In the end of June 2018 several Third Party agents (TPA) have been sending email to the Network Hospitals that from 1st July 2018, cashless service will offered only in Hospitals who have been empanelled for as Preferred Provider Network (PPN).
The operative part of the email reads
“Further to our continuous association, Please be informed that, as per the instructions received from competent authority, since your hospital is not empaneled with GIPSA PPN, with effect from 1st July 2018, cashless pertains to GIPSA insurers (United India Insurance/ Oriental Insurance/ New India Insurance/ National Insurance) is not available for your hospital.”
This is also prominently displayed in the web page of one of the TPAs
In 2011 the four public sector Insurance Companies of the Government of India viz National Insurance Company Ltd, The New India Assurance Company Ltd, the United India Insurance Company Ltd and the Oriental Insurance Company Ltd announced through news paper advertisement that they will be offering cashless service in network hospitals who have been offering attractive packages.
Since then details of packages have not been made available to the Insured. Many Consumer court and Ombudsman rulings have declared the “PPN packages” to be outside the policy . In case of many Consumer disputes the authorities have disallowed any such package agreement between Hospital and Insurance Company to have a bearing on the final claim settlement.
The IRDA Health Insurance Regulation 2016 does not mention any such category for Network Hospitals.
The IRDA ” standard definitions” does not mention about “PPN” hospitals
Great resource document.