Tag Archives: TPA

Comprehensive Cashless Health Insurance For The Whole Family

The concept of nuclear families in India is fast catching up. This is perhaps because people are more equipped with knowledge pertaining to the benefits of a nuclear family. Big homes have broken up and people are more in favour of elementary homes. The advent of the nuclear families concept has ushered in more financial stability in the homes. Nuclear families in a way provide for a wonderful platform for better economic planning and cost-cutting. This is so because there are lesser people to take care of, which allow families to cut down on surplus expenditure.

However, there still exist many joint families in the light of the age old Indian tradition. The joint families usually consist of grandparents, children and other members sharing the same roof. In today”s era, it becomes imperative for joint family members to have a good health insurance policy that safeguards the future of the children and also provides medical coverage for the elderly members of the household. One of the most important aspects that should be kept in mind while buying health insurance is the provision of cashless hospitalisation. Sickness, accidents, diseases can strike anyone, anytime leaving you emotionally and financially devastated.

Cashless care is suitable for joint families. This is because there are so many members of all age groups that require healthcare. It is imperative for large families to ensure insurance that allows cashless benefits in the time of emergency. It usually becomes imperative to assume an insurance policy that serves as an umbrella to cover the needs of everyone. Cashless health insurance takes care of the financial aspects of healthcare activities. As we know that medical costs have reached an all time high, a good insurance policy is a must which assures peace of mind.

Cashless health insurance comprisesof one of the most crucial aspects of health insurance policies and is provided by many health insurance providers in the country. Cashless hospitalisation provides for all the relevant medical expenses that are covered under the insured”s policy. It is directly settled by the health insurance provider with the hospital. The process is catalysed by the help of a third party administrator which is hired by the insurance companies to provide assistance during a claim. In order to successfully file a claim, the insured is required to submit all the relevant and requisite medical documents to the third party administrator. Once reviewed and accepted by the TPA, the claim is approved by the health insurance provider.

It is always advised to undergo treatment in hospitals so that you do not shell any amount from your pocket in the event of an accident or an illness. Log on to the website to gather further information about cashless benefits.

Source:

Irda On Health Insurance Cashless Dispute

The Insurance Regulatory and Development Authority (IRDA) Friday said the issue of offering cashless treatment under health insurance policies issued by the four government-owned general insurers ‘is getting resolved’. IRDA Chairman J. Hari Narayan said that prior to dispute there were only 300 government owned insurers as compared to 400 now.
The four government-owned non life insurers had earlier delisted major hospital chains from offering cashless hospitalization facility for their health insurance policy holders on the ground that the hospitals are over charging the patients.
He was in Chennai to launch the country’s first health cum life insurance product introduced by the city-based Star Health and Allied Insurance Company Ltd partnering with private life insurer Shriram Life Insurance Company Ltd. when he clarified.
There are talks of creation of separate regulator for the healthcare sector. Also, Confederation of Indian Industry (CII) has said none of the major super speciality hospitals have signed with the Raksha TPA (third party administrator).
CIIs members are waiting for a response from the insurers and the TPA since the meeting Raksha in Delhi. As on August 12, the hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted to the TPA.
Once cashless is restored in the empanelled hospitals, in the second phase, hospitals and insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.

The other side:

Shivinder M. Singh, managing director, Fortis Healthcare said ‘There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. This differential is a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals.’
Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre said, ‘This grading or categorization of hospitals should then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex process must be avoided’. It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation and standards of care is done.