The rising health care costs are taking a toll on
people, especially the poor as well as the middle class. This is because of the
very high out-of-pocket expenditure on health care due to the dismal spending
on health by the government. Having a health insurance plan is gradually becoming
inevitable.
One can have two types of health insurance with
limited coverage or unlimited coverage. For example, we may take an insurance
of five lakhs for the full year with a small premium of Rs 500/- per month. We
may not be able to afford a coverage of one crore.
In limited coverage, the insurance may be through
GIPSA or open. If through GIPSA provider, then there will be a capping, a
limit up to which the insurance will meet the expenses of a particular
procedure in a defined Hospital/Nursing Home. Any amount beyond this limit will
be non payable by the insurance company. This arrangement will be
cashless.
Non GIPSA insurance provider, in their limited
coverage, will not have a procedure based capping. With no capping, the
patient or the hospital may be tempted to use a large amount of money in the
first admission itself. As a result, he/she may run short for future admissions
or other members’ claim, if it was a family floater.
General Insurance Public Sector Association (GIPSA)
is the umbrella organization for the four public sector insurance companies
(National Insurance Co Ltd, New India Assurance Company Ltd, Oriental Insurance
Co Ltd & United India Insurance Co Ltd), which cover around 80% of the
country’s cashless insurance market, which introduced the PPN (Preferred
Provider Network) in July 2010 to cap the high costs of surgical procedures.
Non-GIPSA insurance
companies are private sector insurance companies.
Capping of treatment in health insurance is good
for the patient and ultimately benefits the patient and/or the family in long
run.
What should the capping limit be? This is a matter
of debate between hospitals, insurance companies and the government.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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