Page 11 - Insurance Times December 2018

Health Insurance

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IRDAI working group sug- J&K governor cancels J & K group mediclaim Policy
gests coverage of dis- Jammu and Kashmir Governor Satya Pal Malik has ordered the cancellation of
the J&K Group Mediclaim Insurance Policy for Em-
eases contracted after ployees and Pensioners as the tenders were allotted

purchase of health policy fraudulently.
A working group set up by IRDAI has "We are probing this. The tender was invited by
suggested some other company, not the government. We are
t h a t giving this to vigilance and whosoever is involved,
Chronic dis- whether an official or a businessman, will not be
eases like spared," Malik told.
Alzheimer's, On September 20, days after Malik assumed office,
Parkinson's, the contract for providing insurance to 3.5 lakh regular employees of the state
AIDs/HIV infection and Morbid obe- was awarded to private sector general insurance company. The annual premium
sity should be covered under medi- for employees and for pensioners was Rs 8,777 and Rs 22,229, respectively. It
cal cover if a person contracts such was mandatory for all state government employees - gazetted and non-gazet-
ailments after buying a health insur- ted, state universities, commissions, autonomous bodies and PSUs to subscribe
ance policy. to the policy.
The group has also suggested a list According to sources, the Trinity Group had floated the tenders on behalf of
of 17 diseases, including chronic kid- the government. "Changes were made to the conditions by this front to accom-
modate private sector general insurance company," sources said.
ney disease, Hepatitis B, Alzheimer's,
epilepsy and HIV & AIDS, which When contacted, Finance Secretary Naveen Choudhary, told The Indian Express,
could be excluded from health insur- "Trinity came through a bidding process as a transaction advisor, and as a third
ance policies. party interface for grievance redressal. This a standard practice to avoid mis-
takes since government officials do not have requisite expertise in handling in-
"The Working Group recommends surance related queries." He said that the total cost of the group insurance
that all health conditions acquired
schemes was estimated at Rs 280 crore, of which Rs 60 crore was paid as ad-
after policy inception, other than
vance on premium.
those that are not covered under the
policy contract (such as Infertility Sources in the Governor's office said red flags were raised over an advance
and Maternity) should be covered payment of Rs 60 crore made to the company by the state's finance depart-
under the policy and cannot be per- ment through the office of the Finance Secretary. This payment, the sources
claimed, was "without the necessary approvals of the Chief Secretary or the
manently excluded.
Governor". "The order to cancel the current scheme has been typed and signed
"It is suggested a standard format of and will be issued soon," the source said.
consent letter to be given by the
Malik said many employees resisted subscribing to the policy citing high pre-
proposer may be specified," the re- mium. "This led me to study the files again. I came to the conclusion that there
port said.
were issues with the scheme."
The Insurance Times, December 2018 11