We all know how important it is to have a health insurance or mediclaim, in today’s times when healthcare costs are mounting. But merely holding a mediclaim policy is not enough. Apart from being chary about how much premium you need to pay, one should also check on:
 

• Whether cashless facility is available;
   
• Does the insurer have a higher number of network hospitals (more importantly the reputed ones);
   
• List of medical conditions that will not be covered by the policy;
   
• The waiting period for pre-existing diseases and whether there are sub-limits (i.e., the claim amount to be paid into smaller fractions wherein the Health Insurance Company bears some of the cost, while the insured bears the rest.)
   

But recently due to difference of opinion between the civic body and medical establishments, your genuine mediclaim may get rejected, despite you taking care of the above mentioned points. Let us find out how.

The civic body in the month March 2012 made it mandatory for medical establishments to meet the fire safety norms by adding it to the list of requirements for renewing registrations. But most hospitals and nursing homes failed to comply with the stringent requirements in a limited time due to which most of them are functioning without a valid registration since the beginning of April 2012.

The stringent norms enforced by the civic body BMC include those which are followed by big hospitals wherein even small nursing homes are expected to fulfil fire safety norms for entire building even if a nursing home may be occupying just one or two floors. As a result of this, small nursing homes and other medical establishments which are small in scale and size are finding it unviable to adhere to such protocols and that too, within a limited time period. Moreover, these stringent protocols have rendered around 20,000 hospital beds in Mumbai and Thane as 'illegal' due to non-renewal of registration required for running a medical establishment.

Impact of such an initiative on policyholders...
Until the civic body and medical establishments iron out their differences, policyholders should take utmost care while undergoing medical treatment in small nursing homes and medical establishments. Before admission, one should check whether said nursing home or hospital has renewed its registration and cross check it with the insurer.

Our view:
We believe that the insurance regulator - Insurance Regulatory and Development Authority (IRDA) should take up this matter and bring about a quick solution to the differences between the civic body and the medical establishments. The policyholders should get due recourse to claim their dues on medical treatment in case the matter takes a while to be sorted out. Policyholders should not suffer due to a spat between civic body and medical establishments.

 

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