Tamil Nadu

TN government warns insurance company of penalty if cashless treatment is not delivered properly

Image for represenation purpose only. File   | Photo Credit: B. Jothi Ramalingam

The Tamil Nadu government has warned the United Indian Insurance Company (UIIC) that it will invoke a penalty clause, if UIIC fails to instruct all hospitals empanelled under the New Health Insurance Scheme, 2018 to ensure cashless treatment for pensioners/family pensioners.

Under the scheme, healthcare assistance is provided to beneficiaries on a cashless basis for upto ₹4 lakh for a block period of four years for the accredited treatments/surgeries in the hospitals approved by UIIC.

“Any failure to abide by the contract in service delivery, will invite penalty clause and the amount will be recovered from UIIC and settled to the beneficiaries,” said Additional Chief Secretary, Department of Finance, S. Krishnan, in a letter addressed to the Divisional Manager of UIIC, Chennai, dated July 12.

The warning comes in the wake of complaint from the State president of the Tamil Nadu Retired Officials’ Association to the State government on the implementation of NHIS. Empanelled hospitals were seeking large sums of money for providing treatment and also refused to admit pensioners/family pensioners, the association had complained.

The association had requested the government to issue suitable orders to UIIC and empanelled hospitals to provide cashless treatment without any hassles, to patients.

Mr. Krishnan recalled that other instances had also been brought to the notice of the government that some empanelled hospitals insisted on payments over and above the insurance claim from the enrolled beneficiaries. Besides, those hospitals also refuse to implement cashless treatment leading to payment of full amount in view of emergency by the pensioners, he said. “Though there is a provision of penalty clause in the agreement executed between the State Government and UIIC under NHIS, 2018, the State Government has not, so far, invoked the same,” the Additional Chief Secretary said.

As per Clause 22 (1) of the guidelines for implementation of NHIS 2018 for pensioners/family pensioners, it is indicated that in case of deficiency in services or failure to provide services as required by the terms of the scheme, a penalty will be levied as may be determined by the government, subject to a minimum of five times the amount of the expenditure incurred by the government or beneficiary due to non-compliance.

Office-bearer of the Tamil Nadu Government Employees’ Association, C.E. Kannan, said that even government employees faced such hardship in availing themselves of the benefits of the insurance scheme. “We have made several representations to the State government. We expect the government to issue similar strict instruction to the insurance companies so that no beneficiary is put to undue difficulties during the time of emergencies,” Mr. Kannan said.

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Printable version | Sep 22, 2021 8:58:12 AM | https://www.thehindu.com/news/national/tamil-nadu/tn-government-warns-insurance-company-of-penalty-if-cashless-treatment-is-not-delivered-properly/article35675977.ece

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