The Insurance Regulatory Development Authority of India (IRDAI), in collaboration with the General Insurance Council (GIC), is formulating a plan to establish a unified cashless hospital network nationwide. This initiative aims to simplify and streamline the health insurance claims settlement process.
Only about 49% of hospitals in India offer cashless settlement. Moreover, insurance companies frequently alter their lists of partnered hospitals. This is primarily due to rising medical expenses and attempts at fraudulent claims. To counter these challenges, the IRDAI, in partnership with the GIC, is focusing on the creation of a consolidated, nationwide cashless hospital network.
The first phase of this initiative will see the assembly of a comprehensive list of hospitals taken from the networks of various insurance providers. The subsequent phase involves establishing a collective agreement with these hospitals via the GIC. This agreement will cover all recognized health and general insurers. Upon full implementation, customers from any insurance company will have access to this single integrated network, thereby ensuring a smoother claims process and lessening complications.
This plan presents multiple benefits for insurance policyholders. They can expect consistent access to all cashless hospitals, uniform and competitive pricing for medical services, diminished fraud attempts, and enriched industry-wide data, leading to improved analytics. This unified approach might result in reduced overall claims expenses, potentially impacting and possibly reducing the premium rates for policyholders.
Alongside this network, the IRDAI is also looking to roll out a 100% cashless claim settlement system for health insurance. While many insurers currently process claims on a cashless basis at a rate of approximately 65% to 70%, the goal is to make this process entirely cashless. Such a move will likely decrease fraudulent activities and bolster the confidence of policyholders in their insurance plans.
The exact timeline for the execution of these enhancements is not yet finalized. However, according to the Economic Times, they are anticipated to be in place by January 1, 2024. This strategy marks a commendable effort toward increasing clarity, uniformity, and collaboration between insurance companies and healthcare providers. It promises a scenario where all policyholders can readily access quality healthcare services.
