Page 12 - Insurance Times August 2018

Government calls hospitals for empanelment for Rs 5 Irdai in favour of
lakh health insurance scheme
minimising exclusions in
The National Health Agency apex body to implement Central government's
ambitious scheme to provide Rs 5 lakh health in- health insurance cover
surance coverage to about 40 crore Indians,
launched a formal process to empanel public and In a move to benefit policyholders,
private hospitals to implement it. IRDAI said it
has started the
There are concerns in the industry that due to low exercise to
package rates, not many corporate hospitals are interested in getting minimise the
empanelled and the government might have to make do with smaller hospitals, number of ill-
which leads to "quality" concerns. ness/diseases

Indu Bhushan, CEO, of the agency under the Union health and family welfare which are not covered under the
ministry, however, urged all the hospitals and healthcare service providers to health insurance policies.
maintain the motto of service to mankind and come forward to join Ayushman
Bharat, "India's healthcare revolution, in spirit and deed". The IRDAI had from time to time is-
sued guidelines on standardisation in
"I call upon each one of you to partner with the mission through the health insurance and to enhance
empanelment process initiated today to enhance the accessibility for the people transparency and uniformity. These
who need it most," Bhushan said in a statement. "I also request all the States/ include, standardisation of terminol-
UTs Governments to help us in garnering the support of hospitals and healthcare ogy to be used in health insurance
providers for this path-breaking mission." Dinesh Arora, deputy CEO of the policies and standard nomenclature
project, too invited all private and super-speciality hospitals across India for and procedure for critical illnesses
empanelment as they play critical and indispensable role in this mission.
With the increase in the number of
"We are also making every effort to ensure that the empanelment process is companies providing Health Insur-
conducted in a transparent, time-bound and non-partisan manner based on ance there is an increase in the num-
specific criteria, eligibility and guidelines," Arora said. ber of products offered. It is desired
that the industry adopts a uniform
Arunachal CM's Arogya Arunachal Yojana to replace approach while incorporating the
Universal Health Insurance Scheme 'exclusions' as part of product design
as well as for the wording of the 'ex-
Arunachal Chief Minister Pema Khandu called for strict monitoring and imple- clusions'," it said in an order.
mentation of the CM's Health Insurance Scheme during
the soft launch of the Chief Minister's Arogya Arunachal For the purpose, the regulator has set
Yojana (CMAAY). The CMAAY is a health assurance up a 10-member committee and
scheme that will enable citizens to avail cashless health asked it submit its report in eight
services in empanelled hospitals through a web portal weeks. The panel is headed by Suresh
based software developed and implemented by MD In- Mathur, Executive Director (Health),
dia, the third party administrator of the scheme. Insurance and Regulatory Develop-
ment Authority of India (Irdai).
This new scheme will replace the erstwhile Chief Minister's Universal Health
Insurance Scheme. The CMAAY will be dovetailed with the centre's Ayushman The panel will examine the exclu-
Bharat National Health Protection Mission, and implemented by the Chief Min- sions that are prevalent in the health
ister Arogya Arunachal Society through its web portal by the same name. insurance policies with a view to
minimise the number and enhance
The vision is to accord quality and cashless health care services to the people of the scope of insurance coverage.
the state envisaging universal health care to all by 2020. Once launched, the
scheme will offer health care services of up to Rs 5 lakhs per family per year. "Rationalise the exclusions that dis-
Pema congratulated the officers of the state health and family welfare depart- allow coverage with respect to new
ment for working hard and coming up with a well-framed scheme, while reiter- modalities of treatments and tech-
ating that the state government was committed from day one to revive the nologically advanced medical treat-
health insurance scheme. ments. Identify the type of exclusions
which shall not be allowed," said the
12 The Insurance Times, August 2018 terms of reference of the panel.