Technical committee constituted for preparing DPR for Oommen Chandy Health Insurance Scheme
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The implementation of a health insurance scheme with an enhanced insurance cover of ₹25 lakh had been one of the main poll promises of the United Democratic Front (UDF) to the people.
The said committee has been asked to submit its report, including the proposed programme, design and phased implementation roadmap, within four months from now.
The committee will have Girish Radhakrishnan, former chairperson and managing director of United India Insurance Company Ltd., who had also served as Insurance Ombudsman for the State; P.J. Joseph, former chairperson of an agricultural insurance company and former member (non-life) of Insurance Regulatory and Development Authority of India (IRDAI); and K. Sanath Kumar, former chairperson and managing director of National Insurance Company Ltd., as expert members.
Technical expert committee’s terms of reference include the recommendation of the of the overall design of the scheme, including its objectives, population coverage, eligibility criteria, benefit package, financial protection limits and relationship with existing health-financing schemes.
The committee will also propose appropriate institutional and governance arrangements, clearly defining the roles of the government, State Health Agency, Health department, public and private hospitals and other participating institutions.
It will examine the financial modalities of the scheme, including possible funding sources, pooling of available resources, expenditure projections, risk-sharing arrangements, cost-control measures and the short and medium term financial implications for the State.
The committee will also recommend the most suitable implementation mode, including assurance, insurance or hybrid arrangements, as well as the mechanisms for hospital empanelment, strategic purchasing, claims management, quality assurance, grievance redressal and monitoring.
It is also expected to review the experience of health insurance and universal health coverage initiatives in other States and identify lessons and practices relevant to Keralam.
A suitable IT platform and digital architecture required for the scheme, including beneficiary identification, hospital transactions, claims processing, fraud control, monitoring, inter-operability with existing systems, data governance and protection of beneficiary information will also be identified by the expert committee.
The committee will prepare a phased implementation plan covering preparatory activities, transition from or convergence with existing schemes, geographical or population-wise rollout, institutional readiness, timelines, milestones and monitoring arrangements.
In preparing its report and recommendations, the committee may consult relevant government departments, agencies, hospitals, technical experts from the private sector including hospital associations, insurance sector experts and other stakeholders, according to a government order.
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