Tuesday, April 28, 2009

LIC offers health insurance plan

CHENNAI: Life Insurance Corporation of India (LIC) has come out with 'Health Protection Plus' a long-term health insurance plan that offers health insurance covers for husband, wife and the children of a family. The scheme offers hospital cash benefit (HCB) and major surgical benefit (MSB) along with a ULIP component (investment in the form of units) that is specifically designed to meet domiciliary treatment benefit (DTB) / out patient department (OPD) expenses for the insured members, says a release. — Corporate Reporter

Saturday, April 18, 2009

Verify health cover extent before buying insurance

 Recently, a Mumbai senior citizen received his Mediclaim amount, but minus a small sum which the insurer termed as pre-hospitalisation expenses. The 72-year-old consumer, who holds a joint policy with his wife, had been asked by the surgeon to procure certain medicines worth Rs 560 the night before his cataract operation. Although the surgeon issued a certificate saying the prescribed drugs were used during his hospitalisation, the bill amount was not reimbursed.
    This, even as insurance officials say that health policies usually cover pre-hospitalisation expenses up to 30 days before admission and 60 days after. Some insurers offer an extended limit of 60 days before and 90 days post-hospitalisation. There are also schemes where a flat 3-5% of hospitalisation expenses are paid for the period.
    While rejection of health insurance claims is not unheard of, consumer organisations say, sometimes, insurance companies withold a portion of the claim amount too.
    K S (Kaka) Samant, general secretary at General Insurance Pensioners’ Association (western zone), says an amount could be rejected on the grounds that the prescription was not connected to hospitalisation, or that particular illness or disease. “If your claim is for Rs 10,000, generally you will not get the entire sum. Something is reduced.’’ Samant points out a case where a patient was sent from one hospital to another by an ambulance for an MRI. But the ambulance charges were not reimbursed, citing that they are not covered in the policy. “Like this, several things are excluded.’’ V M Oza, honorary director, complaints, at Ahmedabad’s Consumer Education & Research Centre, says exclusions are mentioned in policy documents. Consumers are advised to carefully consider them before signing up.
    Industry officials TOI spoke to say that claims are settled based on supporting documents. According to a senior executive at a Delhibased third party administrator, which processes insurance claims, expenses before hospitalisation, like tests and diagnostics that lead to in-house treatment, are payable. He says, “But suppose you go for a comprehensive checkup, then it is not.’’ A senior Mumbai insurance official adds that sometimes claims are rejected if a consumer picks up more medication than prescribed or makes claims for expenses before or after the stipulated time limit. Samant, however, says companies insist on furnishing details and delay payment. Delayed payment is a violation of the Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002. In case one is unable to get redressal, consumer organisations advise approaching the insurance ombudsman with claims-related grouse.

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Thursday, April 16, 2009

Verify health cover extent before buying insurance

 Recently, a Mumbai senior citizen received his Mediclaim amount, but minus a small sum which the insurer termed as pre-hospitalisation expenses. The 72-year-old consumer, who holds a joint policy with his wife, had been asked by the surgeon to procure certain medicines worth Rs 560 the night before his cataract operation. Although the surgeon issued a certificate saying the prescribed drugs were used during his hospitalisation, the bill amount was not reimbursed.
    This, even as insurance officials say that health policies usually cover pre-hospitalisation expenses up to 30 days before admission and 60 days after. Some insurers offer an extended limit of 60 days before and 90 days post-hospitalisation. There are also schemes where a flat 3-5% of hospitalisation expenses are paid for the period.
    While rejection of health insurance claims is not unheard of, consumer organisations say, sometimes, insurance companies withold a portion of the claim amount too.
    K S (Kaka) Samant, general secretary at General Insurance Pensioners’ Association (western zone), says an amount could be rejected on the grounds that the prescription was not connected to hospitalisation, or that particular illness or disease. “If your claim is for Rs 10,000, generally you will not get the entire sum. Something is reduced.’’ Samant points out a case where a patient was sent from one hospital to another by an ambulance for an MRI. But the ambulance charges were not reimbursed, citing that they are not covered in the policy. “Like this, several things are excluded.’’ V M Oza, honorary director, complaints, at Ahmedabad’s Consumer Education & Research Centre, says exclusions are mentioned in policy documents. Consumers are advised to carefully consider them before signing up.
    Industry officials TOI spoke to say that claims are settled based on supporting documents. According to a senior executive at a Delhibased third party administrator, which processes insurance claims, expenses before hospitalisation, like tests and diagnostics that lead to in-house treatment, are payable. He says, “But suppose you go for a comprehensive checkup, then it is not.’’ A senior Mumbai insurance official adds that sometimes claims are rejected if a consumer picks up more medication than prescribed or makes claims for expenses before or after the stipulated time limit. Samant, however, says companies insist on furnishing details and delay payment. Delayed payment is a violation of the Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002. In case one is unable to get redressal, consumer organisations advise approaching the insurance ombudsman with claims-related grouse.

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Tuesday, April 7, 2009

HEALTH POLICY RENEWAL SET TO GET EASIER

THE ELDERLY AND THOSE
with medical conditions will find it easier to renew their health insurance plans. The new regulations make it mandatory for an insurance company to renew a health insurance policy irrespective of how much it has already paid out in claims, reports Our Bureau in Mumbai. Insurers now have to condone delays up to 15 days from the renewal date.

Life insurers beat slowdown blues


THE lukewarm economic scenario notwithstanding, the life insurance industry witnessed a solid 66% jump in capital deployed during April-December 2008 at Rs 23,271 crore (Rs 13,990 crore), invested almost entirely by the private sector.
    And why not. The sector witnessed 16% growth in total premium income to Rs 1,21,392 crore during the period as against Rs 1,13,048 crore in the corresponding period in the previous year despite a 4% decline in first-premium income. Total premium includes first premium income as well as renewal premium for the period. Interestingly, renewal premium witnessed a near-35% increase.

    "Renewals are that part of a person's funds that are set aside for the long term. Hence, come what may, individuals try and make sure renewals are paid. In addition, renewals are also directly related to policies sold in earlier years; the industry has been growing at a hectic pace in the past few years," Kotak
Mahindra Old Mutual Life Insurance senior vice-president Subashis Ghosh said.
Further, benefits paid to policyholders, including maturity as well as withdrawals, stood at Rs 37,000 crore during the period, compared with Rs 33,800 crore in the previous year. According to data released by the Life Insurance Council,
the industry body for life insurance companies in India, renewal premiums for regular unit-linked insurance plans (Ulips) witnessed a phenomenal 216% growth to Rs 26,637 crore for the nine-month period ended December 31, 2008, as against Rs 8,425 crore in the comparable period. Non-linked premium cumulatively rose to Rs 52,529 crore from Rs 50,268 crore in the earlier period.
    Non-linked premium from single-premium policies doubled to Rs 9,976 crore (Rs 4,932 crore),
whereas premium from Ulips decreased from Rs 15,472 crore to Rs 10,421 crore. New premium from regular-linked policies was down from Rs 25,204 crore to Rs 21,438 crore, whereas non-linked policy premium increased to Rs 10,392 crore (Rs 8,746 crore).

Mediclaim booster for senior citizens & the sick

New Norms Require Insurers To Condone Delays Up To 15 Days From The Renewal Date & Continue Cover Benefits

THE elderly and those with medical conditions will now find it easier to renew their health insurance plans. In response to court orders and recommendations of various committees, the insurance regulator has changed the renewability rules of health insurance policies.
    The new regulations make it mandatory for an insurance company to renew a health insurance policy, irrespective of how much it has already paid out in claims. More significantly, insurers now have to condone delays up to 15 days from the renewal date and carry on the benefits of coverage of preexisting diseases.

    There are large number of complaints against health insurers that they avoid renewing policies of the elderly and those with medical conditions if there is a break of even one day in renewing the policy.
    In a circular issued to all non-life companies this week, the Insurance Regulatory & Development Authority (IRDA) said health insurance policies must be renewed, except when the policyholder indulges in fraud or misrepresentation or when there is a moral hazard. "Specifically, renewal shall not be denied on the grounds that the insured had made a claim, or claims, in the earlier years," the circular said. The directive adds that all health insurance policies must contain a clause that provides for a mechanism to condone delays up to 15
days so that the insured is treated as 'continuously covered' in terms of continuity benefits such as waiting periods and coverage of pre-existing diseases.
    Until now there have been several instances of insurers using the break in continuity as an excuse to reject renewals. In such cases, the proposer is in a spot as no other insurer will cover an ailment for which a different insurer has already paid claims. While younger proposers can get cover with exclusions for pre-existing cover, people over 70 are the worst affected. No insurer accepts a fresh proposal from a senior cit
izen over 70 unless it is under a special scheme. IRDA's directive protects those who are most vulnerable to rejections.
    Henceforth, companies will have to disclose the maximum age until when the renewal will be available. They will also have to disclose how their premium charges progress as the insured ages. The terms of renewal must also state the procedure and terms for enhancing the sum insured or scope of cover. Apart from the directive on renewals, the regulator has also increased the level of transparency on health insurance. If the renewal premium being sought is higher than the existing premium, the insurance company will have to give a note explaining the reasons for the increase and also how it is consistent with the loading structure provided earlier.


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