Page 26 - Insurance Times March 2017 Sample

PPN SYSTEM

- FAILURE OR

SUCCESS

P ublic Sector Undertaking Insurers collectively de- sured under the policies and are mainly divided into three

cided to introduce PREFERRED PROVIDER NET-
categories. These hospitals / Nursing Homes are commonly
known as PPN approved Hospitals and Nursing Homes (NH).
WORK Hospitals system between later parts of
2011 to January' 2012, whereby the Companies
through Third Party Administrators (TPAs) entered into an Cashless facilities for specified procedures can only be availed
agreement with the Hospitals /Nursing Homes (NH) in some in such approved set-ups. It may be noted that every Hospi-
of the major cities in India for providing CASHLESS BENEFITS tals / NH has not agreed for such packages rates and they
to their respective policyholders. charge according to their own tariffs and practice and the
insured has to make full payment and seek reimbursement
In terms of such agreements fixed packaged rates for vari- subsequently under the policy from the TPA. Also this sys-
ous SPECIFIED PROCEDURES OTHER THEN TRAUMA & tem is not applicable for the insured persons under group
EMERGENCY CASES are agreed upon by hospitals/NH to be health insurance policy holders of PSU companies as well as
charged from the insured in exchange of CASHLESS BENEFIT for policy holders of the private insurance companies.
to be provided to the insured availing treatment in such
hospitals/NH. Such package rate varies based on Sum In- Five years are now almost completed ever since this system
has been introduced by PSU companies. Let us examine how
much this system has worked for all stakeholders in the
About the author health sector industry? What were the intended goals when
the system was first introduced and whether these goals
R. C. Thakker have been achieved or not? How far the main stakehold-
ers, i.e. insuring public have been benefited?
A.I.I.I.
Insurance Advisor
Before we examine all these relevant aspects let us under-
Kolkata
stand the finer points of the system. When the system was
26 The Insurance Times, March 2017

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