Thursday, November 10, 2011

If you are persistent you will win

If you are persistent you will win

The health insurance claim of Sanjay (name changed) was rejected by the insurance company. Repeated attempts by the insured with insurance company at various levels were not successful. We as Insurance Brokerage Firm advised him to take up the matter with Insurance Ombudsman. The matter took some time as the office of Insurance Ombudsman is having large number of complaints or cases coming up every day. After processing the date were fixed, the case was taken up and finally the insurance company was ordered to pay the claim. We appreciate the persistence effort put in by the insured, which has brought success to him.

Outlook magazine of November 3, 2011 has carried the case of Dr Kunal Saha, a medical doctor working and residing in USA. His wife had died in Kolkatta in 1998 while undergoing treatment. Kunal was convinced that Dr. Sukumar Mukherjee, the top Kolkatta physician who first treated Anuradha, had inflicted on her a massive overdose of Depomedrol, a long acting corticosteroids that went on to play havoc with her immune system; and that the treatment that followed, involving other doctors and the Advanced Medicare Research Institute (AMRI) a reputed private hospital, had been appallingly negligent .Armed with both certainty and rage, Saha, himself, a Kolkatta trained doctor put his peers in the dock.

Saha had too traveled 50 times over 13 years to India to fight the legal battle. I admire this gentleman.

The claim of Saha was for Rs 77 crores but Supreme Court of India delivered a ruling in 2009 which vindicated his struggle. By finding the Kolkatta doctors negligent, it opened the door for compensation order to be passed.

In October 2011, National Consumer Redressal commission has ordered that three Kolkatta doctors who treated Anuradha and AMFI will have to pay Rs 1.73 crores. Net payment after deductions to Saha will be Rs 1.34 crores. According to Dr Kunal Saha the amount spent by him on legal battle has been of the order of Rs 5 crores.

The points coming up before us are;

1. We should be persistent in follow up of our case whether it is Health insurance claim against an Insurance Company or liability claim against someone, who has not performed his duty.

2. Were 3 doctors or AMFI having professional liability cover in 1998 from Insurance Company? If yes will the Insurance Company pay it?

Let us wait and watch.

Wednesday, November 9, 2011

4 PSU General Insurance Companies to come out with IPO

New India, National, Oriental & United all the 4 PSU General Insurance Companies will be coming out with IPO. Even though some newspapers have written that this is because Government of India is facing financial deficit.

Let us look at the positive aspects of this move of the government;

1. IPO by these strong Insurance Companies will set a healthy record for listing of Insurance Companies in India. It means putting the insurance companies shares on right path i.e. growth 2 or 3 IPO's by Private companies at high premium and then going down on listing or within 2 months of listing would have been disaster.

2. Independent Directors are a requirement of SEBI for listing on Stock Exchange. It means that all the insurance Companies will now become broad based and will start following the rules /concepts of Corporate Governance. It is good for all of us, who are the customers of these Insurance Companies.If you feel that you should be considered for appointment of Independent Director ,this is the time to lobby for it.

3. Listing on Stock Exchange means that name of the company is covered many a times in press/TV so insurance Companies will not have too waste their money on advertising as brand is coming in front of customers on regular basis.

But here is a word of caution. The shares of these companies should not go into the hands of foreign companies because these companies (4 PSU’s) are very valuable because of

1 Real Estate assets( offices/Mumbai Flats owned by New India -thees are worth many many thousands of crores) owned by them. Pvt. Companies are generally operating out of rented buildings.

2. They own valuable investments in stock, accumulated over 40 years.

These shares should go to Indian Citizens who have been the customers of these companies. Therefore I feel;

'Let us write to Finance Minister that 10 % of the equity is reserved for policy holders of the company. We who have been loyal to these 4 companies can get the benefit of appreciation in share price. If you agree make it a point to send a letter to Finance Minister. Let us have this as a campaign.

Sunday, November 6, 2011

List of Insurance Repositories selected for maintaining the Insurance data in de mat form.

Recently when the claim was lodged for health insurance with a general insurance company then the delay in clearing /payment of the claim was that they had called for original proposal form , which was submitted when the insured had purchased the policy for the firs time i.e. 3 years back . What can be the situation if insured had purchased the policy 15 years back ?

We always advise the clients that they should keep all the old policies of health insurance in a file ,as it may be needed in future ,when the claim is lodged.

May be Repositories which will start operations in near future will simplify the whole thing as these will maintain data in de mat form. All of us are hopeful that this will help the insured as well as insurers.

5 companies which  have been selected by IRDA for the work of Insurance Repository  are;

1. National Securities Depository
2. Central Securities Depository
3.Stock Holding India
5 Karvy

It is understood that" In principle" approval has been given to them.
Karvy, which is also in the business of insurance distribution, has been asked to keep arms length distance between Insurance Repository and  its insurance distribution firm . It is a difficult task but we are sure that IRDA, the regulator will take sufficient precautions so that de mat data is not misused.

Saturday, November 5, 2011

Yellow markings in the skin around the eyelids are a warning to you as well as insurer

Researchers in Denmark have come out with a study after compiling data of 13000 persons and that too over 30 years . According to this those who were having patches, known as xanthelasmata were more likely to have heart attack or even die with it within 10 years.

These spots are deposits of Cholesterol which are soft and painless. They do not interfere with eyesight /vision. People generally go to dermatologists or skin specialists and get these treated.

In this Danish study started in 1970’s 12745 people were in the control group Out of this 4.4% were having xanthelasmata.Over 33 years 1872 had heart attack ,3699 developed heart disease and 8507 had died. The study shows that those with markings were 48% more likely to have heart attack,39% more likely to have heart disease and 14% more likely to die. The heart disease link is more acute for men in 70 to 79 years age group.

May be insurance companies issuing health insurance policies/life insurance policies  will start compiling data on xanthelasmata,come out with corrective steps (medical advice or loading of premium ) and save on costs associated with claims.

Apollo Munich / L & T / Max Bupa- which one is better and why?

Apollo Munich / L & T / Max Bupa- which one is better and why?

These 3 private sector companies are competing for business from premium customers or HNI’s, (high net worth individuals) who are looking for better health insurance products with good and attractive features.

Let us see the comparison ;

L & T is charging premium 72% higher than premium of Apollo Munich or 25% higher than premium of Max Bupa. The additional benefits offered are:

Hospital Cash Benefit – Rs. 6000 (max)
Recovery Benefits – Rs. 10000 (max)
Attendant person payment- Rs. 1000

provided the insured remains in hospital for 10 days or more than that.

At the same time L&T  product is losing on the following point;
No Claim Bonus is 5% vs. 10% being offered by Apollo Munich or Max Bupa.

When I checked up with few customers about their reaction on L& T product then the feedback was “no one is wishing to earn Rs. 17000 by getting hospitalized for 10 days. A person who is well off and can pay higher premium of L&T  is not the one who is looking for payment of Rs. 17000.

Let us see how L&T product will perform in the months to come.

Saturday, October 1, 2011

Today (Oct 1, 2011) is a good day as portability of Health Insurance policy has started on Oct 1, 2011

Our compliments to IRDA for bringing this change.

In case any one of you faces any difficulty please inform us or comment on this blog so that it can be taken up with concerned authorities/Insurance Companies.

We feel with a view to fulfill 45 days condition Insurance Companies should start issuing renewal notice 60 days in advance, because only then the customer can fulfill the procedural requirement.

It is then that customer can make up his mind for portability and submit the following

(a) Portability Form

(b) Portability Form

To new insurance company.

We feel Insurance companies should set up the system to issue receipt so that client can use it for reference. A clarification 15 is calendar days or 15 working days will be appreciated. We assume it is 15 calendar days.

Friday, September 16, 2011

HIV patients will be able to get health insurance policy issued

Under the present guidelines of various Insurance Companies have not been issuing Health Insurance policies to HIV patients. From time to time we had expressed that insurance policy should be issued to them, with HIV being mentioned as preexisting disease. We always felt that HIV patient can be involved in accident and may need hospitalization. He can also get some disease which has no correlation with HIV.

It is good to know that IRDA has considered this viewpoint favorably and in near future Insurance companies will start issuing policies to HIV patients with HIV being mentioned as preexisting disease.

We feel it is a good gesture of Regulator as well as Insurance Companies.

Monday, September 5, 2011

It is depressing to know that bribe is demanded in a hospital

Reading of this news item (The Times of India) left me thinking -why it happens in India.

But why it happens? There is urgent need to establish more and more medical colleges/hospitals wish that next budget will bring some proposal which will encourage setting up of medical colleges as will as hospitals.

Be ready to pay Service Tax on health care from next budget (2012)

Be ready to pay Service Tax on health care from next budget (2012). There are clear indications that government is going to impose Service Tax on health insurance from next budget (2012) In case of health care- two options are being considered.
Option 1.

To exclude all services provided by clinical establishments with turnover under Rs.4 crores from the tax. This means that apart from your medical bill at a large private hospital you will also have to pay service tax, which could be 10% of the total amount. The implication of this will be that you should increase sum assured at least by 20% (10% to take care of Service Tax and 10% to take care of inflation).

Option 2.

To leave out hospitals, medical care, diagnostic and paramedical services but tax health check-ups and cosmetic surgery”. After the last budget, the government had deferred a tax on most healthcare facilities in the wake of public protests.

Tuesday, August 16, 2011

Give with one hand –take it away by other hand

Give with one hand –take it away by other hand.

It is very common to hear this type of statement. The same thing was noticed in one of the news item according to which Apollo Munich is going to get approval for health insurance product for senior citizens of any age. This product is going to get approval of IRDA by end of August 2011.

This is one part of the story where it is giving with one hand. The cooling off period will be 1 year or 12 months. This is what we have called is taking away by other hand. We feel Cooling off period of 12 months is totally unreasonable. Which senior citizen will accept this while knowing it? This will encourage tendency for missselling.Let us avoid it .We do hope the regulator will look into this aspect.

Monday, August 15, 2011

Rs 10000 crores underwriting loss by our non life insurance industry during 2010-11 –it needs attention of all of us

Rs 10000 crores underwriting loss by our non life insurance industry during 2010-11 –it needs attention of all of us

It is disappointing to know that Indian general insurance industry which touched premium figure of Rs 42000 crores during 2010-11 has incurred underwriting loss of Rs.10,000 crore .Does it give a signal that for next 5 years these companies will go on incurring losses.
According to Mr. G Srinivasan, chairman and managing director, United India Insurance, commented that the challenges for both the industry and individual insurance companies are enormous.
Over the years, the general insurance industry may be making underwriting losses but the companies have huge investment income by which they have been able to cover up those losses and have been able to show reasonably sound balance sheet over the years, Srinivasan had said at an event in Mumbai.
“The situation will no longer continue because the quantum of losses are increasing. In 2009-10, the general insurance industry had made an underwriting loss of Rs.5,900 crore, whereas in 2010-11 the estimates is that the industry would cross Rs.10,000 crone underwriting losses. The general industry may have to record net losses in 2010-11,’’ he said.
It will be a good idea to know how many cases( number & Rs. Term) are pending against general insurance companies with the following;
Insurance Ombudsmen
Consumer forums at district,state and national level
Civil courts at district ,High Courts,Supreme Court
The figure will be astonishing.

What is the option before the Insurance Companies;
Refix the premium rates
Use the Insurance Broker firms in a big way
Totally do away with their direct sales force .
Strengthen underwriting team.
Merge with other company
Depending on investment income to show reduced losses or a marginal profit is not for what the promoters entered this business. A weak organization is no good for customers.

Sunday, August 14, 2011

Free Medicare to all citizens- Time to introspect

Free Medicare to all citizens- Time to introspect.

Times of India of Aug 8, 2011 has carried a news item on the concept being considered under free medicare. Part of it is:

“Working towards its aim of providing free healthcare to all, the government is planning a national health entitlement card (NHEC) for every citizen that will guarantee access to a package of essential primary, secondary and tertiary healthcare fully funded by the centre.

The proposal, finalized by a high-powered expert panel of the Planning Commission, talks of covering both in-patient and OPD services free of cost with cashless facility. The health package will focus on the most common and high-impact healthcare requirements.

While the centre will bear the cost of services offered under the national health package, state government can add more services at their own cost. The health services can be availed through public sector and contracted private facilities, including NSOs and non-profit agencies.

Service providers, be it public or private, who accept the health card will not provide any services to those willing to pay additional fees either out-of-pocket or through their privately purchased insurance policies.

This is being done to keep away those who can pay to avail health services.”

This news came on (the same day) when the world was facing crisis due to debt/ deficite Aug 8, 2011 some of the major countries USA, Italy, Portugal, Greece are facing crisis due to Social Insurance/ Social benefits which were provided by those governments to their citizens.

The question before us is we on the right track. Is there any survey on lignor consumption in localities where we have so called BPL families living. Are we supporting them so that they can spend more on lignor, panmasala and gutka.

Let us include OPD in our health insurance policies.

Let us include OPD in our health insurance policies.

OPD coverage is equally important. Are we living in mid-eighties when Mediclaim product was developed with coverage for Curative treatment?

The News item as above shows the importance of Diagnostic tests where small amount would have saved pain and agony to Joshi/Mishra, their families and the claim which insurance company will have to pay. Imagine the productivity loss which the employer of Joshi/ Mishra has suffered.

The time has come when we should introduce health insurance which offers OPD coverage.

Friday, July 29, 2011

Is it possible to reduce health care costs?

Is it possible to reduce health care costs?

It is very easy to increase costs. The challenge comes when you have to answer question
“Is it possible to reduce health care costs?”

The truth is yes, it can be reduced if Tiger biscuits can be produced packed transported & then sold at retail level at Rs.50 per kgm by a reputed company Brittania- then why it is not possible to reduce costs when it comes to Health care.

In health care economies can be achieved by
(a)Standardision on design of hospitals
(b)Standardisalon on equipments to be procured/ installed
(c)Use of generic medicines vs branded medicines

(d)Effective procurement of equipment/medicines by hospitals forming consortium

We are sure the cost can be brought down by 25% and the benefit can be passed on to the consumers.

Wednesday, July 20, 2011

Consolidated document containing all terms and conditions on health insurance to be issued by Irda

There have been so many notications pertaining to health insurance that Irda may comeout with a conslidated document having all terms and conditions pertaining to all players( Insurance Companies,TPA,s,Intermediaries). This will help all players/customers to refer to one document and have all the queries answered.

If this comes out -it will be a very good step. We welcome this proposal.

Monday, July 18, 2011

OPD coverage to make beginning in Indian Health Insurance

Non coverage of OPD has been one of the major weakness of Indian Health Insurance policies.
As a part of RSBY pilot project is being launched in Puri ,Orissa and will be followed in Mehsana, Gujarat.
We are sure this will result in reduction in claim figures in these pilot projects and scheme will extended to all over the country.What ever happens to RSBY is ultimtely going to spread to all the policies.

TPA,s should provide service to Insurance Companies only

In the recent past we have been hearing that TPA,s have started providing services to corporate clients inmanaging their health care schemes.

Irda does not wish this to happen.This is a good news.Insurance industry lost some of the corporate clients where the cliam ratio was much less than 100%.As a result clients wwhich were adding to the favourable margins were being lost.

Sunday, July 17, 2011

PSU's still retain 59% market share of Indian health insurance market (2010-11) of Rs.11145 crores

The health insurance figures for the year 2010-11 are available and PSU's have achieved premium figure of Rs.6578.64 crores vs Rs.4949.67 crores(2009-10). This is 59.02% market share vs 59.09% market share which was achieved during last year.

Health Insurance Premium of Indian Insurance Companies 2010-11 vs 2009-2010

You will notice that every company has shown growth in business with exception of Chola.

Growth during the year of this portfolio is 33.05% and 5 top insurance companies and their market share are:
ICICI Lombard deserves appreciation for taking up 4th position as a result Oriental is now at 5th position in the list. Star Health has crossed figure of Rs.1000 crores by touching figure of Rs.1232.44 crores.

Our comment is- health insurance is the fastest growing segment but even then a lot is to be achieved as we have large population and it needs to be covered.

Some are going & some are coming

Bharti group has sold Bharti AXA (both life & non Life) to RIL (Mukesh Ambani Group). DLF Pramerica is being sold to HCL (Shiv Nadar Group). Future Generali (Kishore Biyani Group) is looking for buyers for both of its Insurance companies.

After tasting the attraction of Insurance sector many well known names /business houses have decided to leave.

At the same time some are getting in this sector .Mahindra & Mahindra is entering non life business. . Magna is also entering non life. Edelweiss is entering Life business.Religare Health should be operational in near future.

Delegations of many foreign companies have been visiting India frequently and have been looking for partners. Some of these are:
Samsung Fire & Marine

Let us welcome those who are entering and bid goodbye to those who have left.

CORIS Gipsa TPA JV is not coming

There were indications that CORIS Gipsa TPA JV will become operational by end of 2011 and as a result of the same New/National/Oriental/United (4 PSU’s) will shift their TPA work to the new company.

Tenders were floated and Coris, a French company was selected. Suddenly we find that JV is being dropped. Tendering/Selection process has come under cloud and it was decided by the high ups to avoid negative publicity by dropping this JV.

May be it is the end of the JV idea. Let us wait & watch.

Monday, July 11, 2011

Emphasis is needed on preventive cure

Emphasis is needed on preventive cure.

More and more emphasis needs to be put on preventive cure to reduce hospitalization claims. We always thought that good hygiene is important for healthy life but correlation of brushing teeth twice leading to lower cardiac illness risk is a good and interesting study. This has appeared as a news item in TOI.

Health Insurance portability is delayed

Health Insurance portability is delayed.

In one of my blog I had written that portability of health insurance is having complexities and it will take much longer time to become effective. We have been advising clients that do not postpone buying of Health Insurance policy for portability conditions to be known and being effective. This has happened as the portability is delayed from July 1, 2011 to Oct 1, 2011.

Frauds have no limit in insurance claims

Frauds have no limit in insurance claims.

The following news item is an eye opener, where the person concerned tried to have a claim by taking his father’s death and even managing documents required for lodging claim.

The question before us is:

Was the claim lodged with American Insurance Company, who asked the investigator to investigate the case?

Is it that Indians have stared buying life insurance from foreign insurance companies in foreign?We have started hearing that some people are now buying health insurance outside India because of better coverage.

Wednesday, June 22, 2011

It makes sense to pay 2 years premium and save good amount of your money

It is from time to time people used to ask whether they can pay 2 years premium .Many dropped the idea after knowing the savings,which ws not much.

Apollo Munich has come out with a good option under which you can save 7.5% by paying 2 years premium insted of 1 year.If you look at it carefully you will realise that as far as2 nd year is conecerned the saving turns out to be 15% as far as second year is concerned as this year premium you had to pay even otherwise.

Monday, May 23, 2011

Are the financial results of our General Insurance Companies disappointing?

Yes, it is disappointing to see that large numbers of General Insurance Companies are incurring losses and heavy losses.
Loss figure leaves impression that claims settlement will be a delayed process and may be you will have to settle with figure of 60% or 70%.
Of claim lodged. This is because of the fact that it is important for insurance companies to pay salaries/ bills/travel expenses and then only they can think of funds availability for payment of claims?

We will be happier to see profit making and financially strong insurance companies.

Healthy long life is good- Are you prepared?

We are living longer and in few years the average age of Indian citizens will touch 75 years or may be 80 years. Are we prepared to live longer but in a healthy way? Have we planned for our health care in the coming years? Very few persons have planned for health care, the fact is that for many age related treatments like hernia, cataract, hysterectomy, knee replacement a person may have to be hospitalized.

What I find is that majority of people have left this important aspect of their life to Almightily, God, Goddess or Guruji in whom they have 100% faith.

Someone may need cataract surgery at 60 years and someone may need it at age of 65 years. If you are going to live till the age of 92 years then you will definitely need hospitalization 2 to 5 times.

The solution lies in buying good health insurance and too where you smile will get claim support with a smile. Avoid disfeatured policies with large number of sub limits/exclusion clauses.

Are the financial results disappointing?

It is a disappointing thing when we see that large insurance companies are incoming losses.

Saturday, May 21, 2011

Why you should buy Health Insurance?

1. Good health is most important thing in your life. When you need health care treatment then you must have it, otherwise the whole world seems to be worth nothing to you.

2. Health care costs are increasing due to

• Normal inflation due to increase in petrol costs, electricity costs, taxation, imposition of new levies/taxes.

• Improvement in medical technology results in availability of new equipment, which is better, more accurate in diagnosis. We have moved step by step from x-ray, digital x-ray, CAT scan, MRI, modern models of MRI. More developments will be coming.

• Development of new/better medicines due to application of Biotechnology/ genetics. As high R+D costs are involved and extensive clinical trials cost lot of time/money therefore their price is definitely on the high side in the beginning.

• Highly skilled doctors/nurses/paramedical staff is attracted by developed countries as a result of which health care providers have to increase compensation level to retain the staff.

• Real estate cost is high and is increasing.

All these points indicate/confirm that costs will go up year by year and you have to be prepared for it. We foresee health care costs to go up by 21% in next year.

Many a times I have come across person telling me- I own 3 flats in Gurgaon and if I needed will sell 1 of that to pay for my medical treatment. Reality is that it does not happen. You won’t sell one bathroom of your flat to pay for knee replacement.

You must have a good health insurance policy to take care of your needs.

Some people say that they will go to government or charitable hospital for treatment, when the need arises.

Recently I came across photograph of Safdarjung Hospital, a very famous hospital in New Delhi

The cost of treatment in this hospital may be less but due to excessive pressure to cater to large number of patients you may have to compromise on many things time you should not be surprised if you have to wait for 6 months for MRI test.

Shortage of ventilators has resulted in a stage that attendants or relatives of patients are being asked to pump manual ventilator to revive patients.

You have to make up your mind whether you will like to have good treatment in a good hospital and that too with dignity or you will like to shorten your life. Choice is yours.

Saturday, April 30, 2011

Gross Premium Underwritten by General Insurance Companies during 2010-11

Estimates/statistics of premium earned by General Insurance Companies for the year ending March 2011 are available and the overall increase during the year has been 22%.

Four Public sector companies have crossed the figure of Rs.25001 Crores which needs appreciation by all of us. Total premium of all the Pvt Sector companies (2010-11) is Rs.17567 Crores. Public sector vs. put sector share is 59%: 41%.

Indian Health Insurance Market- 2010-11

Indian Health Insurance Market- 2010-11

Estimates of Indian Health Insurance Market for the year ending March 31, 2011 are now available and according to it this market has touched figure of Rs. 11000 Crores.

Group Corporate portfolio and Group Government portfolio (Schemes like RSBY,) continue to be a loss making portfolio. Retail portfolio continues to be the group where insurance companies have been successful in reducing the claims figures by following rigid norms. May be the decision of PSU’s to go in for strictness i.e. July 1, 2010 and strengthening of PPN has resulted in good results.

Let us hope that all segments of health insurance portfolio will be profitable in few years.

Friday, April 29, 2011

Health care is achieving new heights in India; let us bring innovative changes in Health Insurance coverage

Health care is achieving new heights in India; let us bring innovative changes in Health Insurance coverage

Successful knee replacement of 93 years patient by team healed by Dr. Raju Vaishya of Apollo Hospital New Delhi needs appreciation. The person who was bed redden for 1 year will be able to walk. What a great feeling of achievement for our health care industry .At the same time let us not forget that most of our health insurance policies come to an end at the age of 75 or 80 years.

According to Dr Raju Vaishya “In India longevity of people is increasing and we now have more people living beyond 70 and soon there will be those who will live beyond 80 years.”

The wish of the clients is that all insurance companies should make health insurance policies renewable till the life of the insured. Some have started doing this .Let us hope that during 2011 all the insurance companies will modify there products.

Monday, April 18, 2011

Are they supporting each other Or are they fighting with each other?

Recently we came across a news item that 64% of the cases which came up before Insurance Ombudsman (located all over the India) was pertaining to health insurance portfolio. Let us look at the facts;

Health Insurance as % of non life insurance portfolio = 32%
Group policies issued under Health Insurance portfolio = 50%
Policies issued to Individual/ Families = 50%

It means policies being issued to Individuals/ Families are only 16% of total non life insurance portfolio.

General impression is that claims arising from group policy get paid because they have the bargaining /negotiating power .It means that Individuals/ Families are the worst sufferers as this is the group which is having claims being disallowed.

The question before us is how many of the dissatisfied customers are able to reach the office of Insurance Ombudsman?

64% figure is really a very high figure .Let us try to look at the reasons for this scenario or why it is so?

There are 3 players.

Role of every player is to provide good service to the customer. When the insured has to go in for hospitalization then each one ( Insurance Company /TPA/Health care Provider ) is trying to pass on the buck to other player as if the objective or job description of each one is who can harass the customer most so that he runs away and forgets about claim .
Health care provider says that this insurance company is blacklisted or this TPA is black listed

TPA says that this health care provider is black listed.

Insurance Company says that they are ready to consider the payment of the claim but it will not be on cashless but on reimbursement basis. This defeats the basic assumption of the client that when the need arises he will be able to have payment coming from insurance company.

We need the change in thinking at all levels.

Thursday, April 7, 2011

Is liposuction for obesity – Is it only cosmetic surgery or Is it the need of the day?

Is liposuction for obesity – Is it only cosmetic surgery or Is it the need of the day?

Liposuction is a surgery technique which can be used effectively as a treatment for obesity. Is it right to treat it under the head of Cosmetic Surgery and not allow the expenses for claim under health insurance policy. This has been the practice of all insurance companies.

According to Dr. Satish Arolkar, Plastic Surgeon and senior Consultant at the Asian Heart Research Center in Mumbai “There are many who feel that some of the cosmetic procedures should be allowed an insurance cover. Treatments such as liposuction and abdominoplasty should be covered under insurance as they target obesity.”
We know obesity leads to Complication like diabetes, heart aliments, knee replacement and the claims come in the range of Rs 2 to 5 lakhs. Is it that insurance companies are taking a short sighted approach by not allowing liposuction and abdominoplasty?

The earlier we take far sighted view and enlarge the range of our health insurance polices the better it will be.

Tuesday, April 5, 2011

Yes public opinion can compell even the Finance Minister of India to withdraw service tax

Compliments to Dr. Devi Shetty for taking a bold step in leading the campaign to withdraw the service tax.

All of you , who took up the matter in electronic and print media for withdrawl of this tax also deserve compliments.

Thursday, March 3, 2011

Budget 2011- Impact on Insurance/ Health Insurance

Budget 2011- Impact on Insurance/Health Insurance

Last day of February and people listen to the speech of Finance Minister of India, watch the analysis on TV and read comments in newspaper.

What does it mean to us with respect to Insurance/ Health Insurance

1. All unit linked insurance plans will attract Service Tax so depending upon company/ charges you will definitely pay more. For example, if you paid an annual premium of Rs. 10,000, the service tax (of 10 per cent) charged was Rs. 100. Now, the tax to be paid will be Rs. 150. These charges will be adjusted in the premiums and accordingly the yield will fall as far as you are concerned.

2. Senior Citizens above 80 years will pay no income tax till Rs. 5 Lakh income. It means saving of Rs. 26780 to any one who is above 80 yrs and has income of Rs 5 lakh. It could have been better for FM to give gift of Health Insurance policy for all those who are above 80 years. The same amount would have been given to Insurance Companies and it would have given boost to Health Insurance premium.

3. Service Tax @ 5% will be charged on all services/including diagnostic offered by a hospital or nursing home that has central air-conditioners and has more than 25 beds. This means that service tax will be added in one way or other to pre hospitalization, hospitalization and post hospitalization bills and you will bear it as your insurance limit will be exhausted earlier. Seeing health care inflation and impact of Service Tax the sum assured should be increased by you by 50% this year. It means if your sum assured is Rs 2 lakhs then it is desirable that you should increase it to Rs 3 lakhs.

It the payment is made by TPA/ under cash less then Service Tax was already being paid, therefore this seems to be case or double Service Tax.

Let us wait for some more analysis.

Sunday, February 13, 2011

Health Insurance portability from July ,2011 - Will it bring significant difference to Indian consumers

The significant point which you as a consumer can expect from the portability of health insurance policy (change over from existing insurance company to another insurance company )coming from July 1 ,2011 will be that even if you have an existing disease ( for which you have been treated /paid claim by existing insurance company in last few years say 2 years)you will be able to switch over to another insurance company .You will not be asked to wait for period of 4 years ( pre existing disease being mentioned in the policy as a result of which any claim due to same disease would be non payable for 4 yrs).

The question before us with example is :

Person 'A' having policy for Rs 2 lakhs and paying premium of Rs 2800 per year lodges claim for Rs 1.80 lakh and the same is paid. Next year he wishes to change to another company 'I' by using portability clause.Why should the company 'I' take a client with preexisting disease .The practical scenerio will be that 'I' will not accept the proposal form from 'A'.

The consumer does not have any option because at present the insurance companies are not bound to issue rejection letter or non acceptance letter for returning the proposal form.If the same situation continues ,which we understand is going to be then the client will have no document to complaint to any body for want of the same.

This has been happening with senior citizens when someone above 65 or say 70 yrs for last so many years. When he submits proposal for policy under Varisht Bima the proposal form is not accepted by the Insurance companies.This is the reason that if 100 policies are issued to 60 yrs old age group then the policies issued to 70 yrs old age group (we are talking of new policies not renewal of policies ) come down to 1 or even less than 1 .The underwriters sitting in the branches say that they have instructions to not to underwrite policies for those who are above 65 or 70 yrs.The best thing is that no record is maintained in these branches that how many such proposals were returned by the them in their branch.

If the precautions are not taken in this regard then let us be prepared that portabilty of insurance policy for persons with preexisting diseases is going to be sabotaged by the same underwriters and we will be at same level where we are at present.

If a person is normal then even now many companies have been accepting the proposals or issuing the policies with continuity for healthy persons.The problem is mainly with those persons who have lodged claim in last 2 years.

We will welcome the comments from you .You may like to suggest how this issue should be handled by those who are drafting the portabilty document or notification ,which will be implemented from July 1,2011

Wednesday, February 2, 2011

The Emperor of Maladies:A Biography of Cancer

The Emperor of Maladies:A Biography of Cancer

It is nice to know about achievements of some of our youngsters, who went to USA studied, worked, progressed and have brought fame to India.

Dr Siddhartha Mukherjee, author of ‘The Emperor of Maladies: A Biography of Cancer’ is one such person.

He has came out with a 6 point formula to help India control and combat the cancer epidemic and these are:

1.Put in place a strong tobacco control programme
2.Initiate sexual health education to prevent sexually transmitted cancers like cervical and oral
3.Encourage vaccination
4.Conduct mammography and screening of vulnerable women for breast cancer and those above the age of 50
5.Start screening for and vaccination against Hepatitis B that causes liver cancer
6.Create centralized systems modeled on comprehensive cancer centres in the US that allow researchers to share data and engage in high quality clinical work.

Out of these points 3, 4 & 5 are the ones which can be covered if the patient is covered under preventive care or is eligible for OPD treatment.

Few rupees spent on these by insurance companies can result in saving large number/amount of claim, which becomes payable when the insured has to be treated in specially/super specially hospitals for cancer.

We feel that the time has come to issue health insurance policies with OPD coverage.

Monday, January 17, 2011

Health Cover for all Indians will change the scene

In one of my blog I had suggested that all senior citizens should be asked compulsorily to go in for health insurance.

On the same concept Indian Government is considering to cover all citizens with Health Cover during Five year Plan (2012-2017).

Let us see what it means to you, me or all of us. Different studies may come out with different statistics .If we make some assumptions;
India population: 120 crores
Family size: 5
Households: 24 crores

With growth in population the figure can be Rs 225000crores which is 28 times the present size of health insurance or 7 times the size of general insurance industry.

This is going to give a big boost to healthcare industry and generate employment opportunities.

Sunday, January 2, 2011

Let us welcome Religare ,which is coming up with Health Insurance company

For quite sometime we have been reading news that Religare is looking for foreign partner for launching Health Insurance Company .Some of the approvals have been granted to joint venture with Union Bank Of India.

Let us welcome the entry of 1 more 100% stand alone health insurance company.