Insurance cos to grade hospitals for mediclaim facilities

Health insurance companies and the healthcare industry today agreed to categorise hospitals and expand the list of centres providing cashless facilities under mediclaim policies.

The decision to grade the hospitals into three categories was taken at a CII-initiated meeting between the representatives of large private hospitals and four state- owned insurance companies to resolve their differences over the cashless treatment facility.

Under the new agreement, the hospitals will be graded into three categories -- A, B and C -- according to their infrastructure facilities, specialities, etc, Fortis Hospitals CEO Vishal Bali told reporters after the meeting.

As regards the fate of patients who were entitled to get cashless treatment at large hospitals, Bali said, "For now, the cashless facility is not operational at the hospitals which were de-listed, but the reimbursements are on, which will benefit the patients."

The public sector insurance companies had from July 1 taken off about 150 hospitals from the list of Preferred Provider Network (PPN) that provide cashless hospitalisation services to policy-holders under the mediclaim scheme, which had resulted in the imbroglio.

Bali, however, did not give a timeframe for start of the cashless treatment facility at large hospitals, saying there were many issues which will have to be discussed for that to happen.

The insurance companies, on their part, have agreed to expand the Preferred Provider Network (PPN) list from 300 hospitals spread across four cities of the country at present, New India Assurance General Manager S Gopalakrishnan said.

"The gradation will be of help to us, as it can help us cut our losses from health insurance," he told PTI.

When asked if the gradation of hospitals changes the premiums for the policyholders, Gopalakrishnan said, "They do not change in the immediate term. The policy-holder will be paid as per the sum insured, the categorisation is for our purpose so that we function smoothly."

The representatives of industry chamber CII, the insurance companies and healthcare industry have also set a 90-day period to resolve all contentious issues.

"We will be working closely for a robust mechanism so that there are no issues in the future," Bali said.

In the next two or three days' time, TPAs (third party administrators) will start visiting hospitals in their efforts to expand the list of PPNs, the Chairman of the CII Healthcare sub-committee on Health Insurance, Annaswamy Vaideesh, said.

On the issue of service tax on cashless transaction, Gopalakrishnan said the companies will pay the 10.3 per cent service tax up to the maximum sum assured.

A new 10.3 per cent service tax was introduced on all cashless mediclaim transactions from July 1, to be paid by TPAs to hospitals later.