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Please advise about the renewal of the mediclaim policy for our employees?

Q: We are in the process of renewal of mediclaim policy for our employees. Based on the suggestion received for providing photo identity cards and credit facility at major hospitals, we had enquired from National Insurance Co. for extending the services to us in respect of mediclaim policy we have taken for our employees. The insurance company has informed that the aforesaid facilities can be made available only where servicing of claim is handled by Third Party Agency (TPA). By availing the services of TPA, we will have the following disadvantages:-

  1. Delay in settlement of claims as the same will be handled and settled by TPA and insurance company will have no role to play.
  2. Additional premium of 6% will be payable by us.
  3. Loading/discount on premium based on claim ratio will be guided by TPA. In such case, insurance company may not be in a position to use their discretion for special rates for us.
In view of the aforesaid additional cost and long procedure, we may review the suggestion keeping in mind the benefits, which may be available to the insured. What is your advice, as last year there was no photo card given by the insurance company, for which we have noticed whenever there is a sudden problem, one can not avail the benefit in leading hospital when every employee is on tour. First he has to get estimate or he has to admit on own, do payment and then put up all the papers to insurance company. Please advise.

A:Please note that the claim settlement process generally reported after the advent of the TPA services has improved substantially. Especially in cases where there is cashless settlement of claims, once the treatment has been obtained, your employees will not be concerned about paying the hospital any longer. Though the increase in premium by 6% will be borne by you, the quotation for the next year will be given by the insurer only and not the TPA and the discretionary powers shall be retained with the insurer. The rationale of introducing the TPAs is to initiate the cashless settlement process and improve the settlement time in case of indemnity claims. Our advice will be to take the benefit of the TPA services considering that your employees will get the benefit of cashless treatment and will be saved a lot of time filing claims for indemnity.


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