Page 14 - Insurance Times February 2024

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to be made in the interim Union Bud-
Health insurance companies to offer 100% 'cashless'
get on February 1, the sources told PTI.
treatment in hospitals The Union health ministry is also plan-
The General Insurance Council (GIC) has announced the launch of a new ning to double the beneficiaries to 100
"Cashless Everywhere" initiative that aims to make treatment and payments crore under the Ayushman Bharat
more seamless for policyholders. Pradhan Mantri Jan Arogya Yojana (AB
Tapan Singhel, MD & CEO of Bajaj Allianz General Insurance and Chairman PM-JAY) to include Kisan Samman Nidhi
of the General Insurance Council, announced the initiative on Thursday, stat- recipients, construction workers, non-
ing that the initiative would make it easier to avail treatment from medical coal mine workers and ASHA workers
centres outside the network of the insurance company. in the next three years.
"In order to ensure that serious ill-
The 'Cashless Everywhere' system allows policyholders the freedom to seek
cashless treatment in any hospital, regardless of its network status. This ini- nesses requiring expenditure of more
than Rs 5 lakh such as transplants and
tiative aims to simplify claims processing, mitigate fraud, and bolster over- high-cost cancer treatments etc. are
all industry trust.
also covered under AB PMJAY, the min-
This means policyholders can be admitted to a hospital without paying any istry is working on finalising a proposal
money, and the insurance company will pay the bill upon discharge, easing to increase the cover amount from Rs
the financial burden for policyholders. 5 lakh per family per year to Rs 10 lakh
per family per year from 2023-24 on-
To access the 'Cashless Everywhere' system, policyholders must notify the
insurer at least 48 hours before admission. Emergency cases require notifi- wards," the sources said.
cation within 48 hours of admission, with admissibility contingent on policy The increase in coverage to Rs 10 lakh
terms and adherence to the insurer's operating guidelines. per family per year and increase in
beneficiary base to 100 crore individu-
Currently, the cashless facility is only available at hospitals where the insur- als will involve an additional allocation
ance companies have an agreement. Hospitals without such agreements
of Rs 12,076 crore per annum, the
will necessitate reimbursement claims, which could potentially elongate the
sources stated.
claims processing timeline.
The scheme has successfully catered to
6.2 crore hospital admissions amount-
Cover under Ayushman surance cover under its flagship ing to more than Rs 79,157 crore till
Ayushman Bharat health scheme to Rs
Bharat health insurance now since its launch in 2018.
10 lakh to ensure that serious diseases
scheme likely to be like cancer and transplants that entail If the beneficiary had availed the same
treatment on his own outside the
doubled more expenditure are supported by it, ambit of AB PM-JAY, the total cost of
official sources said on Wednesday.
The government is working on the treatment would have gone up
finalising a proposal to double the in- An announcement to this effect is likely nearly two times, the official said.

The Insurance Times February 2024 13