Why Mediclaim Policy is required for Bankers?. (collected from facebook , contributed by Sri Ravikumar Narayan)
A banker is a common man.
The ultimate sufferer in this is the common man, the poor medical insurance policy holder.
The article says-
.Read My Blog Why Mediclaim Policy Offered BY IBA should Be Rejected Outright By UFBU
A banker is a common man.
The ultimate sufferer in this is the common man, the poor medical insurance policy holder.
The article says-
.Read My Blog Why Mediclaim Policy Offered BY IBA should Be Rejected Outright By UFBU
Those who considered cashless health insurance policies as a lifeline so far, here is a piece of bad news: many insurance companies have stopped direct payment of treatment charges to 150-odd high-end hospitals in New Delhi and surrounding areas from July 1. The virus is said to be growing all over the country now.
One can no longer get these facilities at high-end hospitals in the National Capital Region, Mumbai, Bengaluru and Chennai.
Four state-run insurance companies managed by General Insurance Public Sector Association -- United India, New India, Oriental Insurance and National Insurance -- have taken the decision to stop cashless transactions at some hospitals.
Reason? The insurers claim that several hospitals are making fake claims, by showing higher-than-normal charges and thereby cheating the insurance companies. These insurers claim that they collected Rs 900 crore (Rs 9 billion) towards medical insurance premium and had to shell out Rs 1,200 crore (Rs 12 billion) towards claim settlement, in the Mumbai region alone. They attributed these losses to false claims and inflated bills.
The accusation has understandably enraged the hospitals. Many hospitals have thus begun to reject cashless policies following the insurers' stance. The ultimate sufferer in this is the common man, the poor medical insurance policy holder.
This indicates that one would have to bear the expenses from one's pocket if one is taking treatment from one of these hospitals.
This step by the insurance companies has invited a lot of criticism across the nation.
Medical insurance in India is not that expensive, with Rs 200,000-health cover for a 30-year-old costing under Rs 2,500 per annum in some cases.
What will be the impact of this step taken by the insurance companies? What does the aam aadmi feel about this?
BY Deepak YohannanMyInsuranceClub.com
As you begin the exercise of purchasing health insurance, a number of questions will arise. One of these is whether you should buy a cashless health policy or a reimbursement plan.
A cashless health insurance policy is one wherein the insurance company directly settles bills with the hospital; the patient is not required to make any payments at all. On the other hand, a reimbursement policy requires the patient or policyholder to pay the medical bills upfront, the insurer reimburses these costs later after a claim is filed.
Which of these is the better option? Let us evaluate the two types of health insurance plans under different heads.
1. Choice of Hospital – A cashless health insurance policy limits you in terms of the hospital you choose. To avail of the cashless benefit, the patient must be admitted in a hospital that comes under the insurer's network. Seek treatment at a network hospital and your insurer will settle the bill directly without requiring any payment from your end. However, go to a hospital outside this network and you will have to pay the bills upfront and seek reimbursement later. A pure reimbursement policy, on the other hand, allows freedom of choice regarding the hospital or healthcare provider.
2. Need for Emergency Cash – A cashless policy is a great option for people who are low on cash. If your cash reserves are relatively low, a reimbursement policy would burden your already limited finances. This is because a reimbursement policy requires you to pay the hospital bills upfront. You then have to file a claim and wait for the reimbursement money to arrive. A cashless policy does away with the need for emergency cash. As long as you are using a hospital that comes under your insurer's network, you will not have to pay at all.
3. Rise in Premiums – One problem with cashless policies stems from their requiring no payment from the policyholder. As a result, the policyholder tends to go not merely to a good hospital, but to an expensive one. The idea is that since he is not required to make any payment, he might as well get the best (or most expensive) treatment. The disadvantage is that this could lead to the insurer saddling the insured with higher premiums in the future. This risk does not hold for reimbursement policies, where the insured chooses affordable healthcare providers because the initial payments come from his own pocket.
4. Claim Settlement – A policyholder with a reimbursement plan has to retain all bills, test reports and doctor's prescriptions and then approach the insurer as soon as possible (usually within 30 days) for effective claim settlement. Thus, there is a considerable waiting period between payment and reimbursement. Under a cashless policy, the insured simply has to walk into a network hospital with his cashless card to be admitted and receive treatment. The third-party administrator (TPA) mediates between the insured and the insurer to ensure smooth claim settlement. Emergency cases should be cleared within six hours and all other cases within four days. Smoother settlement is possible if cashless policyholders inform their TPA in advance when going in for pre-planned medical procedures.
As must already be clear, both cashless and reimbursement policies have their pros and cons. Which one you choose will depend entirely on your specific health cover needs. Make an informed choice!
One can no longer get these facilities at high-end hospitals in the National Capital Region, Mumbai, Bengaluru and Chennai.
Four state-run insurance companies managed by General Insurance Public Sector Association -- United India, New India, Oriental Insurance and National Insurance -- have taken the decision to stop cashless transactions at some hospitals.
Reason? The insurers claim that several hospitals are making fake claims, by showing higher-than-normal charges and thereby cheating the insurance companies. These insurers claim that they collected Rs 900 crore (Rs 9 billion) towards medical insurance premium and had to shell out Rs 1,200 crore (Rs 12 billion) towards claim settlement, in the Mumbai region alone. They attributed these losses to false claims and inflated bills.
The accusation has understandably enraged the hospitals. Many hospitals have thus begun to reject cashless policies following the insurers' stance. The ultimate sufferer in this is the common man, the poor medical insurance policy holder.
This indicates that one would have to bear the expenses from one's pocket if one is taking treatment from one of these hospitals.
This step by the insurance companies has invited a lot of criticism across the nation.
Medical insurance in India is not that expensive, with Rs 200,000-health cover for a 30-year-old costing under Rs 2,500 per annum in some cases.
What will be the impact of this step taken by the insurance companies? What does the aam aadmi feel about this?
Should you buy cashless or reimbursement health insurance?
As you begin the exercise of purchasing health insurance, a number of questions will arise. One of these is whether you should buy a cashless health policy or a reimbursement plan.
A cashless health insurance policy is one wherein the insurance company directly settles bills with the hospital; the patient is not required to make any payments at all. On the other hand, a reimbursement policy requires the patient or policyholder to pay the medical bills upfront, the insurer reimburses these costs later after a claim is filed.
Which of these is the better option? Let us evaluate the two types of health insurance plans under different heads.
1. Choice of Hospital – A cashless health insurance policy limits you in terms of the hospital you choose. To avail of the cashless benefit, the patient must be admitted in a hospital that comes under the insurer's network. Seek treatment at a network hospital and your insurer will settle the bill directly without requiring any payment from your end. However, go to a hospital outside this network and you will have to pay the bills upfront and seek reimbursement later. A pure reimbursement policy, on the other hand, allows freedom of choice regarding the hospital or healthcare provider.
2. Need for Emergency Cash – A cashless policy is a great option for people who are low on cash. If your cash reserves are relatively low, a reimbursement policy would burden your already limited finances. This is because a reimbursement policy requires you to pay the hospital bills upfront. You then have to file a claim and wait for the reimbursement money to arrive. A cashless policy does away with the need for emergency cash. As long as you are using a hospital that comes under your insurer's network, you will not have to pay at all.
3. Rise in Premiums – One problem with cashless policies stems from their requiring no payment from the policyholder. As a result, the policyholder tends to go not merely to a good hospital, but to an expensive one. The idea is that since he is not required to make any payment, he might as well get the best (or most expensive) treatment. The disadvantage is that this could lead to the insurer saddling the insured with higher premiums in the future. This risk does not hold for reimbursement policies, where the insured chooses affordable healthcare providers because the initial payments come from his own pocket.
4. Claim Settlement – A policyholder with a reimbursement plan has to retain all bills, test reports and doctor's prescriptions and then approach the insurer as soon as possible (usually within 30 days) for effective claim settlement. Thus, there is a considerable waiting period between payment and reimbursement. Under a cashless policy, the insured simply has to walk into a network hospital with his cashless card to be admitted and receive treatment. The third-party administrator (TPA) mediates between the insured and the insurer to ensure smooth claim settlement. Emergency cases should be cleared within six hours and all other cases within four days. Smoother settlement is possible if cashless policyholders inform their TPA in advance when going in for pre-planned medical procedures.
As must already be clear, both cashless and reimbursement policies have their pros and cons. Which one you choose will depend entirely on your specific health cover needs. Make an informed choice!
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