…Health insurance is a technical concept wherein there are a lot of complicated jargons used in the policy. PPN in health insurance stands for Preferred Provider Network. It is a network of hospitals which are tied up with the health insurance company to provide cashless health claim settlements to policyholders.
PPN rates are specialized rates listed by PPNs for customers of public sector health insurance companies with which the insurance company has a tie-up. PPN rates are specified for a list of specified illnesses only.
Non PPN Package is for Non Network hospital and for which you first have to take charge of the whole bill, and later it will get reimbursed but how much is still a question.
PPN rates would be applicable only if –
The health plan is bought from a Government Health Insurance Company. There are four such companies which are –
- The New India Assurance Company Limited
- Oriental Insurance Company Limited
- United India Insurance Company Limited
- National Insurance Company Limited
- The illness is a listed illness as prescribed by the insurance companies
- Medical treatments are taken at the networked hospital of the insurance companies (PPN)
PPN rate v/s Cash rate v/s Non-PPN rate
Now you know what PPN rates are. But do you know how they are different from other rates applicable in health insurance claim settlements?
Every hospital, which has a tie-up with an insurance company, maintains three different rates for the same treatment. They are–
- PPN rates applicable for claim settlements under plans offered by public sector health insurers.
- Cash rates applicable if there is no health insurance claim and the treatment costs are payable by the patient in cash.
- Non-PPN rates applicable for claim settlements under plans offered by private health insurance companies which are tied-up with the hospital.
Collusion of Health Insurance, TPA and Hospital
We hope you have understood well about PPN Rate, Cash Rate and Non PPN rate, but the question is still unanswered: how are all these finalized? Who had decided this?
This is a kind of black box which is not open to the common public because this is secret due to this huge profit gain insurance companies have every quarter. Have you ever heard about any loss insurance company incurred in your entire life? No, you cannot because the premium you pay for whatever sum assured still you are entitled to get as insurance companies have decided in dealings with TPA and Hospitals. How many of us get any PPN Rate card attached with policy documents? How many of us get to know what kind of agreement has been done between Insurance Company, TPA and Hospital? The answers are always No and this is where these three take advantage of.
Let’s check how they can trap you,
If you have a health insurance policy with Rs. 15,00,000 for all family members with benefits like critical care benefit, pre hospitalization benefit, post hospitalization benefit, impatient benefit, hospital cash benefit, emergency care benefit and so on. Every member who is covered under this health insurance will get one time critical care benefit in the entire policy period even after renewal.
Please note here that with every renewal, your premium would be increased.
They have all set percentages for everything from room rent to ambulance and from what include and what exclude.
Please note that they have a cashless facility in health insurance as a feature.
It is heartbreaking that most of us never check network hospital lists just because we trust that everything will be taken care by the person who has given us policy, TPA, Hospital and Insurance Company but the end outcome is always take a toll on your mental peace with lots of documentation part whether for cashless or reimbursement or any other challenges. Even the system of claim settlement in India is not seamless and paperless like other countries in the world. Though there are health insurance cards, they still are not used in the way it should be.
Let’s come back to the part about what happens if you are hospitalized in an emergency, and you think you have health insurance. The picture is really terrible when you are undergoing some unforeseen trouble. The fantasy of having health insurance at the time of taking the policy, will be under question as you have thought that whatever will happen health insurance will come to my rescue…
The article will continue in the next issue of January…
If you have any challenges regarding your Health Insurance Policy Claim Settlement or Reimbursement, please write to us on editorinchief@mudracompass.com or complain@apoorvaa.co.in and we will highlight your issue and also try to help you.
