Insurance
Mediclaim: Insurers asked to issue guidelines to TPAs on claims

Bombay HC had asked IRDA to have insurers issue guidelines to TPA on claims recommendation within four weeks. They should also see if the insurers can declare pre-packaged rates for 42 ailments in the same guidelines. Are TPAs still settling claims?

The Bombay High Court (HC) had asked Insurance Regulatory and Development Authority (IRDA) to make the insurers comply with its August 2013 circular asking insurance companies to issue guidelines to third party administrators (TPA) on claims recommendation within four weeks. Even though General Insurance Council (GIC), a statutory body representing all non-life insurers, has expressed inability to comply with the HC order of declared pre-packaged rates for 42 ailments, HC has asked IRDA to see if insurers can conform to it.
 

On the 28 November 2013 hearing, Bombay HC judge questioned IRDA about not including it in health insurance regulations to mandate transparency for 42 standard ailments pricing. IRDA replied that insurance companies cannot comply and hence, GIC has intervened to be made party to the public interest litigation (PIL). In short, IRDA put the ball in health insurer’s court instead of mandating transparency from insurance companies.
 

Read - Bombay HC notice to health insurers on pre-packaged rates
 

In the following hearings, GIC agreed that there should be uniformity in packages offered in insurance policies. GIC kept expressing inability to comply with the HC order citing lack of hospital regulator in India as one of the reasons. Mr Damani had argued that there was a provision in the Clinical Establishments (Registration and Regulation) Act to appoint a regulator to regulate the hospitals. Unfortunately, IRDA has not appointed such an authority.
 

Read:  Mediclaim: GIC to file affidavit to express inability to comply with HC order
 

Finally, in today’s (21 March 2014) hearing, GIC said that they will need IRDA to mandate pre-packaged rates in the health insurance guidelines. It means the ball is back in IRDA’s court. It is now up to IRDA to mandate pre-packaged declared rates rather than putting blame on insurer unwillingness. The buck certainly stops at IRDA.
 

According to Mr Damani, “If mediclaim policies indicated the amount an insured was eligible for specific ailments, it will ensure that they have clarity on which hospitals to go; the hospitals too would know how much they would get.” Packaged rate for standard procedures specified in the policy will force the insurance companies and TPAs to become more transparent about what they are willing to pay, avoiding nasty surprises for the policyholder later.
 

Today, the average claim payment for cashless is Rs25,000, but it is only Rs13,000 for reimbursement. It means there is a large chunk of claims that are only partially settled; it is not in consumer interest. There are cases of TPA still writing cheques, which is not in compliance with health insurance regulations effective from October 2013. Moreover, TPAs are not supposed to have any target for claims settlement. But, one TPA internal emails show that employees are given a target for daily claims payment. They cannot pay an amount more than the daily target.
 

According to Mr Damani, “The good old cashless mediclaim days are no longer available with government insurers, who realised it was more expensive than reimbursement claims. There is no financial incentive to restart cashless facility. Information on package rates for 42 standard procedures will help policyholders know what they are entitled to. Today, there is a lack of transparency and third party administrators (TPAs) have huge discretionary powers. Bills for same procedure undergone in the same hospital are settled with different amounts.”
 

Read –Mediclaim packaged rates for 42 ailments will marginalise TPAs' powers

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Citizens join signature campaign to stop persecution of Dr Ashok Khemka

Citizens from the tri-city of Chandigarh, Mohali and Panchkula launched a signature campaign asking Haryana government to stop prosecution of Dr Ashok Khemka

Citizens from Chandigarh, Mohali and Panchkula have launched a signature drive asking Haryana chief minister Bhupinder Singh Hooda to stop prosecution, drop charge sheet and an enquiry by CAG against IAS officer Dr Ashok Khemka.

 

Already over 17,500 people from India and abroad have signed an online petition at Change.org started by Sucheta Dalal, managing editor of Moneylife and founder-trustee of Moneylife Foundation.

 

Dr Khemka dared to question the land deals of Robert Vadra, Sonia Gandhi's son-in-law, with the powerful realty giant DLF, which magically transferred into humungous profits from Mr Vadra.


 

When that happened, the Haryana government did not stop at mere transfer. It wants to crush and victimize Dr Khemka. The Haryana chief minister served Dr Khemka a charge sheet for "having caused damage to the reputation of Robert Vadra and that of DLF," and also for "illegally" cancelling the land deal. It also started an investigation into Dr Khemka's role as the MD of Haryana Warehousing Corporation, designed to harass and intimidate him. In an unprecedented move, the state government has ordered an audit by State Auditor General targeted only at him.

 

Anish Aggarwal, a concerned citizen of Haryana, who is helping Change.org, reach out to the public, said, "Dr Ashok Khemka has remained dedicated to the task of serving the people of India in line with the ethics of the elite service that he joined. But that has not gone down well with our politicians.  He has been transferred 44 times in 22 years - and thrice in 2012 alone."

 

"He (Dr Khemka) is unique because his actions have never been targeted at any political party, but only against corruption. We need more people like him to rebuild India’s steel frame, which is our administrative service. Let us tell Haryana that we, the People will not stand silent while the state persecutes and crushes honest officials," Aggarwal said.

 

At Moneylife Foundation’s 4th anniversary celebration, Dr Khemka spoke about how people remain mute spectators even when they see someone being bashed in public.

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COMMENTS

shirish patwa

3 years ago

It is really very shameful that IAS Officer like Dr Ahok Khemka who is the uprightness personified,should be persecuted by petty politicians like Hooda and others.Rahul Gandhi should stop issuing sermons on probity in public life,if he has any sense of morality left in him.

Challa Hanumanth Rao

3 years ago

I appreciate the daring attempt of Suchetha Dalal to support Dr Kemka openly.I suggest if this govt act proved illegal then a case against DLF and Haryana Govt to be filed and Mr VADRA should be prosecuted and to be sent to Jail.

Pl let me know in what way I can support you from a distant place .

Challa Hanumanth Rao

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The Sensex and the Nifty advanced 3% and 4%, respectively,during the fortnight ended 12th March. ML Small-cap Index,ML Large-cap Index and ML Mid-cap Index advanced 3% each.ML Mega-cap Index and ML Micro-cap Index rose 2% each.

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