IRDAI and GIC are also going to issue an official notification related to this.
When asked for expenses, many questions and answers were given to him.
Only Renu Sankla, who lives in Delhi, can give the best answer to why cashless claim is necessary for a sick person or his family. Renu Sankla’s husband’s finger was cut off in an accident. The hospital she went to was not on the panel of her husband’s health insurance company. Renu Sankla somehow managed to arrange money and got her injured husband admitted to the hospital.
After this, when he asked for the treatment expenses from the insurance company, many questions were asked and emails were sent to him. After being mentally tortured for several weeks, somehow he was able to get only 80 percent of the treatment expenses. If Renu’s husband’s treatment had been under the CASHLESS PLAN, then perhaps Renu would have got the full claim and would not have had to face mental problems. The changes that IRDA and GIC are going to initiate regarding health insurance will benefit crores of people like Renu.
CASHLESS CLAIM FACILITY
In the changed system, even if your health insurance company is not in the panel of the hospital, you will still get the facility of CASHLESS CLAIM and you will get it at the rate of the health insurance company which is already in the panel of the hospital, no matter which company it is. yes. This entire system will work in two ways.
What is the first method?
If you are admitted in an emergency case, your family will have to inform the health insurance company about the treatment. Final bill payment for treatment will be cashless. The hospital may ask you to deposit some money in the name of registration fee.
What is the other way?
This is that if it is not an emergency case and you have reached the hospital to get treatment for any disease, then you will have to give information related to the hospital to the HEALTH INSURANCE company 48 hours before admission. After the information related to your admission in the hospital is verified, your health insurance company will negotiate with the empaneled health insurance company of the hospital and provide you cashless facility. Customers can give information to their insurance company through email or website login.
Same expense claim rates
In the next phase of this change, work is also going on on Unified charges. Under this, the claim rates for hospitals that are not included in the panel of plans of all insurance companies will be the same. Not only this, if you have gone to a hospital which is on the panel of your health insurance company, and the treatment there is expensive, then you can also go to a hospital where the treatment is cheaper, even if it is not on the panel of your health insurance company. yes. With this you can save money on HEALTH INSURANCE CLAIM.
Cashless system as soon as possible
Insurance companies also want to bring the cashless system to their customers as soon as possible. Because this will not only benefit the people, but it will also benefit the insurance companies. Through Reimbursement Claim Plan, many people also used to commit fraud with insurance companies, due to which the companies used to conduct strict audit on the bills of genuine customers.
Due to which the common people were facing problems, this problem will also end with the arrival of the new system. Sharad Bajaj, COO of INSURANCE DEKHO, said that if a scheme like Unified Hospital Network really comes to the ground, then it will prove to be a boon for the people taking health insurance. This will prove to be an important milestone for India’s campaign of HEALTH FOR ALL, INSURANCE FOR ALL.
Claim that focuses on treatment
Cashless Claim is a facility for people taking health insurance, which asks people to focus on treatment and not on expenses. However, now we want to give some information related to the insurance sector, which needs attention.
1. Like in the year 2022, more than 52 crore people in the country had health insurance.
2. The health insurance market in India was worth more than Rs 1 lakh crore.
3. There is an estimate that by the year 2030, the health insurance market will grow at the rate of 11.55 percent, that is, by the year 2030 it will be worth more than Rs 2.5 lakh crore.
