This being my present core specialty , I shall take the opportunity to explain something about these ''Cashless'' cards.
I would like to give a background HEALTH INSURANCE as the ''Cashless'' cards are given only to health insurance policy holders.
Health Insurance cover is provided by General Insurance Companies, just has how Life Insurance cover is provided by Life Insurance Companies.
General Insurance Companies are also called NON-LIFE insurance companies.
Health Insurance Cover commonly called MEDICLAIM POLICY is issued by 4 GIC companies:(These policies are to be renewed yearly just as you renew your motor insurance)
New India Assurance
National Insurance Company
United India Assurance
Oriental Insurance Company
Now , with the privatization of Insurance sector- the following Private insurance companies also sell -Health Insurance:
Bajaj Allianz General Insurance
ICICI LOMBARD GENERAL INSURANCE CO. LTD.
IFFCO TOKIO GENERAL INSURANCE CO. LTD.
RELIANCE GENERAL INSURANCE CO.LTD.
ROYAL SUNDARAM ALLIANCE INSURANCE CO. LTD
TATA AIG GENERAL INSURANCE CO. LTD.
Cholamandalam General Insurance Co. Ltd.
The basic skeleton of the policy remaining the same, all companies have some minor variations in their product.
The product whose review has been requested for : PARAMOUNT CASHLESS CARD is a MISNOMER, as the onus of issuing such cards to Health insurance policy holders is on companies called TPAs.(Third PArty Administrators )and Paramount Health Services is one of the 23 TPAs functioning in India.
TPAs are the new breed of intermediaries in the sector, introduction of whom is benefitting both the insured and the insurer. While the insured is benefited by better service, insurers are benefited by reduction in their administrative costs. But the questions in everybody's mind are - what does a TPA do? Who can be a TPA? What is his source of revenue? How does he benefit the insured?
To put in short, the job of the TPA's is to maintain databases of policyholders and issue them identity cards with unique identification numbers and handle all the post policy issues including claim settlements. In terms of infrastructure, the TPA's run a 24-hour toll-free number, which can be accessed from anywhere in the country. And they will have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy.
SINCE OCTOBER,2002-ANYONE WHO HAS RENEWED / BOUGHT MEDICLAIM POLICY FOR SELF/FAMILY- IS ENTITLES TO RECEIVE A CARD (FROM THE RESPECTIVE TPA APPOINTED BY THAT INSURANCE COMPANY)
The scope of services of a TPA are :
All the records of medical insurance policies of an insurer will be transferred to the TPA.
TPA may issue identity cards to all the policyholders, which they have to show to the hospital authorities before availing any hospitalisation services.
In case of a claim, policyholder has to inform TPA on 24 hr toll free line provided by the TPA.
On informing the TPA, policy holder will be directed to a hospital where the TPA has a tied up arrangement. However policyholder will have the option to join any other hospital of his choice, but in such case payment shall be on reimbursement basis.
TPA issues an authorisation letter to the hospital, for the treatment wherein the TPA will pay for the treatment.
TPA will be tracking the case of the insured at the hospital and at the point of discharge, all the bills will be sent to TPA.
TPA makes the payment to the hospital.
TPA sends all the documents necessary for consideration of claims, along with bills to the insurer.
Insurer reimburses the TPA.
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THE TPAs are licensed by the IRDA (Insurance Regulatory and Development Authority) .
As of today, there are 23 licensed TPAs in India- out of which some 10-12 are operational.
The list of TPAs and more details can be obtained from the website : https://irdaindia.org/tpamain.htm
Important: It is important to note that the CARD ISSUED BY TPAs is NOT a Credit Card, it is just complementary to your health insurance policy, and only on verification of your coverage, will you be given CASHLESS treatment ( ie. admission without collection of deposit FROM NETWORK HOSPITALS OF YOUR TPA + Discharge without payment of bills )
This is a great succor in times where one doesnt have to run around in the middle of the night to collect amount for paying up hefty deposits prior to admission. If the ailment for which you are admitted in a hospital is not covered in your health insurance plan or if you seek admission in a NON-NETWORK hospital- the TPA card will not serve any CASHLESS purpose.
For any further information, kindly send your M2Ms / Comments , I shall be happy to clear your queries.
This review being a technical one, has been compiled with the help of certain Insurance related websites.
