Important Questions on Portability of Health Insurance Policy

Important Questions on Portability of Health Insurance Policy answered by Mr. S. K. Sethi, Director, RIA Insurance Brokers Pvt. Ltd., a Reputed Firm Specializing in the Health Insurance Portfolio

Q. What are the advantages and disadvantages of health insuranceportability?

Ans. Portability of Health Insurance Policy is permitted and its advantages are:

·        No loss of benefits: The waiting period for pre-existing diseases already served in the previous policy is carried forward to the new policy.

·        Better features: You have the option to switch to a policy which is offering better coverage, additional riders, improved services and may be better premium terms.

·        Customer satisfaction: Portability motivates insurers to provide better service to retain the customers or to attract new customers.

There are few Disadvantages of the Portability are:

·        Premium changes: The premium may increase depending on your age, medical history, and other risk factors.

·        Limited portability options: Some insurers may not offer policies exactly matching your current policy's features.

·        Approval risk: Portability requires approval from the new insurer, who may deny it based on the medical conditions or other underwriting guidelines.
It is to make clear that new insurer has right/option to access your expiring health insurance policy details and Claims history.

Q. What should be kept in mind while porting insurance?

Ans. The following points should be kept in mind:

·        Policy renewal timing: As per procedure it is desired that you start the portability process 45 days before the policy renewal date. In the event of refusal by new insurer you will have the option to continue with your existing insurer.

·        Disclosure of health conditions: Provide complete and truthful information about medical history to avoid claim denials at later date.

·        Coverage comparison: Ensure the new policy covers all essential benefits you need.

·        Insurer reputation: Choose a reliable insurer known for good claim settlement ratios and customer service.

Q. When should we choose this option?

Ans. Portability is a good choice if:

·        You are not satisfied with service being provided by your current insurer or agent or the claim settlement process of the insurer.

·        You find better features, wider coverage, or attractive premiums with another insurer.

·        Your healthcare needs have changed, requiring enhanced coverage.

Q. Is it better to take a new plan instead o porting insurance? What are the other options?

Ans.

·        Portability is preferable if you have already served waiting periods for pre-existing conditions in the existing policy.

·        Taking a new plan can be beneficial if your current policy offers limited coverage, but you will need to restart waiting periods.

·        Enhancing your current policy with add-ons or riders is another option to consider.

Q. According to a recent IRDAI report, health insurance rejections have increased significantly. What rights does a policyholder have if a claim is rejected? What precautions should be taken to avoid rejection?

Ans. It pays to move step by step in the right direction for settlement of your claims:

·        Appeal to the Branch Manager: After finding the reason for claim rejection and checking of the facts at your end, you should take up the matter with branch manager.

·        Appeal to the grievance cell: Every insurer has a grievance redressal system to handle disputes. in case of no favorable decision at branch level, you should write to Grievance cell of the insurance company.

·        Escalation to IRDAI: If unsatisfied with the insurer’s response, you can always escalate the issue to IRDAI or approach the Insurance Ombudsman or consumer forum of your district.
We personally feel that going to Insurance Ombudsman is a better option. Full facts are to be presented to Insurance Ombudsman of your region/state.

You should take following precautions to Avoid Rejection:

·        Full disclosure: Provide accurate and complete information about medical history when purchasing or porting your health insurance policy.

·        Policy understanding: Read the policy document carefully to know the inclusions, exclusions, and claim procedures.

·        Timely premium payment: Ensure continuous policy coverage by renewing on time before its due date as claim lodged during the grace period will be rejected by the insurer.

·        Timely Intimation: As and when hospitalization is required intimation has to be sent to the insurer. Documents are to be submitted to insurer within required time frame.

·        Proper documentation: Submit all required documents accurately and in their original form when filing a claim.

Keep in mind Pre-hospitalization and post-hospitalization expenses are also payable to you therefore you should start keeping prescription/Doctor receipts/Diagnostic tests receipt /reports/chemist bills in a file for submission.

Surrender Vs Sale of Life Insurance Policy

Mr. S. K Sethi, Director, RIA Insurance Brokers

1.    How can I sell my life insurance policy to third party/company?

Ans. Life Insurance policy is a contract between Insurer & Insured, where name of the nominee and his/ her blood relation with the insured is a must and important information.

There are instances, where an insurance policy is issued in favor of borrower where premium is paid out of loan amount being disbursed by lender. In such cases the name of the lender is mentioned as a nominee/ beneficiary.

It is very clear that selling of life insurance policy (which has been in operation for some time or few years) is not desirable as nominee (Spouse/blood relation) will not come to know that her name has been removed from the policy.

For endowment and ULIP policies in case an insured is in need of funds then he can borrow good % of the premium paid from the insurer or any bank and in that case, insurer or the bank can have the right over policy and in the event of death of insured the claims payment will be made. In this case the bank will deduct Loan+ Interest and will pay the balance amount to the nominee, mentioned in the policy.

2.    Is selling a policy a better option than surrendering it? What are its advantages and disadvantages?

Ans: Theoretically selling is a better option than surrender value as you will get higher amount.

Assuming the insurer is ready to change the name of nominee to buyer. (who is not a blood relation) - one may face dealing with unfair, cheat, crooked, greedy person who may get the insured murdered, killed, kidnapped with a view to get large amount of sum assured.

Advantage: May be insured is getting few thousand rupees more than surrender value calculated by the insured .

Disadvantage: Can be that he can get murdered/ killed by the buyer (lender).

We personally feel that you should avoid selling of your life insurance policy.

3.    Which agencies/companies in India are authorized to buy Insurance policies? How do they earn from these policies?

Ans: According to our information lender at the timing of granting/ approving disbursing loan is allowed to get policy issued where lender is the nominee/ beneficiary.

Buying of the life insurance policy is in operation and it being done by various companies.

You can locate the names of such companies.

4.    Process: If I want to sell my policy, how can I do it? 

Ans: Normal process for change in name of nominee will be applicable and your insurer will guide you with forms to be filled up.

5.    What is the role of the insurance company in this entire process?

Ans: In the case of overdraft being granted by the bank-policy will be endorsed by the insurer as hypothecated to the bank and returned to the bank.

In this case the original insurance policy bond will be in possession of the bank.

In case of change in name from nominee to the buyer of the insurance policy- Insurer will guide you will forms to be filled up.

6.    After the insurance matures, will the insurance company send the money to the policyholder's account or the third party's account?

Ans: After the maturity of the policy insurer will send money to the bank as per hypothecation details.

As nominee does not have original insurance policy bond with him/ her so he /she can not lodge claim with insurer. Attaching of the original policy bond/ document is a precondition for submission of claim documents to the Insurer.

7. If the policyholder dies before maturity, what will be the process?

Ans: The nominee/beneficiary has to submit the following documents:

·      Original Policy Bond

·      Death Certificate

·      Bank Account Details/ KYC of nominee

·      KYC Documents of deceased.

In case it was hypothecated with the bank then they will submit these documents. Assuming the amount being paid is higher than loan+ Interest amount then the balance amount will be paid to nominee.

8.    LIC has declared such practices unauthorized. What does this mean?

Ans:  Life Insurance Corporation of India (LIC) the leading life insurer, of our  country treated such sale of policy as unauthorized .and many years back took up the case to Bombay High Court where the judgment went in favor of Insure Policy Plus Services (India) Pvt Ltd.

LIC went to the Supreme Court of India and the appeal was rejected. So as on today the sale of insurance policy is allowed.

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Options for paying of Hospitalization Bills

Options for paying of Hospitalization Bills:

If anyone has to get hospitalized for the treatment, when the amount involved is small then it does not matter but when the amount of hospitalization exceeds Rs. 3 Lakhs then payment of hospitalization becomes a challenge

Let us look at the options which are available:

1.     Out of the savings

2.     Borrowing funds from relatives/friends

3.     Credit card

4.     Loan from Bank for hospitalization.

5.     Health Insurance

Let us look at these options in details:

1.     Out of the savings:

Paying hospitalization bills using personal funds, such as savings accounts, fixed deposits, selling of shares, or withdrawal from mutual funds, ensures that no interest or debt is incurred. This method provides financial independence and avoids creation of additional liabilities. However, using savings for medical expenses can significantly deplete the funds earmarked for future financial goals like child education, home buying, retirement, or children’s marriage. It will potentially disrupt long-term financial plans of the family for a long time to come.

2.     Borrowing funds from Relative’s/ Friends

Taking a loan from relatives or friends to pay hospitalization bills can be a convenient option as it generally comes without interest. However, this arrangement may lead to future obligations, as relatives or friends might expect financial support in return when they need it. Additionally, such loans are usually given for a short duration, requiring quick repayment, say in 2 months’ time.

3.     Credit Card

Credit cards provide quick and easy access to funds, enabling immediate payment of hospital bills without delays. However, failing to make payments on time on due date can result in payment of high/very high interest rates, sometimes it is exceeding 36%. Additionally, missed payments or defaults can negatively impact your credit score (CIBIL), for a long time to come.

4.     Loan from Bank for Hospitalization.

Opting for a personal loan from a bank to cover hospitalization bills can be a viable option, as it typically offers lower interest rates compared to interest to be paid to credit cards. However, eligibility requirements must be met, including maintaining an existing bank account for at least six months, having a stable monthly salary being deposited in the account, and providing income tax return (ITR) records. These criteria may make it challenging for individuals without a formal/stable income history to secure the loan.

In case you are considering this option then follow discipline even if you are getting income in cash then do deposit it in bank and then withdrawal it as and when needed.

In summary taking a loan from a bank has its own requirements:

In order to apply for the loan for paying hospitalization bill there are some conditions you have to follow:

1. You must have an existing savings bank account with the same bank.
2. The Account of the bank should has been operational and active continuously for more than 6 months.
3. You should have the regular monthly salary income record with the bank.

5. Health Insurance

a) Lump sum Payment
b) ECS Payment Options

ECS (Electronic Clearing Service) in health insurance is an automated payment method that allows policyholders to pay their insurance premiums directly from their bank accounts. It is a hassle-free way to ensure timely payments without manual intervention.

In the world health insurance is the most efficient and popular way to cover hospitalization costs. It ensures financial security during medical emergencies. It eliminates the burden of large out-of-pocket expenses and provides comprehensive coverage. However, to avail of these benefits, you must have a valid health insurance policy.  Insurance Companies permit clients to pay the premium on yearly, half-yearly, quarterly, or monthly basis.

Why Health Insurance is the Best Choice over Other Payment Options

When it comes to paying hospitalization bills, relying on savings, borrowing from friends or relatives, using credit cards, or taking a personal loan might seem like viable options, but each one has significant drawbacks. Health insurance, on the other hand, provides the most efficient and stress-free way to handle medical expenses. Here’s why:

1. Financial Protection Without Risk: Unlike using your savings, which depletes funds meant for future goals, health insurance covers major hospitalization expenses, reducing your financial burden. It also provides tax benefits under Section 80D, offering additional savings.

2. Convenience & Peace of Mind: Borrowing from friends or relatives can create financial strain and obligations, while credit cards come with extremely high interest rates. Health insurance, however, provides cashless treatment at network hospitals, allowing you to focus on recovery rather than scrambling for funds in an emergency.

3. No Debt or Eligibility Hurdles: Unlike bank loans, which require credit checks, salary records, and income tax returns, health insurance is easily accessible and doesn’t leave you in debt. Additionally, family plans allow you to cover multiple members under one policy, making it a more cost-effective and hassle-free solution.

4. Long-Term Health Benefits: Many health insurance plans offer free annual check-ups, promoting early disease detection and preventive care. This proactive approach ensures you stay healthy and avoid major medical expenses in the future - something no credit card or loan can provide.

In short, health insurance is a smart financial safety net that prevents you from draining your savings, accumulating debt, or facing unnecessary stress during medical emergencies. It offers financial security, convenience, and long-term health benefits - all of which make it the best choice for managing your hospitalization expenses.

Health Insurance Premium collection is touching Rs. 129863 crores in 2024-2025

Few years back (2007-2011) we were very enthusiastic about the growth of Health Insurance portfolio. This was especially true during 2007-08, when this portfolio grew by 59.20%. Let us look at the growth figures in the recent year.

We have drawn graph showing the % growth YOY and, it shows that yearly growth figure in % terms is stagnating for last 4 years around 22%. Even at 20.60% for the current year (31 March 2025) we foresee this figure in money terms and will touch Rs 129863 Crores.

Graph Showing % Growth Year Over Year

Graph Showing Growth in Premium

Premium increase by insurers, increase in healthcare costs, stock market meltdown (February 2025) is guiding us towards customer resistance and experts have started talking about fall in percentage (%) growth of health insurance premium.

Let us try to make projections for next 6 years.

We have done this with growth rate of 12%, 20%, 30% & 60%.

Growth Chart if Premium Increases at Varying Rates

The survey of Research & Analysis Wing of Insurance Foundation of India revealed that top most wish of every individual is that- “He should have good health”. No one wishes to have materialistic prosperity of the world with ill health. This wish will support the growth of health insurance industry in the years to come.

If someone asks me- What should be the growth in health insurance premium with which I will be happy? - I will say it should not be 30 % gross but it should be 30 % net (as we have to discount for inflation of 7 % per annum in normal costs and 20 % per annum in health care costs). Let us not be satisfied with meager growth of 12 % or 20 % let us aim for growth of 30 %.

It means we should have growth of 30% year over year and then the figure will touch Rs. 519755 crores by 2029-30. Let us be clear that Health Insurance portfolio of Indian Non-Life Insurance will be No. 1 portfolio for years to come.

Hospitalization Due to UTIs: Is It Covered Under Health Insurance?

Hospitalization Due to UTIs: Is It Covered Under Health Insurance?

Urinary Tract Infections (UTIs) are a common health issue, especially among women, that can range from mild discomfort to severe complications requiring hospitalization. One crucial question for those affected is whether their health insurance policy covers hospitalization due to UTIs.

Understanding UTIs and Their Severity

UTIs are infections in any part of the urinary system, including the bladder, urethra, ureters, and kidneys. While many UTIs can be treated with antibiotics and do not require hospitalization, severe cases can lead to complications such as kidney infections (pyelonephritis) or sepsis, which may necessitate hospital care.

Why UTIs Increase During the Rainy Season

1.     Humidity and Moisture: The rainy season brings higher humidity, creating a perfect environment for bacteria to thrive. Increased sweating and dampness in the genital area can lead to bacterial growth, particularly of Escherichia coli (E. coli), the primary cause of UTIs.

2.     Wearing Damp Clothing: Getting wet in the rain is common, and wearing damp clothes, especially underwear, for long periods fosters bacterial growth. The warm, moist conditions provide an ideal breeding ground for bacteria, increasing the risk of infections.

3.     Poor Sanitary Conditions: Flooding and poor sanitation during the rainy season can increase exposure to bacteria. Contaminated water and inadequate hygiene practices can introduce bacteria into the urinary tract.

4.     Weakened Immune System: Seasonal changes can weaken the immune system. The shift from dry to wet weather can make people more susceptible to infections as their bodies adjust. A compromised immune system is less effective at fighting off bacteria, making UTIs more likely.

5.     Dehydration: Despite the rain, people often drink less water during the rainy season due to cooler temperatures or difficulty accessing clean water. Dehydration reduces the frequency of urination, allowing bacteria to remain in the urinary tract longer and increasing infection risk.

Even if you are healthy, women aged 50 years and above are at a higher risk of developing UTIs. Maintaining good hygiene is essential, but during the monsoon season, the risk of UTIs can still increase due to environmental factors and changes in immune response.

In extreme cases, patients may need to be admitted to the hospital, sometimes even to the ICU. This is when having a health insurance policy is crucial to ensure you receive the necessary care without financial strain.

Conclusion

Hospitalization due to severe UTIs is typically covered under most health insurance policies, but it's essential to understand your specific policy's terms, conditions, and coverage limits. By being informed and proactive, you can ensure that you receive the necessary care without unexpected financial stress.

Expert Insight

Mr. S.K. Sethi, founder of  RIA Insurance Brokers, specializes in health insurance products for families as well as corporates. For individuals prone to UTIs, having comprehensive health insurance is crucial. It covers the cost of medications, regular check-ups, and specialist visits, ensuring effective disease management. Good insurance also provides access to necessary resources like nutritional counseling, helping patients maintain their health and reduce complications.

Blog of S.K. Sethi, Founder of RIA Insurance Brokers, you may connect him for any query at his email id: sksethi@riainsurance.com

Diabetes: Beyond Sugar - Understanding the Causes and Management

Diabetes: Beyond Sugar - Understanding the Causes and Management

Diabetes is a complex condition influenced by various factors beyond just sugar consumption. Understanding these factors and how to manage them is crucial for preventing and managing diabetes effectively.

Key Factors Contributing to Diabetes

Genetic Factors

Family history plays a significant role in the development of diabetes. Individuals with a parent or sibling with diabetes have a higher risk of developing the condition. Certain genetic markers also increase susceptibility to type 2 diabetes.

Obesity

Excess body weight, particularly visceral fat around the lower abdomen, is a major risk factor for type 2 diabetes. Fat cells release inflammatory markers that contribute to insulin resistance, making weight management crucial for diabetes prevention.

Physical Inactivity

A sedentary lifestyle significantly contributes to type 2 diabetes. Regular physical exercise helps maintain healthy blood sugar levels by increasing insulin sensitivity and promoting glucose uptake by muscles.

Prevention and Management Strategies

Lifestyle Modifications

1. Balanced Diet
• Eating a diet rich in whole foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats, is essential.
• Controlling the intake of processed and sugary foods helps manage blood sugar levels.
2. Regular Exercise
• Engaging in regular physical activity combined with muscle-strengthening exercises enhances insulin sensitivity and helps control blood sugar levels.
3. Weight Management
• Maintaining a healthy weight significantly reduces the risk of developing type 2 diabetes.
  
  

Medical Interventions

1. Medications
• Various medications like metformin, insulin, GLP-1 receptor agonists, and SGLT2 inhibitors can be effective in managing diabetes.
2. Regular Monitoring
• Frequent blood sugar monitoring helps track the effectiveness of management strategies and allows for timely adjustments.
  
  

Conclusion

While sugar consumption is a significant factor in the development of type 2 diabetes, it is not the only cause. Diabetes is a multifaceted disease influenced by genetic, lifestyle, and environmental factors. Adopting a healthy lifestyle and utilizing medical interventions when necessary can help prevent and manage diabetes effectively.

Mr. S.K. Sethi is founder of RIA Insurance Brokers and specializes in health insurance products for families as well as corporates. For diabetic patients, having comprehensive healthinsurance is crucial. It covers the cost of medications, regular check-ups, and specialist visits, ensuring effective disease management. Good insurance also provides access to necessary resources like nutritional counseling, helping patients maintain their health and reduce complications.

Blog of S.K. Sethi, Founder of RIA Insurance Brokers, you may connect him for any query at his email id: sksethi@riainsurance.com

Tackling Inflammation in Diabetes: Eight Anti-Inflammatory Foods to Include in Your Diet

Tackling Inflammation in Diabetes: Eight Anti-Inflammatory Foods to Include in Your Diet

Inflammation associated with diabetes occurs when the immune system becomes chronically activated, leading to persistent inflammation. Elevated blood sugar levels and insulin resistance trigger the release of pro-inflammatory cytokines and activate inflammatory pathways. Over time, this chronic inflammation can contribute to complications such as cardiovascular disease, neuropathy, and kidney damage. Managing blood sugar levels through lifestyle modifications, medication, and dietary changes can help reduce inflammation and mitigate these long-term consequences. Here are eight foods known for their anti-inflammatory properties:

1.     Fatty Fish

Rich in omega-3 fatty acids, fatty fish like salmon, mackerel, and sardines can help reduce inflammation and improve insulin sensitivity. Incorporating these fish into your diet can provide significant anti-inflammatory benefits.

2.     Leafy Greens

Vegetables like spinach, kale, and collard greens are packed with antioxidants and anti-inflammatory compounds. These greens can help lower inflammation and manage blood sugar levels effectively.

3.     Berries

Blueberries, strawberries, and raspberries are loaded with polyphenols, antioxidants known for their anti-inflammatory effects. These berries can also help improve insulin sensitivity, making them an excellent choice for managing diabetes.

4.     Turmeric

Curcumin, the active compound in turmeric, has powerful anti-inflammatory properties. Including turmeric in your diet can help reduce inflammation related to diabetes and insulin resistance.

5.     Nuts

Almonds, walnuts, and other nuts are rich in healthy fats, fiber, and antioxidants. These nutrients can help lower inflammation and improve blood sugar control, making nuts a healthy snack option for diabetics.

6.     Olive Oil

Extra virgin olive oil is rich in monounsaturated fats and contains anti-inflammatory compounds. Using olive oil in your cooking can help reduce inflammation and improve heart health in people with diabetes.

7.     Whole Grains

Foods like oats, brown rice, and quinoa are high in fiber and contain anti-inflammatory compounds. These whole grains can help lower inflammation and improve blood sugar control, contributing to better diabetes management.

8.     Yogurt

Probiotic-rich foods like yogurt can improve gut health and reduce inflammation in people with diabetes. Opt for plain, unsweetened yogurt to avoid added sugars and maximize the anti-inflammatory benefits.

Conclusion

Reducing inflammation is key to managing diabetes and preventing its complications. By incorporating these eight anti-inflammatory foods into your diet, you can help control blood sugar levels and improve your overall health. Remember, managing diabetes is not just about reducing sugar intake but also about embracing a diet rich in anti-inflammatory nutrients.

Mr. S.K. Sethi is founder of RIA Insurance Brokers and specializes in health insurance products for families as well as corporates. For diabetic patients, having comprehensive healthinsurance is crucial. It covers the cost of medications, regular check-ups, and specialist visits, ensuring effective disease management. Good insurance also provides access to necessary resources like nutritional counseling, helping patients maintain their health and reduce complications.

Blog of S.K. Sethi, Founder of RIA Insurance Brokers, you may connect him for any query at his email id: sksethi@riainsurance.com