The state government has announced a revised health insurance scheme that will provide insured families at least four times more money for diagnosis, treatment and postoperative care. The scheme will also channel more money into government hospitals.
Fresh tenders will be called for the revised scheme by July 20. As of now, officials say they are unable to assess how much more this scheme will cost the state exchequer. Industry experts expect it to be 30% higher but add that a competitive bidding process to select insurance vendors could reduce premiums and hence, costs for the government. The DMK government had set aside Rs 750 crore for this financial year in the interim budget. In a press release, chief minister J Jayalalithaa said the new scheme would allow the insured families to receive up to Rs 1 lakh each year against the ceiling of four years in the previous scheme.
For some treatment, claims up to Rs 1.5 lakh would be allowed. "This will be a big boost to patients with chronic ailments," said a senior official of the health department. Under the previous scheme, a person being treated for cancer, for instance, would exhaust the claims in the first two years and the remaining members would not be able avail benefits. With this scheme, the family can use up to Rs 4 lakh for four years.
In addition, hospitals can claim diagnosis and post-operative care cost. It allows post-operative care claims up to five days after the patient is discharged from hospital. The number of diseases covered under the new scheme has been increased to 950 from 642 in the previous one. The scheme includes a range of specialties, including oncology, cardiology, nephrology and neo-natal care and paediatrics. Ailments like heart attacks were left out in the previous scheme because there was only intensive therapy and no surgery. "In the case of newborns, many might require medical treatment for cases of low temperature. This scheme will give them a new lease of life," said paediatric surgeon Dr Priya Ramachandran, Kanchi Kamakoti Child's Trust Hospital.
Many doctors from the private sector welcomed the additional facilities but warned that reimbursements should be scientific. "It's good to have features that the old scheme lacked. But the state government should insist that the hospitals are more scientifically evaluated. Treatment for any disease can't be uniform because then hospitals may not take up treatment for complicated cases," said senior cardiothoracic surgeon Dr K R Balakrishnan, director, cardiac services, Fortis Malar.
Fresh tenders will be called for the revised scheme by July 20. As of now, officials say they are unable to assess how much more this scheme will cost the state exchequer. Industry experts expect it to be 30% higher but add that a competitive bidding process to select insurance vendors could reduce premiums and hence, costs for the government. The DMK government had set aside Rs 750 crore for this financial year in the interim budget. In a press release, chief minister J Jayalalithaa said the new scheme would allow the insured families to receive up to Rs 1 lakh each year against the ceiling of four years in the previous scheme.
For some treatment, claims up to Rs 1.5 lakh would be allowed. "This will be a big boost to patients with chronic ailments," said a senior official of the health department. Under the previous scheme, a person being treated for cancer, for instance, would exhaust the claims in the first two years and the remaining members would not be able avail benefits. With this scheme, the family can use up to Rs 4 lakh for four years.
In addition, hospitals can claim diagnosis and post-operative care cost. It allows post-operative care claims up to five days after the patient is discharged from hospital. The number of diseases covered under the new scheme has been increased to 950 from 642 in the previous one. The scheme includes a range of specialties, including oncology, cardiology, nephrology and neo-natal care and paediatrics. Ailments like heart attacks were left out in the previous scheme because there was only intensive therapy and no surgery. "In the case of newborns, many might require medical treatment for cases of low temperature. This scheme will give them a new lease of life," said paediatric surgeon Dr Priya Ramachandran, Kanchi Kamakoti Child's Trust Hospital.
Many doctors from the private sector welcomed the additional facilities but warned that reimbursements should be scientific. "It's good to have features that the old scheme lacked. But the state government should insist that the hospitals are more scientifically evaluated. Treatment for any disease can't be uniform because then hospitals may not take up treatment for complicated cases," said senior cardiothoracic surgeon Dr K R Balakrishnan, director, cardiac services, Fortis Malar.
Source:TOI
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HEALTH INSURANCE
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