In a move that could come as a major relief to health insurance policy holders, the Insurance Regulatory and Development Authority (IRDA) has assured continuity of services to patients who have been pre-authorised or are already under treatment, even if the hospital in question is removed from the list of preferred provider network (PPN).
However, the impasse between hospitals and health insurance companies over pricing and cashless facility is yet to get sorted out.
The IRDA move will benefit senior citizens the most. “It has come as a huge relief and we have received a note from the regulator and we are happy with the decision,” JR Gupta, chairperson, Confederation of Senior Citizens Association of Delhi, told Hindustan Times.
The regulator has said policy holders must be informed of any change in the PPN list well in advance of the actual withdrawal. Insurers have also been asked to provide nearest alternative options and conditions that apply there. With effect from July 1, the four public sector general insurance companies decided to drop certain hospitals from their PPN list in Delhi, Mumbai, Chennai and Bangalore.
Insurance firms and hospitals are yet to thrash out the contours of a new pricing model where apart from standard factors, the degree of seriousness of a disease or a medical procedure will also be incorporated in calculating premiums. Thus a person paying a higher premium will be entitled to be claim insurance for a more serious degree of the disease, and vice versa.