How to control frauds in health insurance claims?

While we have been happy with growth of health insurance segment in the recent years, some of the negative points have started appearing. In the conferences recetly attended by me, I heard the following statements:

1. Insured getting policies issued from 3 insurance companies. Went for hospitalization, managed 3 original sets of bills, reports, receipts, discharge summaries. Lodged claims with all the 3 companies.

2. Hospital having 10 rooms had informed the different Insurance companies/TPA’s that 18 rooms are occupied or say 18 patients are being treated. Bogus names/patients/records are being maintained. Someone jokingly commented that even a software has been developed to handle the bogus accounting.

3. When a hospital was black listed by Insurance co or TPA then they shifted the hospital 4 buildings away with different name and again got listed with Insurance co's /TPA.

4. First floor of the hospital was being used for marriages as a Banquet Hall,with a view to take the benefit of heavy/busy marriage season.

Question before us is frauds have to be controlled as these are adding to the losses of the Insurance Companies and will ultimately result in increase in premium rates.

What are the alternatives before us?

Lodging of FIR with Police-question is then what next?Is it a piece of paper only?

Should these be referred to Economic Offences Wing of the Police Dep’t?

Do we have this specialised wing in all the states?

Should there be black list for those inividuals who are indulging in fraud so that for their life time they will not be able to get Health Insurance Policy? Imagine the data base size? Are all insurance companies ready to share the data?

Identification number to be issued by Authority under Nandan Nilekani should be made compulsory for all proposals /health insurance policies to be issued. As this will take time (may be 3 yrs to cover our population) Then why not start using PAN No as the controlling number.

Comments are invited.

Soon we will have SBI General Insurance Company becoming operational

We understand most of the approvals are through for setting up of JV between SBI and IAG of Australia and in the coming months this company will become operational.
In view of the recent good achievements of SBI Life it is foreseen the competition will increase in Non Life Insurance/General Insurance segment.

Extensive coverage of the branches of SBI all over the country will be a good feature of this company.

TPA’s to deduct TDS when releasing payment to Hospitals

TPA’s (Third Party Administrators) to deduct TDS when releasing payment to Hospitals

Recent news item indicates that this decision is now being implemented.We are not going into details of the same from taxation angle but we feel that the impact of this will be increase in rates by hospitals as they will find it a necessity to increase the rates with a view to handle the increased need for working capital.

The normal inflation of health care in India is 15% per year-should we expect 18% during 2010. Let us wait and watch.

Medical Mafia Aug 28, 2009 issue of Fortune

It is always a pleasure to read independent articles in publications like Fortune, where an unbiased article can be an eye opener for all of us.

This article is worth reading – where a group comprising of doctors and lawyers handles the cases and fights with Health Insurance company's so that the genuine or inflated claims are made on insurance companies and are also passed.

The team covered in the article manages the best of doctors and they are assisted by lawyers to appear in the courts so that the client gets paid at much higher level. Ofcourse the agreed % out of this payment goes into their (lawyer/doctors) pocket. Question before us is does it happen because Health Insurance co’s in USA are also hesitant in passing of claims?

We do hope that Indian Non Life Insurance co’s as well as Health Insurance co’s will take corrective steps well in advance so that we can avoid excessive role for lawyers to get the claims passed.

Medical Cost Contrast (Source Various editions of Hindustan Times Aug 2009)

Medical Cost Contrast (Source Various editions of Hindustan Times Aug 2009)

Many a times we come across question of persons who access our website and want to know about costs associated with various treatments .It is interesting to find some cost contrasts in various editions of Hindustan Times.We have compiled these for your reference so that you can interpret it in the best possible manner.

1- Treatment: Treatment for brain hemorrhage and face reconstructive surgery

Hospital: Apollo Hospital
Cost: Rs.1,22,922 (Including stay in the hospital)
ICU charges: Rs.56,000(per day, including consumables)
Hospital: Government
Cost: Rs.20,000 – 30,000 (including medicine and consumables)
ICU charges: Rs.10,000 (consumables and bed charges, surgery is free

2- Treatment: C-Section

Hospital: Max Hospital (Pitampura)
Cost: Rs.60,000 (Single room)
Hospital: AIIMS
Cost: Surgery (free)(cost of consumables Rs.3000 + Rs.360 for 10 days hospital stay)

3- Treatment: Change of pacemaker

Hospital: Max Hospital (Pitampura)
Cost: Rs.65,000 (Inclusive of 3 day hospital stay + cost of pacemaker and other consumables (Rs.60,000 – 70,000)
Hospital: AIIMS
Cost: Rs.55,000 (cost of pacemaker + Rs.5,000 for procedure)

4- Treatment: Caesarean Section-Delivery

Hospital: Sir Ganga Ram Hospital
Cost: Rs.35,000 – 40,000 (double sharing) Rs.70,000 (single room)
Hospital: Government
Cost: Surgery 0 (free) (consumables and bed charges:Rs.3,000 + Rs.365 for 10 days at AIIMS)

5- Treatment: Left Leg Femur Surgery

Hospital: Sir Ganga Ram Hospital
Cost: Rs.40,000 – 45,000 (two days)
Hospital: Government
Cost: Surgery 0 (free) (cost of implants and medicines(Rs.8000 – Rs.10,000

6- Treatment: Cancer Treatment

Hospital: Rajeev Gandhi Cancer Institute
Cost: Rs.7,00,000 – Rs.8,00,000 (including medicines, bed stay, ICU charges)
Hospital: Government
Cost: Rs.3,00,000 – Rs.4,00,000 (including consumables)

You may find these useful for deciding what should be the sum assured?

Liver transplant costs how much?

A common question asked is how much health insurance coverage do I need?
It is a very simple as well as a very difficult question.

Simple -whatever you can afford
Difficult-it should cover whatever treatment you may need during the validity of the policy.

I have come across a news item in HT regarding Priya ,who has undrgone liver transplant in Ganga Ram Hospital in New Delhi.It cost her Rs 22 lakhs.This does not incude the travel costs which she might have incurred as she is resident of Mumbai and decided to get the surgery done in Ganga Ram Hospital.

As covered earlier in my blog the maximum insurance coverage available to any one from few Indian Insurance companies is Rs 10 lakhs ( mostly it is Rs 5 lakhs).Even if some one had taken the policy of Rs 10 lakhs,one would have paid Rs 12 lakhs out of own pocket.Let us come out with policies ,where sum assured can be Rs 25 lakhs.Let us see which company makes the beginning.

Insurance Companies to start publishing the financial data

Large number of insurance clients ask us from time to time about the financial health of different insurance companies : As none of the company is listed on the stock ecxchange therefote it was not possible for a common man to find out which company is financially strong or weak .The good time is coming as the Insurance regulator IRDA will make it mandatory for all insurers to disclose their financial statements to the public, even if they are not planning to get listed on stock exchanges.

Disclosures will apply to both public and private insurers and this was announced by Mr. J Harinarayan, Cahirman IRDA in Hyderabad.

The proposed move will bring in transparency and enable policyholders to gauge the financial strength of insurance firms. It will also help potential investors assess the strength of a company as and when the company plans to launch an initial public offering (IPO).

Currently, insurers furnish quarterly statements to IRDA, but as you know this is not in public domain.

Swine Flu -Is it covered or not?

Insurance companies have come out with some clarifications and these are;

(1) Cost of Tami flu is not covered as this is being given by the Government on free of cost basis.

(2) Private hospitals can charge the patient for facilities like tests, beds and doctors fees. And this will be covered.

(3) If admitted in a hospital and the tests are negative then nothing is payable. If positive then it is payable.

(4) If it is a new policy then 30 days clause is applicable.

Summary of all above mentioned points is that do not wait but get health insurance policy immediately,otherwise be prepared to be treated in one of the government owned hospital.

Wish you best of luck so that you don't get affected with this disease.

L&T FIN to own 100% of General Insurance Company

It is good to know that L&T Finance Ltd, a 100% subsidiary of Larsen & Toubro Ltd (L&T), will not be partnering with any foreign entity to float the venture for General Insurance Company

The announcement to foray into general insurance business is expected in the next few months.

Magma Fincorp JV with HDI-Gerling Germany to enter general insurance including Health

An application will be submitted to IRDA for approval to Magma HDI General Insurance Co Ltd for setting up a general insurance company which will handle health insurance also.Magma Fincorp, a Kolkata-based non-banking financial company, is the Indian partner while Germany’s HDI-Gerling International Holding AG.will be the foreign partner.

We welcome this.This company will be the second insurance company from Eastern India. The new company, Magma HDI General Insurance Co Ltd, will apply to the Insurance Regulatory and Development Authority for obtaining licences soon.

After it comes up with a bouquet of non-life insurance products, it plans to enter into medical insurance.

The new company, where the German partner has a 26% stake, will have a total initial capital of Rs 110 crore.

Proposal to set up Health Insurance Council

One of the proposal of IRDA panel, which evaluated the performance of third party administrators, is for setting up of Health Insurance Council. They feel that this is one of the most critical requirements in the industry

It is understood that Insurance Regulatory and Development Authority (Irda) is considering to accept this proposal and “Health Insurance Council" will be set up.

The proposed council will also look to standardize procedures in the industry, and update and maintain standard documents and "standard masters". It could also help solve differences between insurers and TPA’s, and also between insurers.

Any step which is taken for bringing in improvements in service level,bringing down costs,improvement in productivity as well as customer satisfaction is welcomed by all of us.The earlier it is done,better it will be.

Proposal to set up Health Insurance Council

One of the proposal of IRDA panel, which evaluated the performance of third party administrators, is for setting up of Health Insurance Council. They feel that this is one of the most critical requirements in the industry

It is understood that Insurance Regulatory and Development Authority (Irda) is considering to accept this proposal and “Health Insurance Council" will be set up.

The proposed council will also look to standardize procedures in the industry, and update and maintain standard documents and "standard masters". It could also help solve differences between insurers and TPA’s, and also between insurers.

Be careful Insurance companies have started canceling loss making group health policies

Some buyers have been thinking they are smart and by creating excessive competition among Insurance co’s, and Insurance intermediaries they can bring down the insurance premium for Group health policy. As insurance companies have started looking at their portfolio carefully, we can say most of them have started canceling heavy loss making policies. We welcome this as we want healthy insurance companies as large assets of this country are also insured with them.

According to one newspaper report cancellation of group Mediclaim policy midway has gone up by 30 percent during last 6 months.

The question before us is why this has happened? Customers will always like to buy any product, service or insurance at lowest cost. Are we penalizing the underwriters or the sales team which picked up the premium at lower rate to achieve their targets and incentive plans?

We understand practically all private insurers are canceling group health policies with a 30-day notice. Incidentally insured or insurer both have the right to cancel the contract by giving 1 month notice.

According to a source ICICI Lombard has asked L&T to pay additional premium for the group health policy in the middle of the year. When contacted, L&T said that ICICI Lombard has requested for extra premium but has not sent any notice.

An ICICI Lombard spokesperson said that they have a vigilant investigating team, which ensured that genuine claims were paid.

We feel “Cancellation of health policy midway is not a good practice and this shakes the confidence of the public. If the insurer has not priced the risk appropriately or the sales staff has shown aggressiveness in booking the business then they should be penalized first and not the customer. Policy should only be cancelled in case the data given by the customer at the time of quote was given wrongly or the information was concealed.”

Is vertical integration a good thing in Indian Insurance Industry

In management schools vertical integration is taught and there are positive and negative points in having the same.The greatest point is economies.At the same time
under corporate governance, privacy and ethics aspects we are supposed to behave differently.

TPA's are facing rough weather as covered in my various blogs in the past.As predicted by me the third-party administrator business in insurance is going through a churn, with conflict-of-interest issues hastening stake sales.

Bangalore-based TTK Healthcare Services, a third party administrator (TPA) is up for sale. Zurich based Swiss Reinsurance Company, the world’s second largest reinsurance company, owns 26 percent in TTK Healthcare, while the remaining 74 percent is owned by TTK Group and India Value Funds Advisors, a private equity fund.

Sources close to the development said this followed Swiss Re’s decision to go for a joint venture with Religare Enterprises to set up a health insurance company.

We will like to raise the question -Will the insurance companies stop dealing with insurance brokerge firm of Religare? Any health insurance quote given by the insurance company can be used/misused by Religare Swiss re Health co.We will welcome response from any insurance company in this regard

Should we expect the same thing to happen with some other TPA's?

Should lodging of fraudulent insurance claims be made punishable ?

Very intersting and thought provoking question has come before us and it is ;
Should lodging of fraudulent insurance claims be made punishable ?

I came across an interesting news item which has originated from U.K. and it may be an eye opener for many. This judgement also raises the question whether Insurance Company should take the case to such level where the client (even if he has lodged fraudulent insurance claim) is jailed.

You will find the answer in the last 2 lines of the news item in which the statement of the insurance company is as follows;
Andrew McBride, claims director for QBE, said: "QBE works closely with all its policyholders to protect their interests and at the same time offer them outstanding service in claims handling. Fraudulent activities such as this have the potential to raise costs and risks for our other clients."

Yes it is true that those who get bogus claims are contributing towards increase in premium being paid by the honest customers. In this case the figure quoted by the insurance company is UK pounds 40 or say Rs 3100.I wonder how much is being paid by many of us, who are honest customers of Indian Insurance companies.

Let us go to the news item to have the details;

In this case three people have been jailed for 12 months after making fraudulent insurance claims following a coach crash at a wedding.

The bridegroom Andrew Singh and his parents Graham and Niramella Singh were each sentenced at Manchester Crown Court to 12 months for perjury and nine months for conspiracy to defraud. The sentences will run concurrently.

The court heard that the wedding in Preston in July 2004 resulted in 73 personal injury claims resulting from two minor accidents in coaches taking guests to the reception.

One coach collided with a car while another struck a wall at Chipping Village Hall where the reception was taking place.

Of the 27 claims that finally reached court, 25 - including those of Andrew Singh and his parents - were thrown out after a wedding video brought in by the claimants themselves showed many of them dancing enthusiastically at the reception. Both Andrew Singh and his father Graham were seen being carried aloft by guests.

The Singhs denied that a wedding video had existed prior to the trial but when other witnesses gave evidence to suggest that large numbers of the claimants were not present on the coach, the Singhs produced the video in an attempt to establish that they were on the accident coach.

Commenting on the case, Ian Birkinshaw of DWF, who acted on behalf of QBE Insurance in the case, said: "Fraudulent claims are a burden on honest drivers, adding £40 on to the cost of every insurance premium. In this case the claimants' actions also resulted in a two-week civil trial, which cost an estimated £250,000."

He added: "Graham, Niramella and Andrew Singh perjured themselves in court and had children in the witness box claiming to be injured when they were not even on the coach. The judgement sends out a very strong message that the courts will not tolerate this type of behaviour."

Andrew McBride, claims director for QBE, said: "QBE works closely with all its policyholders to protect their interests and at the same time offer them outstanding service in claims handling. Fraudulent activities such as this have the potential to raise costs and risks for our other clients."

HEALTH INSURANCE premium to touch Rs 12000 crores during this year

Yes it is going to be true that HEALTH INSURANCE premium will touch Rs 12000 crores during this year.

Mr. Harish Rawat, Minister of state for labour and employment, informed Rajya Sabha that Rashtriya Swasthya Bima Yojana (RSBY) is being extended to all 600 lakhs BPL families in the country during the current financial year.

Taking average family size of 5 members this means that by the end of March 2010 we will have 30 crores persons covered under this Yojna.

Assuming premium size is Rs 750 per family this means premium collected by the insurance companies will be Rs 4500 crores. Against the backdrop that health insurance premium for the year ending march 2009 was Rs 6000 crores we in www.healthinsuranceindia.org estimate that health insurance premium during this year is going to be in the range of Rs.12000 crores to Rs 14000 crores .

This means that health insurance is becoming one of the prominent segments of Indian Insurance Industry.

Rashtriya Swasthya Bima Yojana (RSBY) to grow(Budget)

While presenting the budget in Lok Sabha ( Indian Parliament ) on July 6,2009 Mr. Pranab Mukherjee ,Finance Minister made the following statement

"Rashtriya Swasthya Bima Yojana (RSBY) was operationalised last year. The initial response has been very good. More than 46 lakh BPL families in eighteen States and UTs have been issued biometric smart cards. This scheme empowers poor families by giving them freedom of choice for using health care services from an extensive list of hospitals including private hospitals. Government proposes to bring all BPL families under this scheme. An amount of Rs 350 crore, marking 40% increase over the previous allocation, is being provided in 2009-10 Budget Estimates."

This means during this year the number of those covered will increase to 65 lakh BPL families.Taking an average of 5 family members this means number of persons covered will be 230 lakhs(2.30 million)'

The recent study of Earnst & Young shows that Indian Health Insurance Industry will touch the figure of Rs 30,000 crores by 2015 seems to be very realistic as RSBY in itself is acting as advertising for health insurance in India.Every person who gets claim settled under RSBY makes 5 other persons aware of the concept of health insurance.



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Third Party Administrator (TPA) Committee submits report to IRDA

The committee headed by S. B. Mathur, Secretary-General of the Life Insurance Council, has recommended the formation of a common body comprising members from the TPA’s, life and non-life insurance companies and hospitals and representatives from consumer groups.

This is a good suggestion as consumer representatives may get a say in claims settlement for Mediclaim policies .We are hopeful that IRDA will accept this recommendation made by the Third Party Administrator Committee.

The proposed body is expected to simplify and speed up cashless claims settlement of insurance policies. The body, it is proposed, would address claims-related complaints by hospitals and take the views of the nominated consumer representatives and other stakeholders in settling disputes. Its operation is expected to be independent of the insurance ombudsmen services. The Ministry of Health, through its Directorate-General, might also facilitate in the functioning of the new body, Mathur said. “We have suggested to the Insurance Regulatory and Development Authority to nominate one or two representatives to look after customer interest,” he said. The nominees, he pointed out, would not necessarily have to be members of consumer associations.

Currently, the policyholders have to rely solely on the TPA’s, which are intermediaries between insurance companies and hospitals for settlements of claims. There are 27 IRDA-approved TPA’s across the country. “The lack of coordination and the consequent blame game among the different stakeholders had thrown up a lot of problems,” Mathur said, adding that the objective of the proposed body would be to help standardize the settlement procedures and bring transparency to the system. Hospitals now are not under the IRDA and their representation in the proposed body therefore could at least make them more accountable, he added.

The panel has also recommended doubling the minimum capital requirement for TPA’s to Rs 2 crore. It has proposed extending licence to a TPA only if it is present in at least six locations. These regulations, however, are not particularly aimed at ranking of TPA’s, he added.

With 4 PSU’s having appointed KPMG to suggest format for their own TPA and ICICI/Star/Bajaj Allianz handling their own claims-we feel increase of equity requirement is unjustified. We foresee some TPA’s are going to return the licence to IRDA in future as the business prospects will be reduced with 4 PSU’s withdrawing the business from existing TPA’s.

With growth of Telecom sector through out the country and availablity of 1 800 free calling service is there a need to have 6 branches. We feel ther is no need provided 24x7 call centre is working efficiently .

HEALTH INSURERS PLAN DATABASE TO CHECK FRAUD CLAIMS

HEALTH INSURERS PLAN DATABASE TO CHECK FRAUD CLAIMS

It is intersting to read in The Economic Times about Insurers Data Base to be set up
According to this nes item health claim data of individuals/families will be compiled for being used by the Health Insurance companies.

My viewpoint is that Health Insurance has been a bleeding portfolio for not because of individuals but because of group policies, which are being picked up by the Insurance Companies at low premiums for achieving the targets .These targets are set up for managers and branches at unrealistic levels.We recently came across a case study where the premium quoted for a group by 3 different co's was Rs 6.50 lakh to Rs. 8.00 lakh.

Then suddenly someone from 4 th Insurance company appears and picks up the policy for Rs 4.00 lakhs.One does not realise how the underwriter of this company calculated that Rs. 4 lakhs is the reasonable and acceptable premium.

Let us come to the news item which appeared as follows;

Faced with mounting losses as claims exceed premium income, health insurers are looking at setting up a shared database of fraudulent claimants and those with pre-existing health conditions. Insurance companies feel that plugging leakages caused by unethical claims would help reduce losses.

Although data on fraudulent claims are absent, insurers say their experience points to several instances of inflated claims. They say such frauds are possible because of poor regulation of health-care service providers. "Industry- level discussions on the subject are already under way," said Anuj Gulati, director, services and business development, ICICI Lombard General Insurance.

Besides inflated claims, non-disclosure of pre-existing illnesses is a major concern for the industry, whose claims payout is estimated to be 130 percent of the premiums collected.

Once a database is in place, insurers can identify frauds if they move from one company to another. "The centralised database would help insurers plug the leakages and also offer inputs for taking more informed decisions while underwriting risks. The discussions are still on at the industry-level and there is a long way to go before it (database) takes definite shape," said Gulati.

Adds Antony Jacob, CEO, Apollo-DKV Insurance Company, "Formation of such a repository — whenever it takes shape — will certainly be welcome. Access to claims and exposure data pertaining to the Indian health market as a whole will be available to health insurers, helping them analyse the data in a meaningful way by using analytical tools while pricing new products and re-pricing existing ones."

In the long run, a central database will also be useful for policyholders, as it will facilitate portability of health insurance. "Some companies may be extremely cautious while acquiring other insurers' customers due to difficulty in underwriting without adequate data to compute the risks. Therefore, a repository giving health insurance companies selective access to proposers' claims history will help in appropriate pricing of the policy, benefiting the customers as well as health insurers," said Gulati


My comment on this news item is
"Let us compile the data of group policies first ,control the claims of group policies first and then move to the creation of the database of the individuals"

RTI TO RESCUE OF MEDICLAIM POLICYHOLDERS AWAITING REFUND

The Times of India has carried an intersting news regarding RTI( Right To Information Act )being used by Anant M Nandu.

The news item covered is :

The Right To Information Act has come to the help of thousands of Mediclaim policy holders who have been struggling to get refunds for the excess premium they have paid.

The Central Information Commission (CIC), in a landmark order, has directed New India Assurance Company Ltd to make public the details of the total number of policy holders who are still to get a refund for the excess premium charged. The CIC has asked the firm to provide the information on the company’s website and send a copy of the information to the Insurance Regulatory & Development Authority.

The CIC’s order came after RTI applicant Anant M Nandu filed a query seeking details on the number of Mediclaim policyholders charged excess premium even after the quantum of premium was reduced.

Grant Road resident Nandu had filed an RTI query last year after he learnt that the company was charging an extra premium during the renewal of his policy. “I had earlier sent them a letter asking for a refund, but they never responded. That is when I filed the RTI query,’’ Nandu said

The question comes to my mind is CIC could take action because New India Assurance is a PSU.What options we as consumers are having with respect to Privately owned companies?

Can we expect from the Government that RTI Act is also made applicable to Private Banks & Insurance Companies.Consumers will be relieved from the difficulties ,they are facing

Comments are invited.

Why should I buy health insurance from you rather than buying from elsewhere?

Very common question which we have from those who access our website is

''Why I should buy health insurance from you?"

Our reply is given and I thought let me put it down for benefit of many of you.

We handle products of all Insurance companies As a leading health insurance source, we are able to offer our customers:

1- Broad Selection. Because we are an Insurance Brokerage Company and not a health insurance company/an insurance company, therefore we can offer products from multiple insurance companies. We offer a broad or we can say 100% selection/range of products from all insurance companies and as a result, it allows you to find the Insurance Product that best fits your needs. In fact, we are the leading source in India of health insurance for individuals, families and corporate clients.

2- Best Prices. Health insurance premiums are filed by the insurance companies to the regulator and are approved by them (Insurance Regulatory & Development Authority). Whether you buy from us, your local agent, or directly from the insurance company/health insurance company, you'll pay the same yearly premium for the same product. Good thing about us is that we tell you about all the products and also the service level of various companies.We have the feedback from large number of our clients.

3- Fast Processing. We offer the fastest way to get health insurancepolicy issued because we focus on health insurance and are handling so many proposals on everyday basis . This reduces average processing time significantly for you.We can be reached by phone /email as per your convenience.

4- Excellent Customer Care. We believe that you should enjoy the best customer experience available for getting the health insurance policy issued from us . The highly trained staff of our company handles your query in the professional way and with care, which it needs as you are important to us .They help you make the most of your money with professional, unbiased advice, which we only can give you because we are an Insurance Brokerage Firm and we handle all the products and that too of all the companies.

ICICI Lombard will not be aggressive in selling Health Insurance

On the one hand we notice aggressive advertising campaign of ICICI Lombard and at the same time we find the following statement has been issued by Sanjay Datta, head of health insurance, ICICI Lombard General Insurance, at an interactive session in Kolkata.
The statement is " Like most general insurance companies, ICICI Lombard would not be aggressive selling group health insurance policy due to high claim ratio"
We feel Health Insurance is a specialized product and co's like BUPA,Munich Re(DKV),Swiss Re will ultimately become active players in the Indian Market and traditional co's( General Insuarnce ) will start losing market share.
Incidentally ICICI Lombard has been having highest premium rates among health Insurance co's of the country.Root cause is that ICICI has been picking up marginal group policies in the past.It is good that they are realizing the realiites of business.

Joint Venture Partners in Health Insurance Companies of India

Very soon we will have Max BUPA and Religare Swiss Re entering the health insurance sector in India. With their joining we will have 4 co's in this sector and the details are;

Foreign Partners in Health Insurance Co's of India - June 2009

Name Foreign Partner Status

Star Health ETA Ascon, Oman Operational,
Revenue Rs.511.93 crores
(2008-09)


Apollo DKV DKV (Munich Re.C.) Operational,
Germany Revenue Rs.48.95 crores
(2008-09)

Max BUPA BUPA, UK Moving towards becoming
Operational

Religare Swiss Re, Switzerland Agreement reached

Reliance General Insurance Company Limited Increases Minimum Sum Assured Limit

Reliance General Insurance Company Limited has increased minimum sum assured limit for Health Wise Silver Plan to Rs.3 lakhs. Even though in leaflets/ brochures Reliance Health Wise minimum sum assured limit for Silver Plan is Rs.1 lakh. But in May 2009 Reliance has stopped accepting proposals for less than Rs.3 lakhs. It means minimum sum assured under Reliance Health-Wise Silver Plan is now Rs.3 lakhs. We feel that this is a step in the right direction as insurance companies are under pressure to control costs. Cost of issuing a policy is estimated at Rs.350 to 450. For a policy where premium is Rs.800 only the insurance company is definitely losing good amount ofmoney.

We are also informed that Reliance has issued guidelines under which at the time of renewal sum assured cannot be increased for Health Wise Silver or Gold. This will motivate customers to buy higher sum in the beginning itself.

For more information visit http://www.healthinsuranceindia.org

Customers to benefit from New Renewal Rules for Health Insurance Policies w.e.f June 1, 2009

Customers to benefit from New Renewal Rules for Health Insurance Policies w.e.f June 1, 2009

These rules as announced by IRDA are:

1. An insurer can’t deny renewal on any ground other than fraud.

2. The policy brochure will have to clearly state the terms and conditions of renewal

3. It will have to mention the age till which renewal will be allowed.

4. It will have to mention the circumstances under which and the extent to which premiums will change.

5. Insurers will have to intimate the policy holder about any change in premiums three months in advance and not at the time of renewal.

6. Renewals will be allowed up to 15 days from the due date.

Renewal Age :

The policy document will now mention the maximum age till which an insured person can renew a policy.

Premium Changes :

Though the insurers will reserve the right to alter the premiums, they would be able to do so only under certain conditions, like the policyholder having a poor track record or medical inflation.

Insurance regulator tells non-life insurers to mention renewal related details in health policy documents to ensure transparency.

Grace Period :

An insurer will have to renew policies up to 15 days from the actual date of renewal.

We will welcome service from Insurance Company where the customer can go to the website and look at renewal premium by feeding his policy number and password-may be his mobile number or date of birth.This will save lot of headache and early collection of premium by the Insurance Company.Let us see who starts this as a customer service.

For more details please visit http://www.healthinsuranceindia.org

Knee transplant is now costing Rs 5.50 lakh

Many emails /phone calls which are received by us ask us the cost of specific treatment so that the sum assured is taken for suitable amount.

Today I met a person who has recently gone for knee transplant in New Delhi and the cost he has incurred is Rs.5.50 lakhs( 550,000).

Costs are going up.It is better to go in for higher sum in the beginning rather than realizing at the time when you need the insurance that you are having underinsurance.

Health Insurance figures for the year ending March 2009 are available

Provisional Health Insurance figures for India for the year ending March 2009 are now available.

At Rs. 6500 crores this shows an increase of 30%. I personally feel the figure should be higher because of the fact that various schemes implemented by the Government of India for below the poverty line persons were implemented during the year. We were talking of crores of persons being insured. If that was true then 5 crores persons would have added Rs 400 crores, may be the impact of cut throat competition has resulted in group health insurance policies being issued at very low rates.

Let us watch as updated statistics will become available in the coming months.

What should be sum assured in health insurance policy?

What should be sum assured in health insurance policy?
This is a very common question which we come across from those visiting www.healthinsuranceindia.org

Hindustan Times of 8th April 2009 has carried some statistics and these are;

New Health Insurance Company's in Indian Insurance Industry

Yes we are expecting good activity in Health Insurance .

At present ther are only 2 operating stand alone Health Insurance company's in India
(1)Apollo DKV Insurance Company Limited
(2)Star health and Allied Insurance Company Limited

We have been hearing that 1 more co is going through approval process and it is Max BUPA.

Suddenly we find that 3 large names from USA have become interested in the growing Indian Market
These are
(1)United Health
(2)Aetna
(3)Cigna

It is great news as we as a country offer huge market potential and large no of stand alone Health Insurance co’s are the only solution to our needs.
No need to mention (as I covered in one of my blog.

“When an Indian goes out of India he can get insurance coverage of Rest. 260 lakhs (Overseas Travel Insurance) but within India he is worth Rs. 10 lakes on the highest side. Is it not surprising –we are ready to insure his car for Rs. 550 lakhs but as far as he is concerned he is worth Rs. 10 lakhs only.

We as a website say
"We welcome the decision of United Health, Aetna, Cigna" to consider India as a destination to grow.

Who gives better Insurance advice Insurance agent or Insurance brokerage firm?

Who gives better Insurance advice Insurance agent or Insurance brokerage firm.

The survey of Economic Tiles has revealed that 85% customers are not satisfied with the advice given by insurance agents.

It is from time to time I have come across questions from customers where they wish to have the answer to the following; why I should use insurance brokerage firm in comparison to use of insurance agent. We have always pointed out that use of Insurance Brokerage Firm (IBF) has many positive points and these are:

1- IBF handles products of all companies so they give the right advice i.e. Which product fulfills the requirement of the customers? They assist the customer in buying the right product from right insurance company at right price.

2- IBF assists you in lodging of the claim and settlement of the same.

3- IBF is an organization and not one man show as in the case of Insurance Agent.


It was interesting to know that survey conducted by The Economic Times has revealed that 85% of customers are not satisfied with advice of insurance Agent.

It is time for you also to switch over to Insurance brokerage firm (IBF).

PNB (Punjab National Bank) loan scheme for hospitalization expenses

Now it is possible to have Bank loan for hospitalization expenses.

Over 80% of population of India does not have any kind of insurance. A person who does not have the money to pay for the hospital expenses had no option but to accept suffering out of the illness/critical illness, if he was unable to borrow money from his relatives or friends. Chances of getting loan from money lender in the village/town were remote as the money lender was not sure whether he will get back the money or not.

Punjab National Bank, one of the PSU Bank has come out with the loan scheme for hospitalization expenses and we are in the process of getting details of the same and will be providing the details in the blog in the days to come.

Indian Health Insurance to Touch $7700 Million (Rs 40000 Crores) by 2015

CII (Confederation of Indian Industries) estimates Health Insurance premium will touch figure of US $ 7700 Million (Rs 40000 crores) by 2015.

According to Dr. Pratap Reddy, Chairman CII National Health Care Council, Health Insurance premium has the potential to touch the figure of Rs 40000 crores by 2015. Last year the figure was Rs 5000 crores. This means that figure will go up by 8 times in 7 years. It is heartning to read such estimates.

Question before all of us is whether Indian Insurance companies or TPA's (Third Party Administrator) are prepared for this increase.

Senior Citizens get relief with Cholamandalam issuing overseas travel insurance policy for 270 days

Senior Citizens get relief with Cholamandalam issuing overseas travel policy for 270 days

Many foreign embassies insist for health insurance policy at the time of grant of visa.They limit the visa duration same as the duration of the policy. Australia is one such country.

It is good that even though all companies restrict the policy for senior citizens to 180 days ,there is at least one company ( Cholamandalam)which is issuing the policy for 270 days.

Our compliments to them for doing so, parents who spend lot of money at go to spend long time with their children can have the satisfaction that they can get visa for 270 days vs that for 180 days.

Indian Insurance Company’s don’t need the premium from NRI’s

Indian Insurance Companies don’t need the insurance premium from NRI’s

India as a country got $ 39 billion(during 2008) from NRI’s who are working abroad. We even have a separate Ministry to take care of NRI Affairs, which shows the importance our Finance Ministry gives to money being sent to India in the form of foreign exchange. We organize full fledged international conference every year. This year it was organized in Chennai recently.

It is surprising to note that we do not need the insurance premium from the same NRI’s.Our underwriting norms are strict.

We have come across many NRI’s who are living in foreign and knowing that when they will return to India at the age of 60 then they may be compelled to have policies developed for Senior citizens insurance which have the following constraints;
Limit on sum assured
Co payment
Higher premium

They have realized that at the age of 55 or 57, if they buy a policy under normal category then they will go on having the renewals under that policy which is much more beneficial to them. Recently we got many such customers .Let us take an example
NRI residing In Middle East
Age 57 Yrs
Wife 55 Yrs
Wishes to have family floater health insurance for Rs. 10 lakhs. Co should be such
and product should be such that policy goes on getting renewal till the age of 80 Years. This means that Insurance co is getting a dependable customer for next 23 years.

Health Insurance Company's
Companies wish is that he and his wife should come to India to get medical examination (ECG, blood test, urine test) done. Expecting a customer to come all the way from Middle East to India( Air ticket may be costing Rs.20000 for each -total Rs 40000) to get the tests done. This is another way of saying to the customer that we do not need your business.
We feel that the time has come when we start treating the customers in a good and respectable manner? Our request to the Insurance companies that the customer is ready to go to get the Tests done at any nominated clinic /hospital in Middle East met with negative response.

This point was put forward in the Assocham Conference in New Delhi and was appreciated by high ups from Insurance companies.

Parents Health and Medical Insurance Policy Rishtey for NRI & All plz visit our website http://www.healthinsuranceindia.org/

Some Facts about Health Insurance Claims 2007-08

We have come across some good statistics about the claims made by health insurance policy holders in India. These are;

Data Sourced From : 28 Third Party Administrators operating in India

Claims Made by Females : 6,50,070
Claim amount paid : Rs 1,359 crore
Average Claim size : Rs 20,903

Average Claim for Cesarean Delivery : Rs 30,000 to Rs 35,000
Average Claim for Normal delivery : Rs 20,000 to Rs 25,000

Claims Made by males : 6,08,023
Claim amount paid : Rs 1,150 Crore
Average Claim : Rs 18,922

No of claims made by those in the age group 41-60 = 4,30,000

Amount paid in claims : Rs 1,001 crores

Lifestyle diseases for which claims are made by those in 41-60 age group
(1.)Heart Ailments
(2.)Diabetes
(3.)Hypertension
(4.)Degenerative Diseases

Share of Individual/family policies in the Premium : 51%
Share of Group Floater policies in the Premium : 33.9%
On an average Premium charged For Corporate Policy is 50% lower than that paid by individuals/Families.

For individual health insurance premium comparative visit www.healthinsuranceindia.org

United India Insurance Company Limited launches super top-up & top-up medicare policy

After the introduction of Top up policy by Star Health and Allied Insurance Company Limited now we have top up and super top up medicare policy from United India Insurance Company Limited. The good thing is that even if you do not have any health insurance policy you can go for it. In the case of Star health and Allied Insurance Company Limited you must have sum assured of Rs 3 lakhs and above (either from Star health and Allied Insurance Company Limited or any other insurance co) and then only you can go for it.

The premium rates are awaited and will be included in the blog/our website www.healthinsuranceindia.org

In the case of United India Insurance Company Limited if you do not have any health insurance policy but you have this insurance policy then the initial sum has to be borne by you and then only United India Insurance Company Limited comes into picture for claim settlement.