Wrichik Basu (ping on reply pls) - I have a que...

1. On a review of the list of items it is decided to classify the existing ‘Optional Items’ into the following categories. - LIST– I:: Items that may be retained ‘as it is’ as optional items – Items specified in the list are the Optional Items to which Insurers may offer coverage. - LIST– II:: Costs that are to be subsumed into the Room Charges – Items specified in the list shall form part of room charges - LIST– III:: Costs that are to be subsumed into the specific (say surgical) procedure charges – Items specified in the list shall be considered as part of procedure charges. - LIST– IV:: Costs that are to be subsumed into the costs of treatment – Items specified in the list shall be considered as part of costs of treatment. 2. Where the costs are to be subsumed into the room charges specified in List – II or procedure charges specified in List III or costs of treatment (including costs of diagnostics) specified in List IV all claims shall be settled in accordance to the terms and conditions of the policy contract. Insurers shall put in place measures to ensure that items which are part of room / surgical procedure /treatment (including diagnostics) as referred in the lists herein shall not be billed to the policyholders by the hospitals and every insurer shall inform or notify the same to the hospitals and the policyholders suitably. Accordingly,all insurers are advised to make it part of their service level agreement with the network providers (hospitals) in case of cashless cases. In case of reimbursements (with other than network providers) Insurers shall settle the claims as per the terms and conditions of the policy contract.