Page 17 - Insurance Times December 2015 SAMPLE

Employees' health insurance scheme by Punjab 'PA' for hospital info
government
available in just one click
In a significant move that will benefit empanelled public and private hospitals
over 6.50 lakh employees and pension- in Punjab, Chandigarh and NCR (Delhi, Former Indian School of Business
ers of the state government, the Gurgaon and Noida) adding that under (ISB), Hyderabad, Professor Mudit
Punjab Cabinet gave its nod to imple- this scheme all the benefits would be
ment Cashless Health Insurance granted to the employee as per Service Kapoor and his
scheme in lieu of the existing student Vaibhav
policy of reimbursement of Rules (Medical Attendance Singh have
the medical expenses. Rules 1940). founded a start-
up called myCOL
A decision to this effect was The expenses on treatment if (My Circle of
taken by the Cabinet in its taken outside the state would Life), whose
meeting chaired by Punjab be reimbursed to the employ- new app provides detailed informa-
Chief Minister Parkash Singh ees by the insurance company tion for over 1,300 hospitals in Delhi-
Badal. within 15 days of submission of NCR through a map-based search.
medical claim.
The app was developed after doing
A spokesperson of the Chief Minister's The scheme would cover pre and post primary and secondary research in
Office said that the facility of cashless hospitalisation benefits up to seven Delhi hospitals to identify the most
treatment would be provided to Gov- days and 30 days respectively, which common issues faced by patients and
ernment employee/pensioners and were not available under the prevail- caretakers, Singh told newspersons.
their dependents in more than 250 ing rules.
Regarding the app singh said,
RSBY reconstructed to make its coverage wider myCOL is trying to fill the huge gap
in accessible information in India.
Rashtriya Swasthya Bima Yojana ary and tertiary benefits could do so as "We are the first-of-its-kind one-stop
(RSBY) will be restructured to make its a top up of the scheme," a CII state- for in-patient care in India," he said,
coverage wider, intensive and IT ment, quoting Union Health Secretary adding that the app offers a person-
driven, the government said. B P Sharma, said. alized caretaker to patients. The
caretakers will help them locate hos-
The restructured scheme, to be coor- Sharma said that an important feature pitals, identify specialists, and get
dinated by the Union Health of the new scheme was the admitted seamlessly. They will also
Ministry, will bring together strong IT platform which handle administrative formalities in-
several disjointed schemes would be created for facilitat- cluding payment and insurance.
coordinated by different agen- ing operation of the scheme.
cies under one umbrella, and Presently, myCOL has 25 people on
is likely to become opera- A large database is being cre- board. "Our target is to have about
tional shortly. ated that would detail facili- 250 people in Delhi at peak load, say,
ties at every hospitals, disease profile in 6-12 months", he said. He also
"The new scheme would have more and other details and would help im- added that most of the staff is drawn
benefits and beneficiaries. MoUs would mensely every stakeholder, he said. from the hospitality and healthcare
be entered with the state govern- management sectors.
ments. Those states which want to The Health Secretary said that the re-
extend the services to people above structured RSBY would cover around 8 to In Delhi-NCR, myCOL hopes to tap into
poverty line (APL) and provide second- 10 crore BPL people and there will be the 'Big Five' to begin with, and is in
enhancement of cash limits for treatment. the process of signing up with Medanta
Medicity. It will also approach
IRDAI to scan increasing health cover rejections Gangaram, Fortis, Max and Apollo.

Rejection of applications for health covers is on the rise with insurers turning myCOL plans to focus on tier 2 and 3
down any applicant having a pre-existing condition or even disabilities. The re- cities, "as a large number of NCR
jections follow the stand taken by the IRDAI that even exclusions named in the beds are filled by out-of-towners". It
policy would be covered once the policy has been in force for four years. While is also reaching out to the Bill &
the regulator can compel insurers to honour claims arising out of pre-existing Melinda Gates Foundation.
conditions, companies are free to reject proposals that don't meet their crite-
ria. Many firms are using this to reject proposals where the insured is already
suffering from a disease.

The Insurance Times, December 2015 13

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