MODALITIES FOR HEALTH INSURANCE SCHEME UNDER DISCUSSION

Chennai: A day after the government announced its decision to extend health insurance cover to the poor, Chief Minister M. Karunanidhi convened a meeting of officials to discuss the modalities of implementation of the project. Emerging from the discussions, he said he had preliminary discussions on the scheme with Finance Secretary K. Gnanadesikan on the method to identify the beneficiaries, financing, floating of tenders and the chronic diseases that needed to be included under the scheme.

“It will take about three to four months for the scheme to be operational,” Mr. Karunanidhi told The Hindu. Since a notification for the general election was expected in between, the government would not be able commence the work on the project. “We will suspend work on the project once the code of conduct comes into force and will recommence after the elections,” he said.

In the discussions, Mr. Karunanidhi felt that beneficiary identification was critical to the scheme and hence the first major task would be identifying them. It was suggested that the government take the database of the Agricultural Welfare Board, which has a list of about 75 lakh members and this could be the start. The government decided to verify the database and involve the district administration in the process of identification of beneficiaries.

While this was on, tenders would be called for from insurance companies to operationalise the scheme and shortlist private hospitals. “Once tenders are called for, we need to give at least 30 days. Within that time period, it is possible that elections are announced. Then, the process will be kept in abeyance till such time the election processes is completed,” an official said.

For now, the thinking in the government is to include only serious ailments for which government sector hospitals in district towns are not able to cater. “We spend about Rs.3,000 crore a year on government hospitals. If we include all diseases, then this investment will go waste,” an official said. With only major diseases included, the government expects the insurance premium to be in the region of Rs.300 crore.

On the question of selecting a firm from among the public sector players in the field, Mr. Karunanidhi said the company was to be chosen after bidding and all procedures under the Tamil Nadu Transparency in Tenders Act would be followed. Also, the firms would have to be approved by the Insurance Regulatory and Development Authority. “We will not be able to prefer a private sector firm or public sector firm in this,” the Chief Minister said.

Source: The Hindu

CII WELCOMES HEALTH INSURANCE SCHEME FOR THE POOR

Chennai: The State Council of Confederation of Indian Industry (CII) on Thursday welcomed the State government move to introduce Health Insurance Scheme for Life Saving Treatments for the poor and low-income groups. Addressing newsmen, Manikam Ramaswami, CII-TNSC Chairman, said “this gesture of Chief Minister M. Karunanidhi will go a long way in not only improving the physical health of the people, but also the financial health as healthcare costs is one of the most important reasons for indebtedness.”

“Besides, it will ensure that Social Development Indices will accelerate faster than Gross State Domestic Product growth rate which alone is sustainable. CII is particularly happy to note that the government has included lifestyle diseases, which is the largest contributing factor to hospitalisation, and high cost of healthcare,” he said. According to Mr. Ramaswami, the idea of preventive healthcare for lifestyle diseases (veedu thedi vandhu varumun kaappom) was mooted at ‘Healthcare for All’ Summit jointly organised by the State government.

As against Varumun Kappom, preventive healthcare for lifestyle diseases is seen as a means to substantially reduce the need for hospitalisation and cover all healthcare costs through an innovative insurance scheme by roping in private healthcare providers in addition to government hospitals. Mr. Ramaswami called for appointment of healthcare worker in the ratio of 1:4000 people to carry out check-up of urine-sugar, urine-salt and blood pressure at doorsteps and inclusion of more number of players under Public-Private-Partnership to give wider choice to employees to select the appropriate insurance scheme.

By February end, CII-TNSC will submit its recommendations to the State government on Employees State Insurance Scheme’s quality of service, its location and the expectation of the employees among other things. The survey was necessitated as most of the employees said that they have spent more than the ESIC money and the services were not satisfactory.

Source: The Hindu

SATYAM RENEWS STAFF HEALTH INSURANCE

Hyderabad: There is a big relief for thousands of employees of the scam-hit Satyam Computer Services across the country on the health insurance front. The Hyderabad-based company has renewed the group health insurance for its employees. According to a Satyam spokesperson, the last date for the payment of the premium was and the company promptly renewed it.

The company has Iffco-Tokio General Insurance Co. as its insurer and TTK Health Care Pvt. Ltd. as the Third Party Administrator (TPA). The renewal premium was roughly about Rs 30 crore. Incidentally, the insurance premium expired at midnight yesterday.
Meanwhile, the company has also said the insurance premium for the Satyamites in the US was paid.
Source: The Hindu Business Line

HEALTH CLAIMS: NON-LIFE INSURERS PLAN THIRD PARTY ADMINISTRATOR

Mumbai: The four public sector non-life insurers – New India Assurance, Oriental Insurance, United India Insurance, and National Insurance – are mulling floating a third party administrator (TPA) company to take advantage of the healthy volumes in the health insurance segment. “There is a case for the four public sector non-life insurers to come together to set up a third party administrator for health insurance due to good volumes in the segment,” said Mr M. Ramadoss, Chairman and Managing Director, Oriental Insurance Company.

An insurance company takes the help of TPA to manage its claims processing and hospital networks. Delhi-headquartered Oriental Insurance Company is planning to set up separate offices to cater exclusively to the needs of brokers, large corporate accounts, retail accounts, bancassurance and dealer tie-ups. The existing offices are being re-designated depending on which business is more dominant in that office. “We are focussing our attention on various segments of the market. Brokers are an important distribution channel and we have set up separate offices to cater to this segment. By March, we should have at least 10 offices catering to the broker segment,” Mr Ramadoss said. The company has also started its first centralised claims service centre in Chennai to service motor-own damage claims.

During the nine months ended December 31, 2008, Oriental’s gross premium has grown by 2.7 per cent to Rs 2,978 crore. It is focusing on reducing its underwriting losses, especially in health insurance claims and motor third-party claims. “We aim to reduce our third party claims in health and motor by 10 per cent and 5 per cent respectively by March-end 2009,” he said. The company is hoping to collect gross premium of Rs 4,000 crore by March 31, 2008.

Source: The Hindu Business Line

SATYAMITES LOSE HEALTH INSURANCE COVER

Hyderabad: Thousands of Satyam employees working across the country are set to lose their health insurance cover from as the beleaguered IT giant has failed to renew the premium. The company did not pay the approximately the Rs 30 crore outstanding premium “despite repeated requests” to Iffco-Tokio General Insurance Company on Wednesday which is the last date for payment, according to reliable sources.

The personnel from the Third Party Administrator (TPA) – TTK Health Care Pvt. Ltd – also tried to reach Satyam top brass in vain. While the lower-level staff replied that a decision would be taken at the top level, none of them took any measures to pay the premium, the source said. “When we asked them for the payment a couple of days ago, we were told that the first priority was to run the office and pay the salaries but not health insurance,” the source said.

The immediate implication for the employees is loss of health cover. “Unlike life insurance there is no provision to pay later with fine. The company has to take a fresh policy. Till then no health claims would be valid,” he said. The limit of health insurance cover for Satyam employees varies at different levels beginning from Rs 2 lakh. The average claim size of Satyam has been between Rs 12,000 and Rs 15,000, according to data available with TTK Health Care.

Employees shocked
When contacted, some Satyamites were shocked to know that the premium was not paid.
“This is very painful as our life has already been ridden with uncertainities over the job itself. I see this as an indication of future shocks. I hope, I don’t lose my job by the month-end,” Mr A. Janardhan, a Satyam staffer, said.

Top brass under cover
Paradoxically, the top brass of Satyam still enjoy insurance cover (other than health) as on date under the D&O policy which protects the personal fortunes of individual directors and officers, in respect of personal liabilities arising out of their wrongful acts such as breach of duty, breach of trust, neglect, error, misstatement or misleading statement.

“As on date the insurance cover for Satyam top brass under Directors and Officers (D&O) and Errors and Omissions (E&O) policies is very much in force,” an official from ICICI Lombard said while refusing to give details about renewal date and premium dues.

Sources: The Hindu Business Line

HEALTH INSURANCE SCHEME FOR THE POOR THIS YEAR

Chennai: The government will launch an insurance scheme for the poor and low- income groups to get the best medical treatment in government and private hospitals, Governor Surjit Singh Barnala said on Wednesday. It would benefit about one crore families. The insurance cover would be up to Rs.1 lakh.

In his address to the Assembly, Mr. Barnala said the government was aware that it was not possible for the poor to pay the cost of treatment in private hospitals, especially for cancer, heart diseases, kidney failure, brain and spinal problems and life-threatening accidents.

“Considering these facts, a new scheme, the Chief Minister’s Insurance Scheme for Life Saving Treatments, will be launched this year.” It would enable the poor to get treatment in government as well as private hospitals for serious ailments. “Each family will be insured for availing itself of free treatment up to Rs.1 lakh. The government will bear the entire premium.”

The State government would further increase the minimum support price for sugar cane. “On the basis of requests, the government has decided to raise it to Rs.1,100 a tonne. In addition, by bearing Rs.90 towards transport charges and providing, on an average, Rs.30 as recovery-based incentive,” the per tonne realisation for farmers would be Rs.1,220.

Mr. Barnala said that after the damage caused by the rain, the government had given farmers Rs.388 crore in relief. The relief distributed to the affected, spread across 12 districts, amounted to Rs.1,027 crore. He urged the Centre to provide, at the earliest, the financial assistance the State government needed to fully restore the affected areas and disburse adequate relief.

On the plight of Sri Lankan Tamils, he said the government had urged the Centre “to take, without delay, appropriate alternative measures like dialogue so as to establish peace, and thus protect the Sri Lankan Tamils who are suffering.”

The government welcomed the law enacted to create a National Investigation Agency, but said it should “operate without interfering with the powers of State governments or affecting individual liberty.” Speaker R. Avudaiappan read out the Tamil version of the Governor’s address.

Source: The Hindu

MATERNITY BENEFIT TO COME UNDER RASHTRIYA SWASTHYA BIMA YOJANA

New Delhi: The Union Cabinet on Thursday approved inclusion of maternity benefit under the Rashtriya Swasthya Bima Yojana (RSBY), subject to the condition that the premium is within the existing limit of Rs.750 per beneficiary. The modification would be applicable with immediate effect and this would encourage institutional delivery among those workers living below the poverty line.

The RSBY was launched on October 1 last year for the BPL population in the unorganised sector. The scheme is being implemented by the State governments through insurance companies by inviting bids from both public and private companies. Almost all States have agreed to implement the scheme during the current year with Haryana, Punjab, Delhi, Gujarat, Bihar, Jharkhand and Tamil Nadu already starting enrolment and issuing smart cards. As many as 12 States have initiated the process and the remaining are likely to start implementation soon.

Until September 23, more than 3.39 lakh smart cards had been distributed covering more than 16.97 lakh people. So far, 1,458 people have availed themselves of benefits under the scheme. The Cabinet Committee on Economic Affairs also gave its approval for continuation of the ongoing Integrated Child Development Services scheme during the XI Five-Year Plan period within the total allocation of Rs.44,400 crore. With this, the total number of anganwadi centres will also increase to 14 lakh.

Regarding the provision of serving hot cooked meals in all anganwadi centres, the government has decided to constitute a Group of Ministers which will give its recommendations after consultations with the State governments.

Source: The Hindu

‘ESI SEEN AS INEFFECTIVE HEALTH SCHEME’

Bangalore: Employee State Insurance (ESI) is seen as an ineffective health insurance scheme for the organised sector temporary employees. In a study by staffing solutions company, TeamLease Services, nearly 70 per cent of temporary employees view the ESI deduction as a form of tax for which they get no or very poor return.

The report says that only 30 per cent of the two per cent who used ESI facilities were satisfied with the facilities and this was because of the poor and dilapidated conditions of the ESI facilities.

Another reason the report cited for poor usage of the facilities was the complex functioning of the ESI scheme that makes it ‘almost incomprehensible to the employee who pays for it.’ Only 15 per cent of the employees surveyed knew how the scheme functioned.

The report says that despite ESI Corporations’ revenues of Rs 2,400 crore in fiscal 2005-06 and an operating surplus of Rs 1,130 crore, the ESI infrastructure is way below WHO standards.

ESIC has a just one bed for 1,882 people to be served, which when benchmarked against bed availability in other countries, the ratio is ‘embarrassingly inadequate and needs to be improved at the least by a factor of 3.’

Mr N. Venkataraman, CFO, TeamLease Services, said about the study, “Our research points to an immediate need to revisit the fundamentals of the ESI scheme to address the radically changed employment scenario in the country. ESI reforms need to be prioritised because of the poor value for money, poor design and lack of consumer choice.”

Source: The Hindu Business Line

INSURANCE SCHEMES ARE NOT IN THE PINK OF HEALTH

New Delhi: How do you provide health care to handloom weavers, who occupy among the poorest segments in the unorganised sector? There are 6.5 million of them scattered across the country and are not always fixed in their occupation.

For the textile ministry that oversees their welfare, the answer was insurance cover — with a private company underwriting the risk. It was seen as a daring move when the scheme was launched three years ago, and has since become something of a trendsetter.
The Health Insurance Scheme for Weavers, launched in 2005, has a number of firsts to its credit. It provides medical assistance for a wide range of common ailments, which means Out Patient Department (OPD) is covered, and also allows beneficiaries to use alternative systems of medicine.

According to an official of ICICI Lombard, which put in the winning bid, the scheme is path-breaking and not just because of its geographical spread. Says Sanjay Pande, head of the insurance firm Financial Inclusion Solutions Group, which deals with government schemes: “There were so many firsts in the scheme that we were petrified.”

Progress, however, has been slow. So far 1.77 million weavers have been covered, but, given the challenges, it is “a hugely successful scheme”, claims Meenu Kumar, chief enforcement officer with the Handloom Development Commissioner’s office, who oversees the project. Among the tougher challenges: selling the scheme to the weavers and putting together a network of rural clinics and hospitals to meet the requirements of the scheme where 70 per cent of the treatment is cashless.

Because of malpractices and shortcomings, close to half of the 3,500 hospitals and clinics that were empanelled have been de-listed. A more controversial issue though is the amount of the insurance cover: beneficiaries are entitled to treatment amounting to just Rs 15,000, a pittance compared to what other government schemes offer. Textile ministry officials tend to bristle at such criticism, with one ministry functionary claiming that “the amount may seem very little but is in fact a big improvement for weavers”. A comparative analysis of health insurance schemes shows that the premium is by far the highest in the weavers’ scheme compared to the benefits offered.

Yeshasvini, the pioneering scheme launched in 2003 for cooperative farmers in Karnataka, charges just Rs 120 annually for insurance cover of Rs 1,00,000. Farmers are entitled to treatment for everyday problems in the rural areas, such as snake bites, electric shocks and farm accidents, and for sophisticated heart surgeries at the best cardiac hospitals in the state. S R Naik, CEO of the Yeshasvini Cooperative Farmers Healthcare Trust, claims with some justification that “there is no such scheme in the whole world”.

For one, it does not have an insurance company underwriting the risk and, for another, it does not use a single rupee from the premium for establishment costs. A small room with just a couple of tables and cupboards is the office of the trust where Naik, a retired official of the department of cooperatives, runs the show, backed by the machinery of the department and a third party administrator (TPA), Family Health Plan Ltd, which implements the scheme.

The TPA is paid a flat sum of Rs 50 lakh a year. But the fact is that the scheme cannot run without government support. The subsidy has been increasing sharply and this year the Karnataka government’s contribution (Rs 40 crore) has outstripped the premium collected so far (Rs 33.45 crore).

Numbers are crucial for health insurance schemes to remain viable. Pande maintains that ICICI Lombard is yet to make money on the weavers’ scheme but hopes to do so when it reaches critical mass. Fortunately for the company, it was able to clinch the subsequent tender (2007-09) also, and the higher volumes are expected to provide profits in the fourth year of operations.

Companies though are willing to pay a price for their learning experience. ICICI Lombard claims it lost heavily on other projects, such as the one for Punjab cooperative farmers (premium collected Rs 5.2 crore, claims paid Rs 28 crore) and in Jammu & Kashmir (premium income Rs 7.2 crore, pay-outs Rs 41 crore). Yet, it is, like other companies in the business of health insurance, jockeying hard for a piece of the action. Most of the contracts for government schemes are said to be hard-fought battles with very narrow differences in the bids.

Says R Sasi Ganapathy, chief operating officer of Star Health and Allied Insurance Co, which covers the risk for AP’s Rajiv Aarogyasri: “There are no big profits in this business just now. In Aarogyasri, we make very little money even though it’s the largest of its kind in the world. For us, it is a stepping stone because the experience is helping us to gain a foothold in other states.”

Star Health, India’s first stand-alone health insurance firm, has invested around Rs 14 crore in Aarogyasri. This may seem a large investment for a small firm but is small beer compared to the business it is expected to garner. The company has won the health insurance tender for three million state government employees in Tamil Nadu and is expecting more business from neighbouring states.

“The brand equity of Aarogyasri is very high and our costing will be tough for other companies to match,” asserts Ganapathy. All the same, it may not be a cakewalk in other states, where the lack of data could make risk-profiling difficult. The big battles will be over the labour ministry’s Rashtriya Swasthya Bima Yojana (RSBY). This is being put to tender on a pilot basis, and so far just three states have awarded contracts for some districts. There is big business in the offing as 16 other states are preparing to seek bids.

Source: Business Standard

FIRST HEALTH INSURANCE POLICY FOR HIV LAUNCHED

Bangalore: A group insurance plan for HIV positive people, covering their treatment cost among others, was on Wednesday launched here in a first such effort in India. The pilot initiative will provide Rs 30,000 insurance cover for 250 people living with HIV in Karnataka's six districts of Bellary, Mangalore, Mandya, Kolar, Mysore and Udupi. The insurance cover entails the beneficiary Rs 15,000 assistance for hospitalisation and a similar sum to his family in the event of his death, Sanjay Rao Chaganti, Programme Director of Population Services International (PSI), an NGO behind the project, said here. PSI in partnership with Star Health and Allied Insurance Company and the Karnataka Network for Positive People (KNP+) has introduced the insurance plan. "It is a problem to enroll HIV positive people, because they either don't disclose or come forward. It is only through the help of organisations like KNP it can be done," Sanjay explained. Andhra Pradesh Aids Control Society has identified 3,000 such persons and they would soon be brought under similar insurance programmes, he said. The annual premium for the policy works out to Rs 1500 per person and the NGO will bear half of the amount. Karnataka State Aids Prevention Society Project Director, Manjunath Prasad said the state had 2.5 lakh HIV infected and 33,000 suffering from AIDS. National Aids Control Organisation Director General K Sujatha Rao said out of the Rs 1100 crore budget provided during 2008-09 for AIDS control, about Rs 150 crore was being spent on creation of awareness about the disease.

Source: PTI, The Economic Times, The Hindu, The Tribune, The Times of India, Daily News & Analysis

MAKEMYTRIP.COM, APOLLO DKV TIE UP

Mumbai: Online travel portal Makemytrip.com has tied up with Apollo DKV Insurance Company for a domestic travel insurance solution, a statement said on Tuesday. The new product called ‘Easy Domestic’ travel will cover travel-related risks of domestic airline passengers. The product would cover travellers against several travel contingencies like accidental death, emergency medical treatment, trip cancellation, trip curtailment, checked baggage loss, flight delays, trip interruption, emergency hotel and emergency travel among others. This all will come for a premium of Rs 111 for all tickets booked online. The policy is valid for the duration of a round trip cross-sector travel or 30 days from the date of booking, whichever is lesser, the statement added.

Source: The Hindu Business Line

APOLLO DKV, MAKEMYTRIP TEAM UP

New Delhi: Apollo DKV Insurance Company, a health insurance company, has tied up with MakeMyTrip, a travel company, to introduce a domestic travel insurance solution for travellers within the country.

The alliance ensures that travellers have the option of a one-stop solution that takes care of their travel and travel insurance needs comprehensively. The new product, Easy Domestic travel, will cover travel-related risks of domestic airline passengers and would come with the added benefits of ‘TravelMate’ to take worry out of travel for all customers.

Speaking at the launch, Mr Chandrasekhar, Chief Marketing Officer, Apollo DKV, said, “Apollo DKV’s tie-up with MakeMyTrip is an important step in making insurance products readily available to large sections of the society. This partnership reiterates our commitment towards enhanced customer satisfaction.”

Mr Chandrashekhar said health insurance and travel continue to be a high-growth sector and more and more travellers are recognizing the need for travel insurance.

Source: The Hindu Business Line

IRDA MAY ENSURE AFFORDABLE HEALTH COVER TO ALL, EVEN AFTER 65 YEARS

Hyderabad: Senior citizens have good chances of getting a health cover even after they turn 65. Insurance regulator IRDA is vetting a proposal to make health cover affordable to all senior citizens. A final view will be taken on providing guaranteed access to health insurance for this segment by the end of this year, said a top official of the regulatory body. The proposal is based on the recommendations of an expert panel on health insurance last year. The panel recommended allowing senior citizens to enter the health insurance system up to 65 years of age — or higher — at the discretion of the insurer.

If they do so, they should be given guaranteed renewal of their insurance without any upper age limit. As a transitional measure — since guaranteed access is being provided to senior citizens for the first time — there should be no upper age limit for entry or renewal for a period of three years from the date the IRDA issues the regulations”, the panel had said. It had made out a case for insurers to fix a “base” price of Rs 3,000 every year for a sum insured of Rs 1,00,000 (at 50 years). “We are examining these recommendations of the panel we reckon that health insurance should be made affordable, given the mounting health care-costs,” said DVS Sastry, director general, IRDA at a seminar on effective cross selling of insurance and mutual fund products organised by Watson Wyatt and the Indian Institute of Banking and Finance here. Several senior citizens have registered complaints with the regulator about insurance companies denying renewals. Industry experts, however, reckon that people should enter health insurance schemes at an early age to enable insurance companies distribute their risks better. Currently, health insurance penetration is minuscule in India. The total premium from health insurance stood at Rs 4,970 crore in FY 08, marking a 55% growth over FY07. Currently, there are only two standalone health insurance companies — Star Health and Allied Insurance and Apollo DKV — offering pure health products. The government is looking at raising the cap on foreign direct investment (FDI) in insurance from 26% to 49%. It is also considering a minimum capital requirement of Rs 50 crore for health insurance companies to make it attractive for new-entrants. Consumers are expected to get a better deal in terms of pricing when competition intensifies among these players.

Source: The Economic Times

FBI: Hospital CEO arrested in health care scheme

LOS ANGELES - A hospital CEO was arrested Wednesday in what authorities said was a scheme to recruit homeless people as phony patients and bill government programs for millions of dollars in unnecessary health services.

Federal agents raided three medical centers and the city of Los Angeles sued the hospitals, saying they used homeless people as "human pawns."
More charges are expected, a federal prosecutor said.
Hospitals in Los Angeles and Orange counties submitted phony Medicare and Medi-Cal bills for hundreds, perhaps thousands, of homeless patients — including drug addicts and the mentally ill — recruited from downtown's Skid Row, state and federal authorities allege.
While treating minor problems that did not require hospitalization, such as dehydration, exhaustion or yeast infections, the hospitals allegedly kept homeless patients in beds for as long as three days and charged the government for the stays.
Over four years, a mentally ill woman identified as "Recruit X" was admitted to all three hospitals for conditions she said she never had, such as shortness of breath and chest pains.
After her stays, she would be returned to Skid Row and use money she received for participating in the scheme to buy crack cocaine, authorities alleged. She was never treated for drug addiction.
The investigation was sparked in 2006 by a Los Angeles police investigation of reports that hospitals were dumping homeless patients on the streets.
Search warrants were served at City of Angels Medical Center, Los Angeles Metropolitan Medical Center and Tustin Hospital and Medical Center, the FBI said.
FBI agents arrested Rudra Sabaratnam, CEO of City of Angels hospital, and Estill Mitts, operator of a Skid Row health assessment center, FBI spokeswoman Laura Eimiller said. They were in federal custody and were expected to be arraigned Wednesday afternoon.
A 21-count indictment unsealed Wednesday charged both men with conspiring to receive and take kickbacks for patient referrals and to commit health care fraud. Sabaratnam also was charged with paying kickbacks and Mitts was charged with money laundering and tax evasion.
If convicted, Sabaratnam could face 50 years in federal prison, and Mitts could face 140 years, authorities said.
Bond for Mitts was set at $25,000. He was expected to be released Wednesday night to home detention, said Thom Mrozek, a spokesman for the U.S. attorney's office. Sabaratnam's bond hearing was set for Thursday.
Both men were scheduled to be arraigned Monday.
Sabaratnam's lawyer Dominic Cantalupo, and Mitts' lawyer John Vandevelde did not immediately return calls seeking comment.
U.S. Attorney Thomas O'Brien said he expects additional charges in the case.
"This is one of several major medical fraud investigations that are ongoing," he said. "There's too much money being illegally stripped from public health care programs and the potential impact to those with a legitimate need is too great to let such fraud escape federal prosecution."
Representatives of the hospitals did not immediately respond to calls seeking comment. Los Angeles Metropolitan and the Tustin hospital are owned by Pacific Health Corp. and Los Angeles-based Intercare Health Systems owns City of Angels.
The city attorney's office said it filed a lawsuit against the corporate owners of the three hospitals — along with Sabaratnam, several doctors and others — in connection with the alleged scheme.
Frank Mateljan, a spokesman for the city attorney's office, said Skid Row workers "were receiving kickbacks up to $20,000 a month from some of these hospitals and they were delivering between 30 and 50 patients a month."
Mitts ran the 7th Street Assessment Center, which screens people for health needs and takes them to hospitals if necessary.
The lawsuit said the "patients" were picked up by recruiters who sent them to the 7th Street center, where they were given phony diagnoses and forms were filled out justifying their eligibility for government medical programs.
Medi-Cal and Medicare would be billed for the ambulance and hospital stay, Mateljan said.
After their hospital stays, the homeless patients would be returned to Skid Row shelters, but "they would go back multiple times," he said.
In the lawsuit, "Recruit X" said she "received very little medical treatment, and none of the treatment that she received was necessary."
At least once, she suffered a serious drop in blood pressure after she was given a nitroglycerin patch for a nonexistent cardiopulmonary condition, the suit claimed.


Source: SHAYA TAYEFE MOHAJER, Associated Press Writ

DIRECTIVE TO INSURANCE FIRM ON EMPANELLING OF HOSPITALS

Kancheepuram: The United India Insurance Company has been directed not to complete the process of empanelling hospitals for the Union and State government-sponsored Rural Health Insurance Policy (Rashtriya Swasthya Bima Yojana) for the families living below the poverty line (BPL) in Kancheepuram district.

Kancheepuram district has been selected as one of the two districts in Tamil Nadu for implementing the Rashtriya Swasthya Bima Yojana on a pilot basis. Tirunelveli is the other one.

As per the scheme, a BPL family, comprising five members, could avail itself of medical treatment at an empanelled hospital for a maximum amount of Rs. 30,000 a year. While the Union government would be paying 75 per cent of the annual premium of Rs.750 per beneficiary family, the State government would remit the remaining premium amount directly to the insurance provider, the United India Insurance Company.

Chairing a preparatory meeting for revenue officials for the implementation of policy, organised by the company here on Wednesday, Collector Santosh K. Misra directed the insurance cover provider to forward the list of hospitals identified by them as per the policy guidelines to the district administration before finalising it to ensure that hospitals located at a particular block or region alone were empanelled. The company should try to empanel hospitals that were located at different parts of the district so that it would be easy for the rural masses to avail themselves of the benefit extended to them under policy.

Responding to his direction, United India Insurance Company Regional Manager, Chennai, P.N. Balasubramanian said most of the private hospitals were not coming forward to get empanelled in the scheme.

However, 25 hospitals, approached by the company had agreed to sign a Memorandum of Understanding to provide healthcare services to the policyholders at the rate specified by the company.

Replying to another query on empanelling names of the BPL family members, Mr. Balasubramanian said the company would go by the list given by the district administration.

If the name of a newborn is to be included in the list of beneficiaries, then the field officer – either a village administrative officer, revenue inspector or any other suitable village-level revenue department employee – should certify that the child belonged to the BPL family.

Source: The Hindu

WIDER HEALTH COVER FOR POOR

New Delhi: With assembly elections in six states and general elections just months away, the government is planning to expand the scope of its health insurance schemes for the poor. At a marginal premium, families above poverty line (ALP) could also get the benefit of insurance cover if the proposal goes through.
The health ministry is planning to modify the scope of its yet-totake-off Rs 8,000-crore National Urban Health Mission (NUHM) for the urban poor to cover services like outpatient care, which are not covered by the Rashtriya Swasthya Bima Yojana (RSBY). Health secretary Naresh Dayal told ET that his ministry was exploring the option of modifying the proposed insurance scheme under NUHM so that the urban poor can get additional benefits.
The government is also examining the possibility of raising the cover from Rs 30,000 initially proposed. These suggestions came up at a meeting of senior government officials last week. APL families are not covered under RSBY.
NUHM was announced in March this year by health minister Anbumani Ramadoss and was to be launched in four months. However, in April, the labour ministry operationalised RSBY—announced last year —for workers in the unorganised sector. Now, the health ministry, which was all set to kick start NUHM on the lines of the National Rural Health Mission, is thinking of re-designing the insurance component of this ambitious programme.
“We are looking at a variety of options. We may either launch the programme with better reach and coverage or will modify it and cover those areas that have been left out by the labour ministry. Once things get finalised, we will take it to the Cabinet for approval. All this may take 3-4 months,” Mr Dayal told ET.

Source: The Economic Times

LOW-CAP COS MAY GET TO ENTER HEALTH INSURANCE

New Delhi/Hyderabad: Insurance reforms seem to be back on track. The empowered group of ministers (EGoM) vetting changes in the insurance Bill is considering allowing health insurance companies to be set up with a start-up capital of Rs 50 crore.
The group, led by external affairs minister Pranab Mukherjee, is scheduled to meet in New Delhi soon to give its final recommendations on the changes in the insurance legislation. This would be the first meeting of the GoM after the Left parties withdrew support and government announced its intention to bring all the Bills related to financial sector reforms during the present term of the UPA. The EGoM will forward its recommendations to the Union Cabinet. The most crucial and controversial proposal is the hike in the foreign direct investment (FDI) cap from 26% to 49%.
The finance ministry has accepted most of the recommendations of the K P N committee with modifications as proposed by the Insurance Regulatory and Development Authority (Irda), and the recommendations have been made a part of the Insurance Laws (Amendment) Act, 2006 (Insurance Bill).
According to a senior government official, the Centre has proposed a minimum capital requirement of Rs 50 crore for health insurance ventures against Rs 100 crore for life and non-life ventures. It is reckoned that a lower minimum capital requirement will attract more players in health insurance, foster competition and improve penetration in the country. The premium from health insurance stood at Rs 4,970 crore in 2007-08, marking a 55% growth over 2006-07. However, this is a minuscule proportion of the country’s GDP.
In case the paid-up capital requirement is relaxed soon, it could benefit the proposed health joint venture between Max India and Bupa of France. Max India chairman Analjit Singh told ET the two partners would be inking the agreement and incorporating the health insurance company next month following which they would seek R1 registration with Irda. “We are looking at a combo offering that will include outpatient and hospitalisation,” Mr Singh said.
Currently, health insurers are given licences under the general insurance umbrella. There are only two standalone health insurance companies, Star Health & Allied Insurance and Apollo DKV. The government has proposed health insurance as a separate category for licensing purposes.
Companies with foreign joint venture partners can operate in life and general insurance business. The prescribed FDI limit of 26% applies to each line of business as these are separate companies. The practice will continue even if the FDI cap is raised, a senior official said. Cooperative banks will also be given licences for insurance ventures. The institutions are only allowed to tie up with insurers to distribute insurance products.
Among the proposed changes, the insurance regulator is set to be armed with more powers and given greater operational flexibility. It will be empowered to clear the appointment of CEOs of public sector insurance companies. The regulator will also have wider powers in inspection of insurance companies. Operational flexibility will enable Irda to respond fast to emerging developments in the market.

The insurance council, an advisory body to the regulator which has been largely defunct for some time, is set to be scrapped. A Special Appellate Tribunal (SAT) will be the arbitrator for disputes. Insurance companies, on their part, will have to become more accountable. They will have to submit balance-sheets once in six months. Their profit-and-loss account and balance-sheets will have to be in sync with the requirements under the Companies Act.

Source: The Economic Times

CEILING ON ESI MEDICAL REIMBURSEMENTS TO GO

Thiruvananthapuram: The ceiling on medical reimbursement to family members of workers covered under the ESI Scheme for treatment done outside ESI hospitals will be lifted.

Labour Minister P.K. Gurudasan said here on Monday that the Union government had approved a proposal of the State government in this regard. Besides, agreements would be signed with outside hospitals for direct reimbursement of bills. The ceiling was Rs.1 lakh for family members, while no ceiling was specified for the member of the Scheme (worker).

He said facilities at super-specialty hospitals of the ESI Corporation would be upgraded. Besides, more government, quasi-government and private hospitals would be enlisted to provide super-specialty services to patients referred by ESI dispensaries and hospitals. The Corporation had authorised the State Medical Commissioner to enter into an agreement with hospitals in this regard, and direct payment of bills.

Mr. Gurudasan said the proposed medical college under the ESI Corporation at Parippally in Kollam district was expected to start functioning from the next academic year. The Corporation had applied for the affiliation of the University of Kerala. The State government was in the process of issuing NOC to the college. He said the government had requested the Corporation that seats be reserved in the college for family members of workers covered under the ESI Scheme.

He said the Corporation had also completed a feasibility study for starting nursing schools in the State. The State government had sought opening of four schools (Ezhukone, Udhyogamandal, Peroorkada and Feroke).

He said hospital development committees were being formed at the ESI hospitals as per the decisions of the Corporation. These committees would be empowered to spend Rs.25 lakh to Rs.40 lakh for hospital development depending on the number of beds. Mr. Gurudasan said after the LDF government came to power, several steps had been taken to improve the infrastructure facilities under the ESI scheme.

Source: The Hindu

INSURANCE FIRM ASKED TO PAY COMPENSATION

Hyderabad: The A.P. State Consumer Disputes Redressal Commission has rejected the repudiation of a policy-holder’s claim by a health insurance company and ordered it to pay compensation.

The commission disposed of the appeal by Royal Sundaram Alliance Insurance Company Ltd. and upheld the order by the Krishna District Consumer Forum towards reimbursement of the medical expenses incurred by B. Ramanadham, a policy holder. Mr. Ramanadham, a resident of Vijayawada, had taken Health Shield Insurance Policy and Hospital Cash Insurance Policy from Royal Sundaram Alliance.

Under these policies, he was entitled to full reimbursement of treatment expenses up to Rs.1 lakh apart from Rs.1,000 a day as inpatient treatment charges. Mr. Ramanadham visited the NRI General Hospital at Chinakakani in Guntur district in June 2007 with the complaint of a backache. He was admitted to inpatient ward of the hospital in August 2007 and discharged after 10 days.

Mr. Ramanadham filed a claim with the company for Rs. 10,525 towards daily treatment charges and Rs.14,725 for treatment expenses. The company agreed to pay only daily treatment charges and rejected the claim for treatment expenses saying that his backache was a pre-existing ailment. The policy holder challenged the company’s decision in the Krishna District Consumer Forum.

The District Forum gave a ruling in favour of Mr. Ramanadham in April by considering backache as a natural ache and not pre-existing aliment. Royal Sundaram opposed the Forum’s ruling and appealed in the State Forum for its reversal. However, the State Forum upheld the directive of the lower forum on July 7. It ordered the company to pay Rs.10,525 and Rs.14,725 respectively for inpatient and treatment charges with 9 per cent annual interest and costs of Rs.1,000 to the policy-holder.

Source: The Hindu

HEALTH INSURANCE FOR TSUNAMI-HIT

Chennai: Families across the State, who were affected by the tsunami, have been provided medical and accident insurance by the United India Insurance Company. Of this, about 6,500 families are in the city.

Addressing presspersons here recently, the company’s chairman and managing director G.Srinivasan said that about 16,000 families across the State have benefited from the insurance cover over the past one year. The Tsunami Jan Bhima Yojana was launched in March 2007 in association with the Central Government.

Disbursed
Insurance claims worth Rs.7.12 crore have been disbursed so far and the cost has been sponsored by Prime Minister’s National Relief Fund. On the benefits, he said the tsunami affected families have been provided a photo identity card which they could use to avail of medical facilities.

Each family is provided with an insurance cover up to Rs.30,000 a year.
About 180 hospitals in the State have been enlisted based on the quality of healthcare and their location. The yearly premium of Rs.800 a family is provided by the Central Government, Mr.Srinivasan said.

A total of three lakh families have been provided the insurance cover in Tamil Nadu, including those in Tiruvallur, Nagapattinam and Cuddalore districts, and in Kerala.
It would soon be expanded to Andhra Pradesh and Puducherry, he added.

Source: The Hindu