lS Prakash, managing director, Star Health and Allied Insurance Company

“We would indentify honest hospitals and reward them. We will also penalise hospitals for fraud, overcharging and deficiency in services . Insurance Information Bureau (IIB) is working on a a project  called `Bima Satrak’ to check frauds in the health insurance,’’ S Prakash, managing director, Star Health and Allied Insurance Company said

Mumbai:

General Insurance Council (GI Council), the official self regulatory organisation (SRO) of 31 general insurers, have unveiled multi pronged strategies including going cashless 100 per cent all over the country and penalising errant hospitals, to improve health insurance penetration in the country.

Currently, almost 52 per cent of health policies are cashless where insurers pay the policyholders treatment cost directly to the hospitals.

Addressing media here along with C.R. Vijayan, acting secretary general, GI Council, S Prakash, managing director, Star Health and Allied Insurance Company, and executive committee member of GI Council on Tuesday outlined some of the initiatives of the council including setting up tech platform for the empanelment of all hospitals, creating a Health Exchange platform(HCX) along with the partnership with National Health Authority(NHA).

“We would indentify honest hospitals and reward them. We will also penalise hospitals for fraud, overcharging and deficiency in services . Insurance Information Bureau (IIB) is working on a a project  called `Bima Satrak’ to check frauds in the health insurance,’’ he said.

In the second step. the Council would decide about the standardisation of services and prices for all he hospitals, he added.

“We will have a constant dialogue with hospitals to iron out pain points. Out top line is their bottomline. We would like to understand each other so that both of us serve the policy holders well,’’ said Prakash.

“To mitigate frauds, we will have unified approach. This will prevent abuse or leakages that are happening. Action will depend on the intensity of the error. We will identify patterns of error and will have unified approach to mitigate fraud,” he said adding that the council has already identified some hospitals which will soon face action.

The actions will include issuing letter of caution, suspension of cashless payment option to the hospital, listing the hospital as an excluded provider, and taking legal action based on documentary evidence.

The council has also decided to set up an appellate committee to which the impacted hospitals can approach for recourse.

The objective is to improve services for insured patients as well as to bring down costs for the industry so that policies are available at affordable costs, he opined.

“This will address the trust deficit. Our objective is to deliver good service to policy holders and to erode negative perceptions so that IRDAI’s vision of having health insurance for all by 2047 is achieved.” he said.

Health Insurance has already become the largest portfolio of the general insurance industry and contributed Rs 73,000 crore in FY2021-22. The total health insurance premium may reach Rs 90,000 crore in FY 2022-23.