AHNA Resumes Cashless Claim Settlements For CARE Health And Star Health  

AHNA (Ahmedabad Hospital and Nursing Home Association) discontinued cashless claim settlements with three Health Insurance Companies including TATA AIG, CARE Health and Star Health Insurance for the residents in Ahmedabad as the insurers delisted many hospitals in Ahmedabad and also refused to revise treatment prices. The change made it financially unsustainable for these hospitals, due to which AHNA discontinued the cashless claims settlements. Due to the changes made by these insurers, policyholders could not access the proper cashless treatments from the restricted hospitals or nursing homes in Ahmedabad.

AHNA resumed the cashless settlement service for CARE Health and Star Health. AHNA’s president Dr Bharat Gadhavi stated that, “We received representation from both Star Health and CARE, and were able to have productive and conclusive discussions with their authorities. Following this, we have decided to reinstate cashless claim settlement for these insurers.”

As AHNA has now allowed the insurers to resume services, it has come as a relief to the policyholders giving them the security of cashless settlements. The policyholders of CARE Health and Star Health Insurance companies previously were not able to file for cashless claims thus had to pay from their own pocket for the medical expenses at the time of treatment and then file for reimbursement from their insurer. Now these policyholders will be able to claim cashless settlements allowing them a hassle-free healthcare experience during medical emergencies or for scheduled treatments both.

No Cashless Claim Settlements For TATA AIG Policyholders: Dr. Gadhvi, AHNAAs

TATA AIG has refused to comment on the matter, the insurer remains blacklisted from AHNA in the city for cashless settlements. Dr. Gadhvi said on the matter, “TATA AIG did not reach out to AHNA for any discussions to resolve the matter. He concluded with staying put on his stance stance on not honouring cashless claim settlement for their policyholders across the AHNA hospital network stands.”

AHNA claimed that, TATA AIG has previously attempted legal actions on the basis of malpractices in AHNA-listed hospitals; due to which the hospitals were delisted from the insurer's network.

According to TATA AIG’s website, as of May 13, 2025, around 25 hospitals remain excluded from its list of network providers across Ahmedabad. The website highlights that “expenses for treatment at any hospital, by any medical practitioner, or other providers that are specifically excluded by Tata AIG and listed on our website will not be covered.”TATA AIG has allegedly blacklisted around 35 AHNA-member hospitals, including Aditi Hospital, Narol ICU and Multi-speciality hospital, Mahavir Clinic and Nursing Home, Shreejee Hospital, and Swastik Hospital, due to malpractices.

Incurred Claims Drop for Insurers Amid State’s Cashless Claims Blockage

The Indian Insurance Research and Development Authority (IRDAI) has reported that health insurers Star Health and CARE have received valid claims ratio of 66.47 per cent and 57.69 per cent respectively, while TATA AIG has a health-related incurred claims ratio of 77.94 per cent. The valid claims ratio indicates how much money an insurer is paying out in claims during a specific period, as opposed to the total premiums it collects within that tenure. Experts suggest that an incurred claims ratio between 75 per cent to 85 per cent is optimal, reflecting financial sustainability and effective claim honouring. In Ahmedabad, Gujarat, cashless claim settlement remains low for these insurers, with only 29.43 per cent of all claims in the individual category being cashless.