Risk Cover For Out-Patient Treatment On Cards

The New India Assurance Co is planning to introduce a new cover for out-patient treatment.

This will open a new chapter in the history of health insurance as the existing Mediclaim policy of the four state-owned general insurance outfits covers only the cost of hospitalisation.

To start with, New India Assurance is planning to offer the out-patient treatment cover to ex-defence personnel.

The proposal to insure 18 lakh ex-defence men and their dependents (the total number amounting to 75-80 lakh) will cost the defence ministry around Rs 1,000 crore annually in premium.

The scheme is being worked out by New India Assurance, and would offer the ex-servicemen total cashless treatment.

Presently, they are being paid Rs 100-150 monthly for out-patient department (OPD) treatment together with their pension.

The Insurance Regulatory and Development Authority (IRDA) has already given its approval for the launch of the scheme and the proposal is now lying with the defence ministry.

At the recent rally by ex-servicemen in New Delhi, the Prime Minister gave assurance that a scheme was in the pipeline to provide them health cover.

Ex-defence men have been demanding adequate healthcare services. However, the limitation at Army hospitals leads to inadequate coverage for the existing and ex-servicemen, especially since serving people are given top priority.

An individual presently bears an average yearly cost of Rs 1,500 in OPD treatment, which is not covered under any insurance scheme.

The scheme being worked out by New India Assurance, estimates a claim ratio of 75-80 per cent, which is well under the existing high claim ratio of 130 per cent for Mediclaim policies.

Industry sources revealed that the state insurer is looking at stringent checks and balances in terms of cost control.

It has identified 201 centres to be established across the country where ex-servicemen would be given OPD treatment.

These centres, which would be either set up or tied up by third-party administrators (TPAs), in turn, would be affliated to about 500 "preferred" hospitals, where the insurer would have the list of cost and charges.

This, explained industry sources, would ensure cost control for the entire gambit of the policy.

The alarming claims ratio prevailing in state insurance companies cannot allow for leakages in the proposed plan.

Therefore, the proposal would take into account the necessary software, reinsurance treaty, infrastructure facilities, TPA qualifications and capabilities, all to ensure cashless services and treatment.