IRDAI, NHA form working group to strengthen health insurance ecosystem in country

In a bid to strengthen the health insurance ecosystem in the country, the Insurance Regulatory and Development Authority of India (IRDAI) and the National Health Authority (NHA) have formed a working group on the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to work on areas of network hospitals management and data standardisation, among others. The Union government on September 23 had launched the AB-PMJAY, which aims to provide a cover of Rs 5 lakh per family per year for availing secondary and tertiary care, cashless treatment at empanelled private and public hospitals across the country to families listed in SECC (Socio-Economic Caste Census) 2011.

The 11-member group will have representatives from both IRDAI and NHA. Dinesh Arora, Deputy CEO of NHA will chair the working group. In six months, it will submit a report on how to detect and deter fraud through a common repository and capacity-building. It will develop standards for field verifications and investigations besides guidelines to ‘name and shame’ fraudsters.

As part of Network Hospitals Management, the working group will define hospital infrastructure and facility audits, and develop a roadmap to get a common list of accredited hospitals for the industry. It will also take up a comparative study of packages and their rates, besides defining standards. Additionally, it will suggest common IT infrastructure for health insurance claims management to increase efficiency and transparency among stakeholders.