Chief Minister

Mediclaim cashless facility in turbo

eHEALTH BureauThe insurance supported mediclaim policy that entitles the user to avail cashless facilities, will no longer be available at high-end hospitals like Apollo, Fortis, Ganga Ram, Max or Medicity in Delhi, the national capital region (NCR) and the metros of Mumbai, Bangalore and Chennai.All insurance companies providing mediclaim facilities, a cashless health insurance, have stopped direct payment of treatment charges to 150 high-end hospitals in Delhi and NCR alone from July 1. If has to go to any of these hospitals, he will have to pay from own pocket despite having a valid mediclaim policy with all premiums paid. The user will then have to reclaim the amount from the insurer with no guarantee that the entire amount would be reimbursed, reports media.Meanwhile, Chief Minister Sheila Dikshit on this has promised to look into the issue seriously. Smt Dikshit said that her government needed a week’s time to try to find a solution. “We will do something. Give us some time. We will hold talks within a week and try to find a solution to the problem,” the Chief Minister said. At least 18 insurance companies, including the four public sector entities, have taken off more than 150 hospitals in Delhi and NCR from their designated list for the cashless facility. This facility will now be available at only 100 hospitals, none of them from the big chains. There’s been a similar axing of hospitals from the list in other cities.According to them they are making an estimated loss of INR  1,500 crore annually on a yearly premium collection of INR  6,000 crore on mediclaim policies across the country, according to Pawan Bhalla, the CEO of Raksha TPA, the third party administrator (TPA) which is a facilitator between the insured and the insurer.The insurers have identified the four metros of Delhi, Mumbai, Bangalore and Chennai to start with the new package deals. The scheme would then be rolled out across the country. These four metros account for almost 50% of the INR  6,000 crore annual mediclaim premium collected by the 18 insurers. Overall, the premium collection on health insurance is estimated to be upwards of INR  9,000 crore.


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