Page 12 - Insurance Times September 2023

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News

Final decision over health Regarding errors in linking of Aadhaar
Prudential plans health in Tamil Nadu, NHA replied that the
fraud vests with states
insurance venture in state is using its own IT platform (and
The CAG's performance audit report, database) for beneficiary identifica-
India tabled in the Lok Sabha recently, tion. NHA has urged states to migrate

London-based Prudential is looking revealed multiple cases under the to the Aadhaar based BIS platform of
to set up a health insurance ven- scheme, providing treatment for NHA to strengthen beneficiary verifica-
ture in India. The company, which patients who had already been tion protocols, according to the CAG
is in a partnership with ICICI Bank declared dead, as well as for thousands report.
for its life insurance and asset of people using the same Aadhaar In 7.5 lakh cases, the beneficiaries
management business, may need number or invalid mobile phone were found to be linked with the same
to look for another partner as the number. However, the Health Ministry mobile number, 9999999999, which
latter has a non-life venture - ICICI defended the scheme, saying that was invalid. Health ministry sources
mobile numbers did not play any role
Lombard General Insurance. claimed this may have been possible
in the verification of scheme
There are five standalone health because initially, the mobile number
beneficiaries.
insurance companies in India - was not a mandatory field during ben-
Aditya Birla, Care, Manipal Cigna, The National Health Authority (NHA), eficiary verification. "However, since
implementing agency for ABPMJAY, there was a field for mobile numbers,
Niva Bupa, and Star Health. Health
insurance is the fastest-growing while accepting the audit observation, it is possible a random 10-digit number
stated that the National Anti-Fraud was entered by the field-level work-
segment in non-life, and its share
Unit (NAFU) had sent periodic remind- ers," one of the sources said.
has risen from 29.5% in FY231 to
ers to the states/UTs highlighting dis-
35% in FY23. In a recent investor crepancies in verified data. Other irregularities pointed out include
call, Anil Wadhwani, CEO of Pru- treatment of a beneficiary already
dential, said, "India is clearly an ex- "However, 'public health' being a state shown as 'died' during earlier claim,
citing market, with a large popu- subject, the final decision in this regard admission of the same patient in mul-
vests with the state governments. Also, tiple hospitals during the same
lation... there is significant under-
penetration." NHA is developing a policy to disable hospitalisation period, and number of
'Add Member' functionality in case of patients admitted to a hospital exceed-
Besides the growth opportunity, a any beneficiary family with more than ing its declared bed strength.
presence in health insurance sup- 15 members," NHA said.
ports the life business by providing
Further, it added, NAFU is sending a PSU insurers review plans
information on health. It also en- communication to the states/Union
sures that a line of business is not of captive health TPA
territories to fully audit all such cases
impacted by market performance
where family size is above a certain Public sector insurers are relooking at
or interest rates.
threshold. their investment in Health Insurance
The Insurance Times September 2023 11