Hospital Size a Hurdle for IRDA's Health Insurance

IRDA has its reasons to restrict insurance for a minimum of a 10 bed hospital and one of them is to provide better care to customers.

Many of the IRDA approved changes in health insurance to take place from the 1^st of July are customer friendly and welcome, except the one clause about the size of hospitals.

According to IRDA regulations (Insurance and Development Authority) all eligible hospitals have to include 10 inpatient beds in small townships and 15 beds in larger ones. The hospital should have qualified duty doctors and nurses on a 24 hour basis with a well equipped operation theatre.

Insurance Concepts and IRDA [Insurance Regulatory and Development Authority]
Insurance is a federal subject in India. It is a subject matter of solicitation. The legislations that deal with insurance business in India are Insurance Act, 1938 and Insurance Regulatory & Development Authority Act (IRDA), 1999.

Now, most hospitals can fulfil the required criteria except the one with – number of beds. The maternity hospitals in the suburbs of Mumbai are fully recognized maternity care centres. Many insurance companies have their individual network hospitals. When a patient uses a hospital which is not in the network – then the hospital must conform to the IRDA guidelines.

According to Vivek Desai the Managing Director of Hosmac – a consulting firm - finds that there are small hospitals in the smaller towns and though the number of beds may be a problem at present, it would help patients in the future. “Smaller hospitals are already facing woes because patients prefer to go to bigger hospitals, especially those which have health insurance. Also, treatment for critical care would be an issue in smaller hospitals,” he says.

There may be approximately 20 general insurance companies of which only 6 cover maternity in the family floater and individual policies.

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Divya Gandhi head and principal broker at Emkay Insurance Brokers, is of the opinion that restrictions with regard to the size of the hospital is a way to address false bills.
“Not all third-party administrators have the manpower to physically check all bills. So, if there is a limit on the bed size, it is similar to an assurance that the hospital would be audited and forged claims would be few,” she says, adding that the large number of small maternity hospitals in metros could be a hurdle.

References:

Health Insurance Guidelines by IRDA
The IRDA has agreed to make insurance mandates which suit the beneficiaries.

Hannah Punitha (IRDA Licence Number: 2710062)

Priya Nair, June 2013

IRDA Plans to Develop Systems to Detect Claim Frauds
IRDA would rather save genuine customers from facing hardship with their claims by putting fraud detection systems in place at the earliest.

Source-Medindia