Monday, March 26, 2012

Documents needed for filing claim under 3rd party claim for accident to MACT

Documents needed for filing claim under 3rd party claim for accident to MACT

Following documents should accompany the petition for filing claim under 3rd party claim for accident to MACT:

1. Copy of the FIR registered in connection with said accident, if any.

2. Copy of the MLC/Post Mortem Report/Death Report as the case may be.

3. The documents of the identity of the claimants and of the deceased in a death case.

4. Original bills of expenses incurred on the treatment along with treatment record.

5. Documents of the educational qualifications of the deceased, if any.

6. Disability Certificate, if already obtained, in an injury case.

7. The proof of income of the deceased/injured.

8. Documents about the age of the victim.

9. The cover note of the third party insurance policy, if any.

10. An affidavit in support of the above documents and detailing the relationship of the claimants with the deceased.

You will find this list useful so that complete documents are lodged and claim / case is settled at the earliest.

Should Insurance Companies reward customers having good eating habits?

Should Insurance Companies reward customers having good eating habits?

Scientific studies reveal that there is a definite correlation to what we eat to our health conditions. Lot of research is going on and there have been many studies which have established this correlation. Recently, we have come across two different studies which have shown that the two most deadly diseases especially are related to the lifestyle and prove have definite correlation to what we eat.
Study 1 “Soft drinks raise heart attack risk”.

“Drinking one sugar laden soft drink every day dramatically raises the odds of having a heart attack” A study has confirmed. Diet varieties of Soft drinks /Cakes/ Ice-cream /or frozen yogurt (that use artificial sweeteners) got a clean bill of health. It is found out that a daily sugar sweetened drink raised risk of heart attack – including a deadly one – by 20%.
The study, reported in the journal “Circulation” also found that the more sugary drinks someone had, including still fruit squashes with added sugar, the chances of risk rose. Water, coffee and tea are the best drink choices, followed by low fat milk. Tea and coffee are okay too, but only if taken without sugar.
Study 2 “Regular & daily intake of large bowl of white rice increases chances of diabetes”

British Medical Journal has covered a study which was conducted over a period of 4 to 22 years. According to this “Eating one large bowl of white rice every day increases the risk of diabetes by 11%.”

A team of Harvard School of Public Health and Harvard Medical School who looked at 2 studies in Asians (Chinese and Japanese) and two in western populations found that every large bowl of white rice eaten a day is linked to an 11% increased risk.

As these studies are having large sample base and are conducted over long period we come to the conclusion that it is high time that the insurance companies in India will start rewarding people, who have healthy food habits. At the same time in comparison to this diet if the person consumes too much of sugar laden soft drink or is habitually a rice eater then premiums can be loaded.

We invite comments from you.

Monday, March 19, 2012

Government wishes PSU banks going to exit from Insurance, which is a non core activity.

Government wishes PSU banks going to exit from Insurance, which is a non core activity.

Everyone one wants to diversify when times are good but when the times are tough there is heat to squeeze. The banks have been asked by the government to get out of non core business such as Insurance. It could be a big blow to banks if this is implemented. Some of the banks would have to exit joint venture and industry would be seriously hampered, considering the agency model for insurance is under question due to high attrition and lack of professionalism.

As per the news published in Economic Times the Government’s pre-conditions for capital infusion stems from the concern that a number of non-core banking activities, particularly life and non-life insurance activities are capital guzzlers. Banks have to infuse capital for years in these ventures since it may take several years to break even. "The government is worried that demand for capital will rise every year if banks decide to undertake these activities. As an owner, they will then be obliged to infuse more capital to sustain the bank, something they would want to avoid when the fiscal deficit is out of control," said a senior bank official from public sector bank.

If this is indeed implemented then we as a country will need new non banking players to enter the insurance business In the recent past many business houses who entered got disheartened and have been in the mode to exit. Some of these are

• Bharti Axa : Bharti

• DLF Pramerica : DLF

• Future Generali : Future group

We wonder whether 49% FDI in insurance sector will make much impact.

Few days are left for making Significant Savings in Health Insurance Premium

On April 1, 2012 the service tax on health insurance premium would increase to 12.36% from the existing rate of 10.30%. It means that you have to pay a higher premium. For example if you pay a premium of Rs. 20,000/- for the health insurance premium, this is how you will be impacted:
Let us take elaborate this example. Total premium payable during this 2 years period is Rs 44,532 (Rs. 22060 + Rs. 22472) assuming that you decide to buy it before April 1, 2012.
It will be much better for you to go in for 2 years policy being offered by certain Insurance companies by giving discount of 7.5%.
From the above example you can see that you will be able to save Rs 3,721 on the 2nd year premium which is equal to 16.87% whereas banks FD for the same duration would not give you more than 6%-7% returns.

Thursday, March 15, 2012

Health Insurance may Touch Rs. 141500 crores if all are covered

Health Insurance may Touch Rs. 141500 crores if all are covered

In my blog of 1st February,2010 I had come out with a suggestion that all senior citizens should be asked compulsorily to go in for health insurance so that this portfolio increases. For initiating this great initiative, Government can support the scheme initially with some subsidy and later on reduce the same.

Hindustan Times has covered the news according to which now Indian Government is considering to cover all citizens with Health Cover during Five year Plan (2012-2017). It is a welcome step by the government to include all under the ambit of health Insurance. It is heartening that Clinical Establishment will also be regulated.
Let us see what it means for us. Below are the assumptions

India population: 120 crores
Family size: 5
Households: 24 crores

If we take an average of 5 lacs crore dedicated for healthcare for the 12th Five year plan it translates to expenditure of 1 lac crore each year. Dividing this by the 24 crore households the average expenditure comes to around Rs.4167each year. The question arises: Is Rs. 4167/- per house hold sufficient?

If we talk of providing health insurance to all the people the average annual premium per family would be

If we talk of only insurance premium required each year to cover the households the average cost per family each year would be Rs. 5896/- . Clearly there is a deficit of Rs 1700/- per year for each household.

However, what will be interesting is to know how the government will be able to bridge this deficit. Even in countries where it exists for example Australia Medicare levy (tax) is charged. The levy funds the scheme that gives Australian residents access to health care. The Medicare levy surcharge (additional tax) may apply to high income individuals or families who don't have private patient hospital cover or Mediclaim.

The Restore Option – New terminology in Family Floater Health Insurance

The Restore Option – New terminology in Family Floater Health Insurance

People often asked me whether I should go for Individual policy for family members or should I go for Family Floater.

Our answer had been consistent, If you can afford, then individual policy would be better especially, if the policy includes people of higher age.

Most people would abide by our recommendation and buy family floater for young family (immediate family consisting of spouse and children) and individual plan for aged people.

Of course when this was recommended there was no restore option in family floater plan.

What is Restore Option?

It essentially means that there shall be automatic restoration of the Basic Sum Insured immediately upon exhaustion of the limit of coverage during the policy period.

For example the couple has family floater policy for 3 lakh. If the one of the spouse covered under the policy was admitted to the hospital and underwent a Bypass Surgery costing 3 lacs and unfortunately, in the same policy year the other spouse had to be hospitalized due to accident and the expenses incurred during hospitalization was Rs1 lac. The insurance company would have only paid Rs. 3 lacs for 1st hospitalization and the couple would bear the cost of the 2nd hospitalization from their own savings.

In case they had bought the policy with the “restore option” Both the hospitalization would be covered. As soon as the limit gets exhausted the sum insured would be automatically reinstated to the original insurance cover.

Let us understand further, suppose the 1st claim for Bypass Surgery is 4 lacs instead of 3 lacs. Then amount payable for 1st claim would still be 3 lacs and 1 lac for the 1st claim would be paid by the couple from their savings. The 2nd claim for the accident would still be paid under the restore option for the other spouse’s hospitalization.

In the same example, if the 1st claim for Bypass Surgery is 2 lacs and the 2nd claim for accident for other spouse is 2 lacs then 2lacs for 1st claim is payable. However, only 1 lac for the 2nd claim for other spouse is payable. The restore is only triggered when basic sum assured is exhausted.

Who offers the restore option?
As on today there are three plans offering this facility:

Optima Restore from Apollo Munich
• Family Health Optima from Star Health Insurance
• My health Medisure Prime Insurance from L&T Insurance

All these plans are relatively new. L&T Insurance offers the restore option only in case of second hospitalization due to an accident.

How much does it cost?

For Insurance cover of 5 lacs with Restore option, a family of two kids below 18 years and parents aged 36-44 years residing in Delhi. The premiums are below.
It sound really great, Are there any catches?
• This option is not available for lower sum insured. Both Apollo and Star Health plan provide this benefit for cover of Rs. 3 lacs and above.
• The restore benefit cannot be claimed on the disease/illness for which the claim has already been made in the policy year.
• If you are looking for plan with additional benefits such as maternity benefits, critical illnesses cover, cash benefit for accompanying the insured child etc, these plans would not be providing these benefits.
Overall the plans are appealing and have been received well by the buyers of health insurance policy. Companies are even accepting portability under these new plans.

Friday, March 9, 2012

Health care costs will go on going up as the price of real estate goes up in New Delhi & other Metro cities

Health care costs will go on going up as the price of real estate goes up in New Delhi & other Metro cities.

It is interesting to see ad of Delhi Development Authority (Government body controlling land in the capital city of India- Delhi/ New Delhi) which has advertised for plots for:

Nursing Homes

in different parts of Delhi state.
You can look at sr. no. 2 where reserve price for 6 Hectar plot is Rs.464 crores. Assuming 500 beds will be available in this hospital the fixed cost of land for every bed will be Rs.92 lakhs. To this you have to add the following costs.

Construction cost
Equipment cost
Manpower cost

You can well imagine what a patient will have to pay when he is admitted to this hospital in 2016 or 2017, when the hospital will be operational.

This leads us to conclusion that one must have Health Insurance policy to pay for those costs.

Take up your claim with Insurance Ombudsman- There are good chances of Success

Take up your claim with Insurance Ombudsman- There are good chances of Success

RIA Insurance Brokers Pvt. Ltd. has always stood by its customers and helped them to get settlement of health insurance claims from insurance companies and their TPAs.
In a recent case one of our client’s claim was rejected by the Insurer on the ground that the insured was not required to be hospitalized for abdomen pain. Furthermore, they contested that the insured should not have ever gone to hospital for such pain. The claim amount for hospitalization was Rs 18,732/-.
We believe that treating doctor’s decision is important (also proved in this case). An insured person should not take any symptom related to his health lightly, however minor it may seem. In this case too, the insured followed the advice of the doctor and was hospitalized. In a recent case we have seen that a young man collapsed during the Gurgaon Marathon due to dehydration. Unfortunately, the young man died in a leading hospital in Delhi after being hospitalized for over 30 days due to complications caused as a result of dehydration.

We advised our client to take the next step as per the process i.e to approach the Insurance Ombudsman. We helped the client in presenting his case before the Ombudsman. The Insurance Ombudsman directed the Insurance Company to pay the claim amount along with interest @ 8% from the date of the claim. The Insurance Company has paid Rs. 18,958 along with the interest @ 8% i.e. Rs. 2,401 to our customer as directed by the Ombudsman.

The settlement of Rs. 18,958 has again highlighted the fact that persistence is the key. We have always maintained that if you are persistent and have professional guidance then the chances of your insurance claim being settled in your favour are more than 98%.

Thursday, March 8, 2012

Maternity cover -Is it covered under health insurance ?

This is the most common question we come across from customers. The answer is yes as well as no.

No, because most of the companies do not cover maternity under individual or family floater policy .
Yes, because some companies cover this but with conditions .Let us have a look at this .

Apollo Munich covers from 7 th year ,which means you should have been having the policy in existence for 6 years.
Max Bupa covers from 3rd  year.
L& T  covers from 5 th year.

Yes there are limits & sub limits, which one should keep in mind.
Is it that our insurance industry is having a short sighted approach in not covering this risk.I feel it should be covered by all insurance companies from 2 nd year .This will increase the size of the market .

Wednesday, March 7, 2012

Have you faced inconvenience in using Health Insurance portability within the company and within the city?

Have you faced inconvenience in using Health Insurance portability within the company and within the city?

We appreciate the concept of health insurance portability which was introduced by IRDA in October 2011. As a result a policy holder can shift from one insurance company to another insurance company within the city and within the country without losing the benefits accrued on the previous policy. Those who have shifted their policy in recent months are having a feeling of satisfaction. However, in case of public sector companies such as National Insurance Company Ltd, The New India Assurance Co. Ltd, The Oriental Insurance Co. Ltd and The United India Insurance Co.Ltd. It is a practice that different branches of same insurance company have different TPAs even within the same city. As a result of that if the customer wants to shift from one branch to another branch even within the same city then hassles are being created because the data from the old branch or TPA has to be shifted to the new branch as well as new TPA. Lot of difficulty is being faced by the customers in this regard.

It is high time that PSUs come out with policy that either all branches of the company in the same city use the same TPA or instructions should be given to the TPA and data transfer should be immediate. This will result in removing hindrance in shifting from one branch to another.

When one can shift from one company to other then why not portability from one branch to another?

Is prosecution of officials of National Insurance right step?

Is prosecution of officials of National Insurance right step?
According to a news item- 3 officials of National Insurance are to be prosecuted.

Is it a right step? It can happen for those who are working for PSU’s then why not for those who are working for Private Companies? Does it curb innovation, motivation to take decisions? Is it that those who do not take any decision get promoted because their track record is clean? Your comments are invited.