Photo Credits: Health scheme: what about the empanelled hospitals?
PANAJI
One of the main highlights of the ambitious Universal Insurance Scheme that is expected to roll out on August 15 is the government's tie up with private hospitals in the State. While this will certainly be a boon to Goans seeking treatment, there is still no clarity on the list of such empanelled hospitals.
Under the recently-launched Deen Dayal Swasthya Seva Yojana (DDSSY), Goa Medical College (GMC) will offer a total of 278 treatments out of the total 447 medical ailments. Other government hospitals including primary and community health centres, cottage hospitals, community health centres and ESI hospitals are also included.
Besides these government hospitals, the card that covers an entire family can be used at a few empanelled hospitals. 10 private hospitals in North Goa and 15 in South Goa will be selected as part of the scheme.
Speaking to The Goan, an official from the Directorate of Health Services (DHS) revealed that the list of such hospitals is yet to be prepared, and is expected to be ready in a month’s time. The job of empanelling private hospitals, however, lies with the insurance company, United India Insurance Company Ltd.
As part of the scheme, the company would have to empanel 25 private hospitals across the State, and any relaxation in the rule would be decided by the state level committee.
Additionally, beneficiaries, instead of opting for government hospitals, have the choice of availing treatment at private empanelled hospitals based on rates for differently graded hospitals.
For example, a coronary balloon angioplasty ranges from Rs 1,46,797 at a Grade A hospital, but would cost instead cost Rs 1,27,650 at a Grade C hospital. The cost of the procedures will be deducted from the card that offers a coverage of up to Rs 2.5 lakh for a family of three or less and Rs 4 lakh for a family of four and above.
The scheme covers 19 diagnostic procedures, mental illnesses, 54 Ayurvedic procedures and 15 yoga and naturopathy procedures.
When a beneficiary approaches an empanelled hospital for treatment, the beneficiary’s fingerprint will be authenticated and details on the operational validity of the card, amount claimed, open claims, balance amount that can be claimed and the family members eligible for the claim will be made available.
The hospital will then confirm the cost of the beneficiary’s treatment. If the balance amount in the card is less than the treatment cost, the 'DDSSY Sahayak' will inform the beneficiary of the same, and the excess cost will have to be paid by the beneficiary separately to the hospital.
Approvals for the treatment would then be granted within 12 hours for a normal case and 3 hours for an emergency case. Once the treatment is done, the claim will be closed.
Registrations for the smart card will begin next week and its implementation will begin on August 15.
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PRIVATE 'MATTER'
- Beneficiaries, instead of opting for government hospitals, will be able to get treatment at any of the empanelled private hospitals
- Cost of the treatment will be based on the 'grade' of the hospital
- When a beneficiary approaches an empanelled hospital, the beneficiary’s fingerprint will be authenticated and details on the operational validity of the insurance card, amount claimed, open claims, balance amount that can be claimed and family members eligible for the claim will be made available
- The hospital will then confirm the cost of the treatment, and if the balance amount in the card is less than the treatment cost, the beneficiary will be notified, and the excess cost will have to be paid by the beneficiary separately to the hospital
- Approvals for the treatment would then be granted within 12 hours for a normal case and 3 hours for an emergency case. Once the treatment is done, the claim will be closed
