Don’t fret if you meet in an accident as your public sector insurance company will still give you the desired cashless facility
People who had bought insurance cover from public sector health insurance companies can now use the cashless method for settling their claims. These policyholders will get cashless treatment in case of accidents or emergency in all hospitals, including those de-listed by the public sector insurance companies, according to an official.
“People who had an accident and those who are in need of any emergency hospitalisation would be allowed to take the cashless route for settlement of claims. We will also not restrict them (the insured) to the new preferred provider network (PPN) list of hospitals” an official from New India Assurance Company said.
The news that cashless insurance claims coming from accidents and emergency treatment would be accepted should provide a certain amount of relief to customers. Emergency hospitalisation here means any urgent need of medical treatment, which would lead to the patient going to the Intensive Care Unit (ICU).
According to an official from Meditek, a third party administrator (TPA) company, out of the total cashless claims from public sector insurance firms last year, only 10% came from accidents or ICU treatment while the remaining 90% came from planned admission. This may be another reason as to why the insurance company would prefer letting accident or emergency treatment be given cashless settlement as compared to planned admissions.
Earlier, public health insurance companies, which include Oriental Insurance Co, National Insurance Co, United India Insurance and New India Assurance Co, had decided to de-list some hospitals from their PPN claiming that these de-listed hospitals were making false claims and over-charging their customers. The public health insurance firms have nearly 80% of the total market share in this segment. These companies together collect premiums worth Rs900 crore but had to shell out Rs1,200 crore every year, making a loss of Rs300 crore annually.
Public health insurance companies have drastically cut down the list of hospitals in Mumbai, Delhi, Chennai and Bangalore. In Mumbai, top hospitals like Cumbala Hill Hospital, Breach Candy, Bhatia Hospital, Lilavati, Hinduja and Jupiter, have been taken off the list. In Delhi hospitals like Apollo, Fortis, Ganga Ram, Max or Medicity have also been scrapped for cashless settlement.
The decision of the four insurers to de-list some hospitals and not to allow cashless settlement created panic among a lot of customers. Currently, TPAs have contracts with hospitals and are added as PPN on the insurance companies’ list.
However, public insurers have some issues with TPAs and are not happy with the manner in which claims are being processed and settled by them. This has resulted in the four insurers planning to start their own singular in-house process to handle cash settlements, according to the official from New India Assurance.
“We think there are multiple TPAs across various companies, which make the span of control wide for us. This also makes our task to focus and control difficult and we think we can do better than them,” he added.
According to the official, TPAs did not meet their expectations and were not able to bring down the treatment costs through negotiations with the hospitals. With their claims ratio around 115%, the four public sector insurers are exploring ways to minimise their claims outgo.
In the past, Moneylife had reported (http://www.moneylife.in/article/8/5146.html) how TPAs tried to push discount offers based on the number of patients admitted to a hospital and a policy of ‘best-preferred’ hospitals. Both these TPA schemes have been rejected by medical professionals and organisations. According to the discount offer policy being pushed by TPAs, hospitals would get a 10% concession if they were to provide Rs10 lakh of business; the best-preferred hospitals scheme will see TPAs choosing 50 hospitals for working with them. However, doctors complained that TPAs delayed payments and their processing information were not feasible.
An indispensible guide to help Indian companies venture abroad
Cash rich Indian companies are looking to spread their wings abroad in search of viable opportunities for acquisitions. Several Indian companies have already made their mark in global markets and others are keen to follow suit. Although enormous opportunities and potential for global expansion exist, it brings in its wake some rather piquant issues which need careful deliberation. Longtail International's 'A Guide to International Financial Centres: What Indian investors need to know' should serve as a prime resource for Indian companies and businessmen to arm themselves for the challenges posed while investing abroad.
Every financial investment destination presents its own set of opportunities and challenges and hence, choosing the right destination involves a lot of homework. Each international financial centre from New York to London and from Mauritius to Singapore differs in terms of foreign investment policies, regulatory and tax environment. The wrong call may expose investors to high degree of risk and lead to substantial losses. Choosing the right destination will ensure just reward for your patience and determination. This book serves as a ready reckoner for Indian investors to help in identifying potential investment destinations. Compiled by some of the world's foremost experts on taxation, legal and other matters, the guide delves deep into the intricacies of each IFC and attempts to demystify the investment climate abroad. It examines 19 such financial centres across the globe including Bahrain, Barbados, Cayman Islands, Dubai, Hong Kong, Seychelles and Switzerland, among others. Some of the prominent contributories to the book include Kiran Mazumdar Shaw, CEO and founder of Biocon, Zia Mody, Legal Consultant and Founder of AZB & Partners, Dinesh Kanabar, Deputy Chief Executive Officer and Chairman Tax for KPMG, India and Nishith Desai, International Tax, Corporate Lawyer and Founder of Nishith Desai Association (NDA).
"You've got to get a lot of advice", asserts Kiran Mazumdar Shaw, who has made managing global growth a study in success for Indian diaspora. "Atleast get two or three viewpoints before you do these acquisitions. The legal complexities of dealing with US companies can be quite serious, and you've got to understand that from the outset. We acquired the assets of a US biotech company and the whole process was a huge learning curve. It wasn't simple. And not just the US but Europe too. And we completed the tax structuring exercise before we even made the German acquisition. Because there again you, can get hit very badly. It's a learning process and it is very important to do your homework", she adds. Other advisors warn that Indian businesspeople often "Shoot without aiming", "Don't plan for the future" and ignore the problems of "cultural mismatches" as they tend to keep an "Indian mindset" when outside India.
Written in simple and concise manner, the guide provides an easy understanding of the complexities in international taxation and equips the reader with the best expert advice available to make cost and tax effective investments around the world.
Hiring a financial planner or advisor for your money management needs is perhaps one of the most...