Page 18 - The Insurance Times July 2020

Over 14.60 lakh migrant Since the launch of the healthcare sulting in inflated bills, the commission
scheme in September 2018, more than has asked hospitals to intimate patient
workers received free 95-lakh people have received treat- parties on billing on a daily basis via

healthcare under Auyshman ment worth nearly Rs. 13,000 crore. text messages, WhatsApp or email and
More than 12.52-crore e-cards have inform them in advance of any sub-
Bharat been issued across 32 States and UTs. stantial increase in the estimated cost,
About 14.60 lakh migrant workers The claims raised so far total about Rs. citing reasons.
have availed themselves of the 14,677 crore.
healthcare facility under Ayushman Rise in Covid Claims offset
Bharat Pradhan Mantri Jan Arogya West Bengal Govt caps pri- by lower Non Covid Claims
Yojana (AB-PMJAY) in the last 45 days The insurance industry is likely to wit-
after the scheme was extended to vate hospital advance de- ness a spike in health claims primarily
such workers across States. posit at Rs. 50k coming from Covid-related illnesses.
The Centre had, in June, extended the The West Bengal Clinical Establishment However, the increase in such claims
flagship health insurance scheme to Regulatory Commission (WBCERC) has is likely to be offset by a fall in non-
migrant workers across States, in the barred private hospitals from charging Covid claims, as people avoid elective
wake of the lockdown and travel re- more than 20% of the estimated cost procedures and hospitalisation as the
strictions imposed. of treatment or a maximum of Rs pandemic rages.
50,000, whichever is less, as advance
As on July 17, claims worth Rs. 2,077 According to Mahesh Balasubramanian,
deposit from patients at the time of
crore have been made, according to MD and CEO, Kotak General Insurance,
admission. While maintaining that pa-
the National Health Authority (NHA) there has been a spurt in claims with the
tients can't be refused admission with-
data. rise in Covid-19 cases. However, the situ-
out the payment or denied treatment,
Migrants were identified based on e- the WBCERC advisory issued says that ation is expected to normalise by Sep-
cards. According to Indu Bhushan, the advance deposit must be made tember, with claims coming down to pre-
CEO, ABPMJAY, the NHA is coordinat- within 12 hours, failing which the hos- Covid levels.
ing with the States to issue ecards to pitals can cancel the admission. "People are staying away from hospi-
eligible persons. tals for all kinds of optional surgeries.
Families of several Covid patients in the
NHA has launched a campaign,' city have alleged being charged ad- So, claims are lower there, and the
Swasthya ki Chaanv, Shehar ho ya vance deposits going up to several increase in Covid claims is being bal-
Gaanv', to reach out to migrants and lakhs by private hospitals. anced by the reduced non-Covid claims.
educate and empower them to make The chairman of WBCERC, Justice (re- I expect the situation to normalise by
use of the free healthcare services tired) Ashim Kumar Banerjee, said the August-September and we should be
back to pre-Covid levels in terms of
under the scheme.
decision to cap the advance deposits claims," he said.
Under Ayushman Bharat, the Centre charged by private hospitals was taken The current crisis has pushed insurance
provides a cover of up to Rs. 5 lakh per "after due deliberation and careful companies to depend heavily on their
family per year for secondary and ter- consideration". digital architecture. They have been
tiary care hospitalisation to over 10.74 The advisory says that in case the working on improving the scope and
crore poor and vulnerable families patient's family is unable to pay the reach of digital channels, thereby lead-
(about 53 crore beneficiaries).
advance amount immediately, the hos- ing to cost reduction and increased ef-
The total number of hospital admis- pital would grant a "provisional" admis- ficiency. According to Mayank Bathwal,
sions so far was at 1.09 crore. Under sion. "In case the amount cannot be CEO of Aditya Birla Health Insurance, it
this scheme, there are 1,578 health paid during the stipulated 12 hours, is a great time to leverage the aware-
benefit packages with defined rates. the hospital is at liberty to cancel the ness created by the pandemic and fo-
Over 20,000 public and private hospi- patient's admission and ask the family cus on creating more customer engage-
tals across the country have been to take the patient back within an hour ment and product relevance.
empanelled to provide in-patient ser- thereafter," it says. The industry has also been seeing a
vices to the beneficiaries.
Stating that it has come across com- structural change in the volume, nature
Covid-19 treatment is also covered plaints of unnecessary investigations and composition of insurance demand
under the scheme. and repeat of costly investigations re- and claims. T

18 The Insurance Times, July 2020