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PSUs ordered to provide customers with list of hospitals not covered under cashless mediclaim

Last Updated: Sep 06, 2011 | 3417 Views

Many a times policyholders get medical treatment from a hospital of their choice or convenience. Public sector insurance companies (PSUs) have a tie-up with certain hospitals that feature in their Preferred Provider Network (PPN). These hospitals offer cashless mediclaim facility to policyholders however, there are many hospitals which are not under the PPN and the expenses on treatment have to be borne by the policyholder.

Under the Right to Information Act (RTI), the Central InformatioHospital list for Cashless Mediclaimn Commision (CIC) has directed the four PSUs - New India Assurance Company, United India Insurance Company, Oriental Insurance Company, and National Insurance Company, to provide names of all hospitals that are not in their PPN list. Along with the names, these insurers will also have to specify the reasons for taking these hospitals off their list.

The order was passed after an RTI activist Chetan Kothari filed an application with Public Information Office (PIO) of New India Assurance Company, last year. On receiving the application, instead of giving a reply, after a delay of 30 days, the PIO transferred his query to the first appellate authority. The appellate authority directed the PIO to provide Chetan Kothari with the information, which was not acted upon. Following this, Mr Kothari filed a second appeal before CIC, against New India for not providing the names of hospitals.

On July 27, 2011, CIC Information Commissioner Deepak Sandhu said, this information needs to be disclosed as the person may have taken a mediclaim policy on the assumption that, the cashless facility will be made available to him or her in all hospitals that feature on the list provided by the company. He also added that the insurance company's obligation is not reduced in anyway in terms of the amount of premium required to be collected from the policy holder. Whereas, the insurance company, in a non-transparent fashion, reduced the facility that was available to the appellant (policy holder) at the point of taking the mediclaim policy by taking off some of the hospitals from their list of hospitals providing cashless facility.
 

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