The government has proposed to impose penalty on insurance companies for delay in payment to hospitals for settlement of claims under its ambitious Ayushman Bharat National Health Protection Scheme (NHPS).
Under the scheme, if an insurance company delays the claim payment beyond 15 days, then it would have to pay a penalty of one per cent interest on the claimed amount per week till it finally settles the claim.
The insurance company will pay the penalty directly to the hospital concerned, according to the model tender document that was released on Thursday, a health ministry official said.
The model tender document also comprise a list of the procedures and their rates which would be covered under the scheme along with the ones which require pre-authorisation.
Twenty states and Union territories have so far signed MoUs with the Union Health Ministry for implementing the NHPS that aims to provide a cover of Rs 5 lakh per family annually to 10 crore vulnerable families.
Four states – Delhi, Odisha, Punjab and West Bengal – have not yet given any positive response towards adopting the scheme, the official said, adding that discussions with these states are on to bring them onboard.