Med insurance: Can’t pre-declare rates, cos tell HC

Mumbai: The General Insurance Council (GIC) representing 27 non-life insurance companies told the Bombay high court on Thursday that it cannot pre-declare package rates for 42 standard ailments in policy documents.      A division bench of Chief Justice Mohit Shah and Justice M S Sanklecha was hearing a public interest litigation filed by activist Gaurang Damani on medical insurance woes faced by people. 'Pre-declare insurance rates for transparency'  Mumbai:An HC bench of Chief Justice Mohit Shah and Justice M S Sanklecha at a hearing on October 22, 2013 had made insurance companies parties to a PIL on medical insurance woes, seeking that they pre-declare their package rates.      Expressing the inability of the firms to implement the court's order, GIC's advocate Asim Vidyarthi said: "It is difficult to grade hospitals. Also, hospitals do not come under any common regulatory authority and do not accept package rates proposed by insurance companies."      He also said insurance firms cannot work out package rates for "so many ailments". This was contradicted by Damani, who said that the National Insurance Company has a contract with the state for the Jeevandayi Arogya Yojna, where they have declared package rates for 971 procedures. Vidyarthi sought time to file a detailed affidavit elaborating reasons for refusal to pre-declare package rates.      Damani submitted that package rates should be pre-declared in order to bring transparency to the consumer who will know the exact amount to be reimbursed. "Then the consumer can decide whether he can take treatment at a hospital like Breach Candy or a local nursing home," said Damani, adding that a dispute on this has been going on for several years between hospitals and insurance firms. "Insurance companies can declare package rates according to the policy's sum assured," he added.      The court also asked the Insurance Regulatory and Development Authority (IRDA) why it does not put a clause on pre-declaration in the regulation itself so that insurance firms have to comply. IRDA's advocate Paritosh Jaiswal said the authority accepts the court's order but insurance firms have expressed their inability to do it. "You are not doing it because you think it is the court's baby and not yours," remarked Justice Shah. The next hearing is on January 9, 2014.— Rosy Sequeira