Health Insurance, Cashless 'Juggernaut'!
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ICMR HOME | Case Studies Collection
Case Details:
Case Code : INS054
Case Length : 10 Pages
Period : 2010-2011
Pub Date : 2011
Teaching Note : Not Available
Organization : -
Industry : -
Countries : India
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INS054) click on the button below, and select the case from the list of available cases:
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This case study was compiled from published sources, and is intended to be used as a basis for class discussion. It is not intended to illustrate either effective or ineffective handling of a management situation. Nor is it a primary information source.
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Excerpts
Insurance Industry in India: Prior Liberalization
Insurance industry in India begun with the establishment of the Oriental Life Insurance Company in Kolkata (the then Calcutta) in 1818. Oriental Life Insurance Company was started by the Europeans to serve only Europeans (though, later it started serving Indians also). Bombay Mutual Life Assurance Society heralded the birth of first native life insurance company in the year 1870. The Insurance Act 1938 was the first legislation governing both life and non-life insurance and to provide state control over insurance business...
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Insurance in India Post Liberalization
In post liberalization era, following recommendations of the Malhotra Committee, in 1999, the Insurance Regulatory and Development Authority (IRDA) was constituted as an autonomous body to regulate and develop the insurance industry...
Cashless Claim Facility
Health Insurance policy with cashless claim facility was first introduced in July 2002, by Bajaj Allianz which allowed the insured to get treatment at a network hospital (hospitalization, surgery, or both depending on the kind of policy) without having to pay for it at the hospital. The insurance company was settling the bill directly...
Policy Restricted, Customer Victimized
General Insurance Public Sector Association (GIPSA), a group of four public-sector general insurance companies (New India Assurance Company, United India Insurance Company, Oriental Insurance Company and National Insurance Company), with effect from July 1, 2010, removed about 150 hospitals from the list of preferred provider network (PPN) that provide cashless hospitalization services to policy holders under the scheme...
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Negotiations for Settlement
GIPSA claimed that PPN would benefit not only insurers but also customers in the long run. Private Insurance companies continued to honor claims in cashless mode but supported GIPSA and reiterated that costs need to be addressed by the constituents of healthcare industry...
Exhibits
Exhibit I: Insurance Companies Operating in India
Exhibit II: Procedure for Availing Cashless Claim
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