The government has proposed to impose penalty on insurance companies for delay in payment to hospitals for settlement of claims under its ambitious Ayushman Bharat National Health Protection Scheme (NHPS). Under the scheme, if an insurance company delays the claim payment beyond 15 days, then it would have to pay a penalty of one per cent interest on the claimed amount per week till it finally settles the claim.
The insurance company will pay the penalty directly to the hospital concerned, according to the model tender document that was released on Thursday, a health ministry official said.
The model tender document also comprise a list of the procedures and their rates which would be covered under the scheme along with the ones which require pre-authorisation.
Twenty states and Union territories have so far signed MoUs with the Union Health Ministry for implementing the NHPS that aims to provide a cover of Rs 5 lakh per family annually to 10 crore vulnerable families.
Four states – Delhi, Odisha, Punjab and West Bengal – have not yet given any positive response towards adopting the scheme, the official said, adding that discussions with these states are on to bring them onboard.
Prime Minister Narendra Modi is expected to roll out the scheme on August 15.
The initiative would eventually become the world's largest healthcare programme as India has the second largest population globally and will change India's health landscape, J P Nadda had said.
The centrally-sponsored scheme will target poor, deprived rural families and identified occupational category of urban workers' families, 8.03 crore in rural and 2.33 crore in urban areas, as per the latest SECC data, and will cover around 50 crore people.
"The states will be allowed to implement the scheme through insurance companies or Trust/Society or a mixed model and will be an entitlement based scheme with entitlements decided on the basis of deprivation criteria in the SECC database.
The Health Ministry officials said the government has allocated Rs 10,000 crore for the scheme on initial estimation for the financial years 2018-19 and 2019-20.