The discounts given by hospitals to health insurers will soon get reflected in policyholders’ medical bills. This development comes in the wake of the regulator asking insurance companies and third-party administrators in June last year to pass on discounts received by them from hospitals to policyholders.
Insurers get discounts of around 15 per cent from hospitals for bringing volumes to them, said Segar Sampathkumar, General Manager at New India Assurance.
Suresh Sugathan, Head of Health Insurance at Bajaj Allianz, said: “We pass on to the policyholder the discount or negotiated package rate that we get from hospitals. As a result of this, the sum insured would go down by a lower amount after making a claim.” A senior official from a general insurance company said that often third-party administrators (TPAs) do not pass on the discounts given to insurers by hospitals to policyholders to bring down costs. However, the Insurance Regulatory and Development Authority of India (IRDAI) recently clarified that claim settlements can be done only by the insurer and not by the TPA.
Amit Bhandari, Head of Health Underwriting and Claims at ICICI Lombard, said that at present the discount is given to an insurance company’s payment as hospitals link it to the volumes that insurers bring in. “So, if the claim amount is ₹5 lakh, then we are asking hospitals to give discounts on that amount instead of the amount that we pay, especially in cases where the medical bill is higher than the sum assured in the insurance policy,” he said.
According to Shreeraj Deshpande, Head of Health Insurance at Future Generali India Insurance, the benefit for the retail policyholder is that they will now have a higher balance sum insured in the policy after a claim in that year, while for corporates the net savings will help in lowering their premium outgo during renewals.