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PSU insurers ask hospitals to accept new rates for cashless plan

The four public sector insurers that together command nearly 65%-70% health insurance market share have made it clear that only those hospitals would be included in the list that adhere to their conditions on medical costs

Locked in a battle with big healthcare firms over censoring cashless health insurance claims, state-run insurers today asserted that the facility would be extended only to those hospitals that agree to their rates for medical expenses, reports PTI.

"The purpose of working out such package rates and stabilising the hospitalisation costs will benefit the insured in many ways," the four state-run general insurance companies — National Insurance Co, New India Assurance Co, Oriental Insurance Co and United India Insurance Co — said in a joint public notice.

Presumably hurt on their balance sheets by the allegedly inflated bills for medical costs of people covered by cashless mediclaim facilities, these insurers have pruned the list of hospitals in four large cities for providing this facility with effect from this month.

The selected list of hospitals in Delhi and National Capital Region, Mumbai, Chennai and Bangalore, does not include big chains like Fortis and Max Healthcare and was prepared on the basis of those accepting rate packages prepared by the insurance firms for medical procedures and hospitalisation costs.

While the insurers' move has been vehemently opposed by large hospitals, the general public has also been caused inconvenience as settlement claims for many of them were refused at the hospitals not on the preferred list for such a facility.

A conciliatory meeting was arranged between the insurers and the hospitals in Mumbai on 13th July, after which the insurance firms agreed to work upon expanding the list of approved hospitals for cashless facility.

In today's statement, the four public sector insurers that together command nearly 65%-70% health insurance market share, however, made it clear that only those hospitals would be included in the list that adhere to their conditions on medical costs.

"We along with some TPAs (third party administrators), worked out package rates for some of the procedures/ hospitalisation expenses, which are commonly claimed under our health insurance policies," the statement said.

Having offered these rate packages to various hospitals over a period of several months, those agreeing to the offer were included in a "Preferred Provider Network", or a network of hospitals where cashless mediclaim facilities would be available, the insurers said.

For treatment at non-PPN hospitals, the policy holders would need to seek reimbursement of expenses later.

Under the cashless facility, the policyholders do not need to first pay the hospitals and later claim the expenses. Instead the insured sum gets deducted from the medical bills in the very first place.

With effect from 1st July, the PPN model was made operational in Mumbai (74 hospitals), Delhi NCR (131 hospitals), Chennai (65) and Bangalore (58).

The insurers said that "many more hospitals have evinced interest in joining our PPN and we would be including them too." The insurers have also agreed to work with corporate hospitals and other stakeholders to devise a structure for expanding the PPN.

The four state-run companies also made it clear that their move to restrict cashless facility to approved hospitals would bring down the costs for the insured.

"Lower cost of every hospitalisation will leave a larger balance in the sum insured in the policy for future hospitalisation within the policy period."

"Lower cost will also reduce loading on policy premium at the time of renewal," they said, while adding that their step was "in the interest of all health insurance policy holders.


Daily Market View: The uptrend is intact

The market should continue to move up, subject to dips

The market traded on a firm footing in the early session; however, gains were erased by weak European markets and profit-booking towards the fag end of the session. The Sensex closed at 17,938, down 48 points (0.2%) and the Nifty shut at 5,386, down 14 points (0.2%). The indices started the day with a sharp rise, taking cues from Asian markets. They traded in a range-bound manner in the morning session. However, the market pared gains in the afternoon session on the back of weak European markets.

Asian markets were up on Wednesday, as better-than-expected results from Intel propped up technology shares in the region. Key benchmark indices in China, Indonesia, Singapore, Japan, Hong Kong, Taiwan and South Korea were up 0.6% to 2.7%.

Wall Street rallied for a sixth straight day on Tuesday, on Alcoa's stronger-than-expected quarterly results announced after market hours on Monday. Intel Corp, too, reported results that beat expectations after trading hours on Tuesday. The Dow was up 147 points (1.4%) to 10,363. The S&P 500 was up 17 points (1.5%) to 1,095.3. The Nasdaq jumped 43.6 points (2%) to 2,242.

Singapore's economy grew at a 26% annual pace in the second quarter after a record surge in the previous three months, spurring the nation's currency. Growth was revised to 45.9% for the first quarter, the fastest since records began in 1975, the trade ministry said today.

Back home, finance minister Pranab Mukherjee said that inflation would come down to 5%-6% by the year end. Wholesale price index (WPI) based inflation inched higher to 10.55% in June, owing to the pass-through effect of the hike in prices of petroleum products announced on 25th June. However, the double-digit inflation in June could be partly attributed to a low base in the year-ago period when inflation was at -1.01%, which means even a small increase now would seem large.

Foreign institutional investors were net buyers of stocks worth Rs784 crore on Tuesday. Domestic buyers were net sellers of equities worth Rs650 crore. 

GEI Industrial Systems (up 0.8%) has received two orders worth Rs64 crore from the power sector for supply of air-cooled steam condensers. The orders are for power plants being set up by Ind-Bharat Thermal Power Ltd at Tuticorin in Tamil Nadu and Shree Renuka Sugars Ltd for a captive power plant at Gandhidham in Gujarat.

Larsen & Toubro (up 2.5%) has won an offshore rig-refurbishment contract from Oil & Natural Gas Corporation Ltd (ONGC) valued at Rs376 crore ($83 million). The company's newly-formed Floating Systems Business Unit (FSBU) has been awarded the project. The unit offers single-point responsibility for execution of offshore drilling rigs and floating production units in both domestic and international markets.

Tata Power Company's (up 0.06%) 50.4MW wind farm at Khandke in Maharashtra was commissioned in December 2007. The application for registration of the Khandke wind farm with the United Nations Framework Convention on Climate Change (UNFCCC) as a Clean Development Mechanism project has now been approved. The Khandke project is expected to earn 85,000 Certified Emission Reductions annually from UNFCCC.

Hero Honda Motor's (up 0.7%) promoters have realigned their shareholding in the company. Hero Cycles has transferred its shareholding to Hero Investments. With this the Indian promoter group now consists of Hero Investments and Bahadur Chand Investment.  

Hotel Leelaventure (up 0.7%) has posted a 25% and 67% growth in sales and operating profit respectively.


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