Bombay HC had asked IRDA to come up with package rates for 42 ailments based on policyholder’s sum insured and type of hospital. GIC will file affidavit to detail the reasons for inability to comply. Why does IRDA not mandate it in the health insurance regulations?
The Bombay High Court (HC) had issued notices to 27 non-life insurance companies offering health insurance seeking pre-packaged rates for 42 ailments on the basis of sum insured and on the type of the hospital. General Insurance Council (GIC), a statutory body representing all non-life insurers, has expressed inability to comply with the HC order citing lack of hospital regulator in India as one of the reasons. They will file an affidavit detailing the reasons for non-compliance.
According to Gaurang Damani, an activist who has filed public interest litigation (PIL) on issues facing mediclaim policyholders, “Maharashtra government Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) has 971 procedures for which they have pricing agreement with National Insurance Company. Why GIC cannot do it for just 42 ailments based on sum insured and type of hospital? Lack of hospital regulator should not prevent GIC from complying with HC order.”
Read - Bombay HC notice to health insurers on pre-packaged rates
HC had earlier directed Insurance Regulatory and Development Authority (IRDA) to come up with package rates for 42 standard ailments in the policy document. IRDA put the ball in health insurer’s court instead of mandating transparency from insurance companies. With increasing number of claims partially paid without any consistency, shouldn’t IRDA make efforts to make the mediclaim policyholder know what the policy will pay for different procedures?
In the hearing today (28 November), 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 PIL.
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 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.”
The next hearing is scheduled for 9th January.
Read –Mediclaim packaged rates for 42 ailments will marginalise TPAs' powers
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