The Public Sector General Insurance Companies have been incurring health insurance claims in excess of premium received and after factoring in acquisition costs, which are around 10%, and the management expenses which are over 25%, the Combined Ratio i.e. the total expenses for health portfolio exceed 140% of the premium income.

In an effort to rationalize the health insurance portfolio and provide health care at an affordable cost and at the same time help the insurer to control ever increasing cost of health care, the Public Sector General Insurance Companies have initiated the process to create a Preferred Provider Network (PPN) of hospitals in four cities i.e. Delhi, Mumbai, Chennai and Bangalore. At present the PPN includes a network of 449 hospitals (Delhi-163, Mumbai-121, Chennai-84 and Bangalore-81) and more number of hospitals are joining the network. These hospitals provide cashless facility to the insured and package rates for 41 common surgical procedures have been fixed. These package rates would stabilize the hospitalization cost and would benefit the insured by lowering the cost of every hospitalization leaving a larger balance in the sum insured for future hospitalization. In order to minimize inconvenience to the insured persons, effort has been made to have a geographical spread of the network hospitals.

In addition to above, the cashless facility is also available in non-PPN hospitals for emergency and trauma cases and the settlement of claim on reimbursement basis continues to be available for all hospitals, in these cities. In rest of the country, the earlier process of rendering cashless facility is still continuing.

This information was provided by the Minister of State for Finance, Shri Namo Narain Meena in reply to an Unstarred Question in Lok Sabha today.

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  1. Nani Reporter says:

    The insured public should be made aware of these 41 surgical procedures and the packaged rates for each. Why have Preferred Provider Network of hospitals only? Why should doctors/surgeons be out of the circle? In such a scenario the patients would suffer. While the insurance company would reimburse hospitals at the packaged rates, the charges of surgeons above such packaged rates, would have to be borne by the patient from his pockect even though there may be a balance available on mediclaim policy. This is most inequitable. Additionally, what about hospital costs incurred by patient due to negligence of hospital staff which would be outside the packaged procedure? Also, why should not the hospitals guarantte the treatment received, say, if the patient, after discharge, complaints of the same ailment within,say, 90 days of such dicharge? Any answers? (that is if these comments do reach where they are addressed)

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September 2021