The ‘Cashless Everywhere’ feature in health insurance is a recent initiative designed to revolutionize how individuals access medical care. Spearheaded by the General Insurance Council (GIC), this system allows policyholders to avail of cashless treatment at any hospital across India, even if the hospital is not part of their insurance provider's network. This eliminates the need for upfront payments and cumbersome reimbursement processes, ensuring that insured individuals can focus on their recovery without financial stress.

How It Works

Under the ‘Cashless Everywhere’ system, the insurance company directly settles the bills with the hospital. To avail of this facility, the insured needs to have an active health insurance policy with a company that is part of the ‘Cashless Everywhere’ program.

Here’s a breakdown of how it functions:

1. Pre-authorization Request: For planned treatments, the policyholder must inform the insurer at least 48 hours before hospitalization. In the event of an emergency, the insurer must be notified within 48 hours of admission. This notification is crucial for the insurer to initiate the verification process.
2. Verification Process: The insurer evaluates the claim, verifying policy details, coverage, and the estimated hospital expenses. Key documents such as the policyholder’s ID, health card, medical records, and doctor’s advice are required for this step.
3. Approval from Insurer: Once the claim is verified and approved, the insurer provides an authorization, ensuring direct payment to the hospital.
4. Hospital Treatment: The policyholder receives medical care without the need to pay out of pocket.
5. Claim Settlement: The hospital submits the bills to the insurer, who then settles them directly.

Eligibility

To be eligible for the ‘Cashless Everywhere’ facility, policyholders need to meet certain criteria:

• Active Health Insurance Policy: The insured must have an active health insurance plan with the ‘Cashless Everywhere’ feature.
• Pre-authorization Approval: The insured must notify the insurer and obtain pre-authorization before treatment.
• Covered Medical Expenses: Only treatments and hospitalizations covered under the policy are eligible.
• Valid Identification: The insured must provide necessary documents like policy details, ID proof, and medical records for verification.
• Hospital Compliance: The hospital must comply with the insurer's guidelines, including honoring cashless approvals. The hospital should have a minimum of 15 beds and be officially registered under the Clinical Establishment Act with the respective state health authorities.

Benefits

The ‘Cashless Everywhere’ feature offers several advantages:

• Access to Any Hospital: Policyholders can receive treatment at any hospital across India, whether it is part of the insurer's network or not.
• No Upfront Payment: It eliminates the need to arrange funds before hospitalization, reducing the financial burden on patients and their families.
• Quick Claim Approval: Reduces waiting time as the insurer directly approves and settles the claim.
• Reduced Financial Burden: Prevents sudden out-of-pocket expenses, especially during emergencies.
• Convenient Medical Care: Ensures seamless treatment without worrying about hospital tie-ups or complicated paperwork.
• No Geographical Restriction: Cashless treatments are available whether in the city they work in, their hometown, or while visiting any other part of India.

Premium Rates

Premiums for health insurance policies offering the ‘Cashless Everywhere’ feature can vary based on several factors, including the insured's age, the sum insured, and the specific coverage offered by the plan.

Effective from September 22, 2025, the Goods and Services Tax (GST) on health insurance premiums has been reduced to 0%. This change makes health insurance more affordable, reducing the premium amount by the 18% that was previously applicable as GST. For instance, a policy that previously cost ₹29,500 with GST will now be priced at ₹25,000.