New Delhi: Suspended since July, the cashless
treatment facility by PSU insurers is likely to be restored
fully in city hospitals within a week, but the insured might
have to pay higher premiums for treatment in super specialty
"I am hopeful that cashless mediclaim treatment would be
fully restored in 7 days. Going forward we will see the
component of co-pay gaining more importance. There would be
different premiums for different hospitals," Max Healthcare
Institute MD Pervez Ahmed said after a CII initiated meeting
of hospitals and the Third Party Administrators (TPAs).
Sources said in a week`s time each hospital would work
out a package rate with the TPAs, which are the facilitators
between the insured and the insurer.
IRDA Chairman J Hari Narayan had yesterday said the costs
of treatment could vary from hospital to hospital in the
"Markets will get segmented and certainly there would be
differential pricing. We have moved away from administered
pricing and now prices have to be left to market forces," he
From July 1, the public sector insurance companies had
taken off about 150 hospitals from the list of preferred
provider network (PPN) that provide cashless hospitalisation
services to policy holders under the mediclaim scheme.
Later, the insurers had partially restored the cashless
facility for emergency, ICU, cardiac care and trauma.
Ahmed said the hospitals, within 24 hours, would give all
the rates to the TPAs, following which they would fine tune
different packages for hospitals.
"The insurance companies have asked the TPAs to work on
their behalf. Now there would be individual negotiations
between hospitals and TPAs. We will do it in seven days and
restore the cashless mediclaim fully," he added.
At present, health insurance is a loss-making proposition
for many insurance firms as they give more in claims than they
collect from premiums. In fact, the claim ratio, which
measures this trend, is about 130 per cent for the industry.
There are about eight crore mediclaim policy holders in
Four insurance companies -- New India Assurance, United
India Insurance, National Insurance and Oriental Insurance --
stopped the cashless service because of alleged over-billing
by some private hospitals.
Ahmed said in the current scenario, standardised rates
are not possible. "The insurers would accept the propositions
of the TPAs. We will involve insurers for refining the
products," he said.