PPN Scheme in Health Insurance

PPN Scheme in Health Insurance

The Cashless Medical Insurance is provided by the Public Sector General Insurance Companies (PSGICs) through Third Party Administrators (TPAs). However, the health insurance portfolio is characterized by mounting losses mainly because some of the hospitals tend to charge health insurance policy holders at rates which are quite higher than the reasonable cost of treatment. As a result the policyholders are generally left with smaller amount of sum assured to be used for any further hospitalization during the remaining period of the health policy thereby causing undue hardship to them. Keeping this in view PSGICs have started rationalization of empanelment of hospitals and standardization of rates and specified procedures followed by the hospitals. The names of the hospitals that have agreed to work at given rates for specified procedures have been added to the Preferred Provider Network (PPN) for providing cashless health insurance facility. This has been started w.e.f. 1.7.2010 in the cities of Delhi, Mumbai, Bangalore and Kolkata. In the rest of India the earlier process of rendering cashless facility is still continuing.

Presently, 539 hospitals (Delhi-170, Mumbai-169, Chennai-104 and Bangalore-96) are on the PPN that have agreed to work at given rates for specified procedures. However, apart from the cashless facility under the PPN Network, the settlement of claims on reimbursement basis continues to be available for all hospitals (Including non-network ) in the country. The list of hospitals in the PPN in the four cities is available on the websites of TPAs/Insurance companies.

This information was given by the Minister of State for Finance, Shri Namo Narain Meena in written reply to a question raised in Lok Sabha today.

Source; PIB