According to IRDA
regulations (Insurance and Development Authority) all eligible hospitals have
to include 10 inpatient beds in small townships and 15 beds in larger ones. The
hospital should have qualified duty doctors and nurses on a 24 hour basis with
a well equipped operation theatre.
Now, most hospitals
can fulfil the required criteria except the one with - number of beds. The
maternity hospitals in the suburbs of Mumbai are fully recognized maternity
care centres. Many insurance companies have their individual network hospitals.
When a patient uses a hospital which is not in the network - then the hospital
must conform to the IRDA guidelines.
According to Vivek
Desai the Managing Director of Hosmac - a consulting firm - finds that there
are small hospitals in the smaller towns and though the number of beds may be a
problem at present, it would help patients in the future. "Smaller hospitals are already facing woes
because patients prefer to go to bigger hospitals, especially those which have health
insurance. Also, treatment for critical care would be an issue in smaller
hospitals," he says.
There may be approximately 20
general insurance companies of which only 6 cover maternity in the family
floater and individual policies.
Divya Gandhi head and principal
broker at Emkay Insurance Brokers, is of the opinion that restrictions with
regard to the size of the hospital is a way to address false bills.
"Not all third-party administrators have the manpower to physically check all
bills. So, if there is a limit on the bed size, it is similar to an assurance
that the hospital would be audited and forged claims would be few," she says,
adding that the large number of small maternity hospitals in metros could be a
Hannah Punitha (IRDA Licence Number: 2710062)