PPN Network
PPN stands for Preferred Provider Network. At present it is applicable to the four public sector insurers only – United, New India, Oriental and National. These PSUs have a tie up with hospitals all over India. Under this arrangement, standardized rates are applicable for certain listed illnesses. The package generally covers
Room Charges
OT Charges
Investigations
Medicines during the IPD
Fees of in house panel of doctors
Implants (mostly on actual basis)
Incidentally, three types of rates may be applicable in a PPN hospital for a particular illness.
for PSU insurers on cashless basis
for private insurers on cashless or reimbursement basis
for patients who have no health insurance – cash basis
Many a time, policyholders do face difficulties availing a PPN package. Suppose the Insured Person’s hospital bill amounts to Rs. 75000 but the package rate is Rs.60000. And the pre existing & post hospitalization expenses total up to Rs.15000. Who pays the extra Rs.30000 paid by the Insured Person? While some amount from pre existing & post hospitalization expenses may be paid by the insurer, it is doubtful if the entire amount of Rs.30000 will be received.
What is the IRDAI’s stand on this vexed issue of PPN rates?The IRDAI in its ruling against Good Health TPA Ltd. dt. 17/11/2014 has stated that:“In case the insured opts for some packages which are over the PPN rates or prefer hospital out of PPN, the insurer should honour all such reimbursement claims if admissible.”
Remarks:
PPN was touted as saving money for the insured so that he/she would have more balance left in the sum insured limit. However it mostly results in the insured paying the extra charges over the approved cashless amount.
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