Page 13 - Insurance Times April 2024

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analysed the claims data for each pro-
Ayushman Bharat health insurance cover likely to be
cedure to come out with the average
doubled cost of each procedure.

The government may double the ceiling on its flagship health insurance Speaking to DC, an insurance official
scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) said, "The indicative pricing depends on
from the current Rs. 5 lakh to Rs. 10 lakh in the interim budget on 1 Febru- the location where treatment is being
ary, two officials aware of the matter said. sought. For example the hospital in a
The Union budget for FY24 had allocated Rs. 7,200 crore for Ayushman Tier 1 city or Tier 2 or 3 city, the type
Bharat, a number that may more than double to around Rs. 15,000 crore of facilities a hospital has, is the hospi-
in FY25. The health ministry has requested the finance ministry for Rs. 1.1 tal a super specialty hospital, and
trillion for FY25, up 23% from Rs. 89,155 crore in FY24, said one of the two other factors. For patients with co-
officials cited above, both of whom spoke on the condition of anonymity. morbidities, the treatment cost over
The FY23 budget had set aside Rs. 86,200 crore for the health ministry. and above the fixed charges will be
considered." "The hospitals cannot
Emails sent to spokespersons of the health and finance ministries remained force high treatment costs on insured
unanswered till press time. Health schemes have helped the Bharatiya
patients nor can we force our pricing
Janata Party win four of the five states that went to polls recently. The on them. Insurers will be free to nego-
success of state-led health schemes and their popularity are now proposed
to be replicated at the Centre with enhanced insurance coverage under tiate with the hospitals and onboard
them on these indicative rates," added
Ayushman Bharat, the officials cited above said.
the official.
Started in 2018, Ayushman Bharat offers insurance for secondary and ter-
tiary care hospitalization across empanelled public and private hospitals. It Husband wins Rs 1.57
covers up to three days of pre-hospitalization and 15 days post-hospitaliza-
tion expenses for diagnostics and medicines. So far, the scheme has ben- crore health insurance
efited 600 million people. claim against LIC after a 5-
year fight
Insurers Move Closer to (GICl), a self-regulatory body of non-life Life Insurance Corporation of India (LIC)
and pure health insurance companies
Common Empanelment of had appointed consulting firm PwC to was ordered by National Consumer Dis-

Hospitals come out with indicative rates for vari- putes Redressal Commission (NCDRC) to
pay Rs 1.57 crore to the husband of
Non-life insurance companies have ous medical procedures. The consult- deceased policyholder. She died from
moved a step closer to launching com- ing firm has just submitted its report Breast Cancer in April 2017 and in
mon empanelment of hospitals to containing indicative pricing for the 23 March 2018 LIC rejected her husband's
check spiraling health insurance claim most common procedures that bring insurance claim. NCDRC said in its order
costs. The General Insurance Council the maximum claims. The study that LIC provided a deficient service by

The Insurance Times April 2024 13