Super Specialty Private Hospitals in the state would be included under Health Insurance/Protection Schemes like Rashtriya Swasthya Bima Yojna (RSBY), Mukhya Mantri State Health Care Scheme (MMSHCS) and Himachal Pradesh Universal Health Protection Scheme (HPUHPS) for providing cashless treatment under Critical Care of Rs. 1.75 lakh per annum and for cancer treatment, the maximum limit is Rs. 2.25 lakh on family floater basis.
Health Department spokesperson said that HP Swasthya Bima Yojna will be the State Nodal Agency for the scheme. The Super Specialty Private Hospitals interested for empanelment under Critical Care should have the facilities for treatment of Cardiac and Cardiothoracic Surgeries, Genito Urinary Surgery, Neurosurgery, Radiation Oncology, Trauma, Transplant Surgeries, Spinal Surgeries, Surgical Gastro Enterology, Hemophilia and Cancer.
He said that the hospitals will enter into agreement with HP Swasthya Bima Yojna Society and the hospitals have to provide the Critical Care facility on pre-defined package rates only.
The hospital will provide cashless treatment to the smart card holder family and amount will be reimbursed by the State Nodal Agency on the basis of pre-defined package rates after checking the claim papers and relevant documents.
He said that the support Agency under Mukhya Mantri State Health Care Scheme and HP Universal Health Protection Scheme will conduct the periodical medical audit of these hospitals. An Agency will be selected by the State Nodal Agency specially for Medical Audit.
The selected agency will conduct the regular medical audit of claims under Critical Care and if any hospital found indulged in misuse of scheme/fraud/abuse/unwarranted procedures then the hospitals it will be de-empanelled from schemes immediately and also legal proceedings will be initiated against such hospitals.