Insurance companies may face penalties for delays in claim settlement under NHPS

The government of India has introduced a proposal for imposing penalty on insurance companies in event of any delay in payment to hospitals under the flagship programme Ayushman Bharat National Health Protection Scheme (NHPS). According to the proposal, insurance companies have to pay one percent interest weekly on the claimed amount till settlement of the claim payment as a penalty if they exceed the stipulated deadline of 15 days.

According to the statement of an official in the health ministry, the insurance company would have to ensure direct payment of penalty to the concerned hospital which should be based on the model tender document released on Thursday. The model tender document includes an assorted list of procedures alongside their rates that can be covered under the scheme as well as the procedures which require prior authorization.

Twenty different states and Union territories have signed MoUs in agreement with the Union Health Ministry for implementation of the NHPS aimed at provision of insurance coverage up to Rs. 5 lakh for every family on an annual basis to an estimated number of 10 crore vulnerable families. Presently discussions with four states Punjab, Odisha, West Bengal and Delhi are underway for bringing them onboard the scheme. According to officials of the health ministry, the scheme has been allocated with a budget of Rs. 10,000 crore based on initial estimates for the 2018-19 and 2019-20 financial years.

According to the statement of Union Health minister, JP Nadda, the Ayushman Bharat scheme is touted to become one of the largest healthcare programmes in the world since India is ranked second on a global platform in terms of population. The programme is also considered as a prolific measure for reforming the healthcare landscape of India. Statistics obtained from SECC are clearly indicative of the extent of the centrally-sponsored programme implying the coverage of 8.03 crore families in rural areas and 2.33 crore families in urban areas which are poor and financially deprived rural families as well as identified occupational category of families in urban areas.

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