Ludhiana, October 14
Paying hospital bills was never so convenient as it has become after the introduction of some new medi-claim schemes that have virtually freed-up its policy holders from getting embroiled in financial transactions with hospitals and nursing homes after sudden hospitalisation.

Designed specifically with consumer interest in mind, these medi-claim policies from new entrants in the insurance sector operate through third party administrators (TPAs) that do all the necessary paper work while the policy holder simply walks in and out of designated hospital or nursing home by merely flashing a health insurance card.

Many top public as well as private sector companies have tied up with TPAs who do the necessary job. A third party administrator is licensed by the Insurance Regulatory and Development Authority (IRDA) Act to work as a mediator. Mr Manu Virmani, manager marketing, Bajaj Allianz General Insurance Company, said, “A TPA gets the intimation of claim and verifies whether a valid policy exists. He guides the patient to a hospital, where the company has a tie-up”.

An insurance agent with one such private sector company, on condition of anonymity, disclosed that the cashless facility, basically originated from West and was introduced in India about a decade ago. “The policy literally had to be pushed in the market as there were no buyers. But then overcharging by the hospitals became the major problem. For a treatment costing Rs 30,000 the hospitals would charge Rs 1 lakh convincing the insurance companies to shell out the money. Because of misuse, medical insurance was not “pushed”, said the insurance agent.

Insurance agencies offering medi-claim policies include the National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance.Mr R.K.Marwaha, assistant divisional manager, United India Insurance, said that the cashless hospitalisation facility has recently been re-introduced in the city.”We are getting a good response and we have already tiedup with hospitals like Dayanand Medical College and Hospital and Christian Medical College and Hospital”, claimed Mr Marwaha.The private sector companies in the city include Bajaj Allianz, IIFCO TOKYO, Reliance General Insurance and ICICI Lombard.

Diseases like first heart attack, bypass surgery, stroke, cancer, kidney failure, major organ transplantation, multiple sclerosis, aorta graft surgery, primary pulmonary arterial hypertension and paralysis are covered though conditions apply. “But congenital diseases, all expenses arising from AIDS and related diseases, cosmetic, aesthetic and related treatment and use of intoxicating drugs and alcohol are excluded under the policy.”

The policy holder can opt for a sum assured from Rs 15,000 to Rs 5 lakh depending on the terms and conditions of the insurance companies. The age starts from 5 to 75. “All these are tax benefit schemes under section 80 D”, said Mr Virmani.