Despite news every now and then that the cashless facility will be started by PSU insurers at corporate hospitals in the four metros, there is hardly any progress in the matter
The three-month-old imbroglio between public sector insurers and hospitals over the cashless facility remains unresolved. Corporate hospitals are still unable to come to an agreement with public insurers over the standardised rate for different procedures.
Segar Sampathkumar, deputy general manager, New India Assurance, says, "We want to negotiate with corporate hospitals on a one-on-one basis because each hospital is different and hence will have different standardised rates. However, the committee of hospitals is keen to negotiate with the insurers, rather than have individual hospitals talk separately."
Sampathkumar said that the company had a meeting with the committee on 8th September and conveyed its position. "They have not got back to us, but we hope to meet again early October and make progress. The cashless imbroglio does not affect our business. We are a 90-year-old company with good credibility. We are trying to correct the system in the interest of policyholder. If there is high charge from hospitals, it will reduce the sum assured for policyholder and may not cover another illness in the same year," he said.
A recent survey found that despite the removal of the cashless feature, corporate hospitals in Mumbai were overcrowded and that there were no beds available for a new patient. The country is suffering from a lack of quality hospitals.
For now, both sides appear to be dillydallying since there has been no major business impact. The Insurance Regulatory Development Authority (IRDA), the regulator also does not seem to be eager to get involved in the issue.
According to industry sources, private insurance companies may join public insurance companies to negotiate rates with corporate hospitals. Private insurance companies have barely been able to keep their neck out of the water till now. They will be watching with interest the outcome of this conflict, to see how it might benefit them. Most private insurers are far from breakeven themselves. Addressing an event in Mumbai recently, Bajaj Allianz's chief executive Hemant Kaul said that the industry is not making money on mediclaim.
According to M Ramadoss, chairman and managing director, New India Assurance Co Ltd, "Insurance companies have been witnessing inflated, fraudulent, and unwarranted claims by some hospitals, when the patient had declared that he/she had insurance cover and chosed to go for cashless treatment. This is why insurer-funded healthcare cost turns out to be more than the individual-funded cost. We are trying to get as many hospitals on the Preferred Provider Network (PPN). The rates could vary from hospital to hospital, based on the location, facilities, equipment, etc. It is not as if one-size-fits-all. If there is an industry standard for standard rates, we will welcome it. Due to the absence of it, I have to step in, but not to rob hospitals of their profits. We are trying to benchmark average costs of the previous two-three years and using recommendations of doctors on panels to come up with frozen standard rates for procedures and treatments."
In August, the Delhi High Court had asked insurance regulator IRDA to make some arrangement to provide cashless facilities to policyholders in the wake of the dispute between insurance companies and city hospitals, because of which medical policyholders were inconvenienced. "The Insurance Regulatory and Development Authority (IRDA) should, as a regulator of the insurance industry, intervene and ensure that such changes do not affect existing policyholders...," Justice S Muralidhar said.
"You (IRDA) cannot leave patients suffering, saying that a meeting will be convened. Patients are not getting treatment because of the dispute between insurance companies and hospitals. It is your duty to act timely." The court also took strong exception to the remark by the IRDA chairperson, published in a newspaper, that it was a matter between insurance companies and hospitals and that there was no regulatory issue involved. IRDA has till date managed to evade its responsibility in the matter.
A proposal approved by the cabinet will constitute a statutory authority to be called the National Identification Authority of India. It’s the new name for UIDAI.
The Union Cabinet on Friday approved a proposal to introduce the National Identification Authority of India (NIAI) Bill 2010 in Parliament.
The bill proposes to constitute a statutory authority to be called the National Identification Authority of India and lay down the powers and functions of the Authority, the framework for issuing unique identification (UID) numbers (Aadhaar numbers), major penalties and other related matters through an Act of Parliament. The proposal by the government is not new, apart from a new name for the controversial Unique Identification Authority of India (UIDAI).
"After the bill is passed in Parliament, the name UIDAI would be changed to NIAI. The rest of the functioning and job of the authority would remain the same," said Awadhesh Kumar Pandey, assistant director general for media, UIDAI.
According to a statement released by the government, the setting up will involve an expenditure of Rs3023.01 crore, which includes project components for issue of UID numbers (called Aadhaar numbers) by March 2011, and recurring establishment costs for the entire project phase, over five years ending March 2014.
The statement tries to provide more information about Aadhaar, but creates more confusion. It says, "The UID project is primarily aimed at ensuing inclusive growth, by providing a form of identity to those who do not have any identity." Does this mean that those who have an identity will not get the Aadhaar numbers? In addition, what about the inclusive growth of other people who already have some kind of identification? There are hardly any answers to these questions.
The statement also talks about strengthening of equity among marginalised sections of society. It is not clear how the Aadhaar numbers would be able to do this. The government claims that apart from providing an identity, the Aadhaar numbers would enable better delivery of services and effective governance. Would this imply that someone from Tembhali village in north Maharashtra's Nandurbar district will automatically receive food under the public distribution system (PDS), when the middlemen have looted the food before it can even reach the shop?
What's more serious is that the government does not say anywhere that the Aadhaar numbers will be issued to the citizens of India. Instead, it mentions that the Aadhaar numbers will be issued to "individuals residing in India and to certain other classes of individuals". This means that immigrants from neighbouring countries, residing illegally in India, would be able to procure such numbers too, akin to the ration card (PDS Card), and become citizens of the country.
Prime Minister Manmohan Singh will inaugurate the ambitious UID project at Tembhali village in north Maharashtra's Nandurbar district this month-end. According to a report from the Press Trust of India, the 12-digit Aadhaar number will be mandatory for all government schemes and will serve as a unique identification number for citizens.
To get the number, citizens are required to produce any of 29 listed documents as proof of domicile. If no document is produced, the district collector in rural areas and municipal commissioners in the urban areas will be authorised to issue an identity certificate to the individual.
The scheme involves cross selling health, wellness, beauty and financial products under the garb of preventive healthcare
Jiyo Fit is a new product launched by Bajaj Allianz General Insurance, Yes Bank and Visa. Under this, the policyholder can spend on partner gyms like VLCC, Talwalkars and Gold Gym to earn points; reward points on purchase of healthy foods, including fruits, vegetables at high-street retailers; more points on regular medical check-ups and discounts on diagnostic tests at partner clinics; as well as discounts at partner chemists. There is also an option to purchase Visa debit card from Yes Bank at Rs150 per annum and open a zero balance savings account with Yes Bank.
Bajaj Allianz, which has made its name for quality service, will start the Jiyo Fit wellness initiative in 15 towns in India in the first phase.
The big idea is preventive healthcare, says Hemant Kaul, CEO, Bajaj Allianz. The plan is to help reduce the claims ratio through helping policyholders adopt a healthy lifestyle and incentivise them to maintain healthy practices and stay fit. A high claims ratio is killing the health insurance business. Almost all insurers are losing in trying to provide health cover. But the reasons for the high claims ratio lie elsewhere-fraudulent claims, exorbitant hospital costs, medicine costs, lack of proper loading of group insurance. This is bleeding insurers and in turn affecting individual policyholder benefits and premiums.
But what if a policyholder visits a local gym and buys fresh fruits and vegetables from the local subzi mandi with cash, or uses a regular debit card for purchases of health products at high-street retailers? That may keep you healthy and may do as much for preventive healthcare, but it will not earn you points under the Jiyo Fit plan. One will have to go to the marquee gyms and health food retailers under the plan. In that case isn't this a cross-marketing of health, wellness and financial products? A Bajaj Allianz source told Moneylife that the company would not earn commissions from any of the partners. The sole benefit for Bajaj Allianz is a reduction of the claims ratio that would improve profitability.
The sources said that a company survey indicated that women were keen on redeeming points/discounts at beauty clinics and spas. Bajaj Allianz has extended the 'innovative' initiative to accede to the wishes of women policyholder. But the link between beauty clinics and spas and preventive healthcare looks rather stretched.
Indeed, a key component of the 'innovative' preventive healthcare initiative could be the zero-balance savings account from Yes Bank and debit card from Visa. As Uttam Nayak, country manager-South Asia, Visa, puts it, "We have been after Yes Bank for a tie-up for long time and now we are working with them, thanks to the innovative approach from Bajaj Allianz." What has Visa and Yes Bank got to do with Jiyo Fit? Well, some 97% of the personal consumption expense (PCE) is in cash. "The target is to have PCE with 16% electronic usage…soiled cash notes can be unhealthy for individuals," said Nayak.
Do others have similar offerings? New India Assurance gives a discount on the premium if a policyholder shows he has a gym membership. It's a more direct approach, but it does not crosscheck if a policyholder visits the gym regularly. Apollo Munich has a wellness approach with Healthline. Just ring them and quote a customer ID to reach experts and avail their help in primary consultation, health-related counselling, individual referrals, health information, nutrition and diet. The services on the Healthline are available at no extra cost to customers.
Under the Bajaj Allianz initiative, policyholders will earn points for every visit to the gym. It is an optional offer and is not bundled. We are sure more insurance companies will join the bandwagon in the days ahead to propagate the wellness initiative. Of course, its success will depend on simplicity, the quality of health education and the relevance of the services offered.