Srinagar: Jammu and Kashmir government may revisit its agreement with insurance company ICICI Lombard that provides medical insurance to its employees, many of whom have complained that the company declines claims on various pretexts.
The state government has conveyed to the company the dissatisfaction among the employees and warned that it may reconsider the agreement if the trend continues.
Currently 19,000 employees (only gazetted) are entitled to Mediclaim Insurance, which was introduced by Omar Abdullah-led government in 2014 for a period of three years.
The policy provides insurance cover of Rs 5 lakh per family unit on floater basis against a total payable premium of Rs 6,081 per annum per employee. The employee and his five dependents within the 3 months-80 years age group are covered under the scheme.
“Many complaints were resolved and even the non-gazetted cadre employees wanted to be included in the scheme. But before that, we want the ICICI to redress the complaints,” said an official dealing with the scheme.
One of these complaints is about an employee whose mother was admitted to New Delhi’s Max and Medanta hospitals. After being denied insurance payment, he had to shell out the expenses out of his own pocket.
When it came to making payment at the Max Hospital, the employee was told that the ICICI Lombard has severed the tie-up with the hospital the very night the patient was admitted for treatment. When he called the company, he was asked to take her to Medanta.
But the company did not pay the bill of Rs 15,000. The reason behind declining the employee’s claim for cashless treatment (whereby payment is directly made by insurance company to the hospital) was:
“Based on our assessment of documents submitted the treatment is possible in the OPD and hospitalization is not justified. Hence the request for cashless treatment is not admissible.”
The rejection came even though doctors at both Max and Medanta hospitals had recommended hospitalization for a series of medical examinations.
When contacted, two ICICI officials (none of them was willing to identity himself) told Kahsmir Reader on phone that the patient in question was admitted for tests only and she was entitled to payment according to the policy.
“We have not ended our tie-up with Max Hospital but there was some operational issue with the hospital at that time,” one of them said.
The state government had entered into an agreement with the company in 2014. After complaints from employees, former finance minister Haseeb Drabu had ordered that payments towards the insurance company should be released in installments, but that has not changed the company much.