Can you rely on your policy?

ACCORDING to the Irda, of the 7.62 lakh life insurance claims filed in 2009-10, nearly 15,000 were rejected by insurers. This means 15,000 families were denied the money that policyholders had thought would reach them if they died. Though the 2010-11 figures are still being compiled by Irda, unaudited data individually sourced from insurance companies shows that roughly 16,000 insurance claims ended up in the rejection bin last year. The rejection ratio of some companies, especially those that started operations a few years ago, is alarmingly high. Aegon Religare rejected 45% of the claims. Future Generali, IDBI Federal and DLF Pramerica turned down one of every fifth claim that was raised. In comparison, the LIC has a rejection ratio of just 1.1%. 

    Does this mean buyers should stick to older, established insurance companies and steer clear of the newer players? Not really. Claim settlement statistics should not be seen in isolation. Most of the claims received by the new companies are early death claims, where the policyholder died within two years of buying the cover. "An early claim is a warning as this could be a deliberate attempt to defraud," says Yateesh Srivastava, chief marketing officer, Aegon Religare. In suchcases, insurers investigate the cause of death in great detail, which could take up to six months. 
    Early claims are not a problem because if everything is found to be in order after the scrutiny, the company will pay the insured sum even though it might reach the nominee late. The bigger problem is rejection of claims because the insurance company believes that pertinent facts were deliberately suppressed by the policyholder at the time of buying the cover. The villain is often the insurance agent, who filled up the form on behalf of the buyer. Don't think the agent is doing you a favour if he deliberately overlooks any health problem. He's doing so only to sell the policy and will not be around to help when the claim gets rejected. 
WHAT YOU SHOULD DO Don't rely on the agent: Fill up the application form yourself. If you can't, go through the form after the agent has filled it. Retain a photocopy. Don't hide your health condition: Do not withold any information relating to your health and family medical history. Incorrect information is the most common reason for rejection. Don't avoid medical tests: A rigorous medical test actually helps the buyer. It rules out the chances of the claim being denied on account of pre-existing diseases. Give correct information:Be completely honest about your age, occupation, income and other insurance cover. Crosscheck the policy: After the plan is issued, check the policy document and notify the insurance company if there is any inaccuracy. 
Why claims are REJECTED 
Early death 
If death occurs within two years of buying the policy, the insurer will probe the case closely. This can take up to six months. 
Non-disclosure of health condition 
If insurer believes the policyholder deliberately hid his condition, claim can be rejected. 
Non-divulgence of family medical history 
If close relatives suffer from a disease but it's not mentioned in form, the claim may be turned down. 
Details of hazardous occupation 
Certain jobs carry a high risk. If the policyholder has not correctly stated his occupation, the claim can be refused. 
Over-insurance 
One must declare income and other insurance plans. Taking a high cover and not mentioning other plans arouses suspicion. — ETW, May 9, 2011

T H E B E ST OF INSURANCE BIGGER LIFE COVER, LOWER PRICE

It's more important than buying the right stock or investing in the best mutual fund. And it's more useful than any other investment in your portfolio. Yet, many Indians continue to buy insurance for the wrong reasons. Insurance is the lynchpin that keeps your financial plan steady even if unforeseen events threaten to derail it. This is why ET Wealth covered life and general insurance in detail, telling readers about the benefits of taking cover against risk, guiding them on the best ways to insure themselves and cautioning them against mis-selling by unscrupulous agents. Advice on life insurance would have been incomplete without talking about eschewing unsuitable policies or ensuring that a claim is not rejected. We also tracked the changes in the health insurance landscape as also the possible impact of portability.

    It's that time of the year when showrooms try to get rid of merchandise that may not find buyers till next year. So, something far more precious than off-season apparel and household appliances is being sold at unbelievably low prices. Term plans, which are seldom pushed by agents, but are arguably the best form of insurance, are being sold at premiums 40-50% lower than those offered 1-2 years ago. 
    Much of this has to do with the growing competition in insurance. Some of the newer players, desperate to get a toehold in the market, are offering lower premium rates to attract customers. They are encouraged, in part, by the improving life expectancy figures in the country. The average Indian now lives for almost 65 years, compared to about 55 years in the 1980s and 58 years in the 1990s. 
    There is more good news. Online term plans, where a customer buys the policy directly from the company, are up to 35% cheaper. By removing the intermediary between the customer and the company, the Internet has helped bring down the price of the cover. Says Madhivanan B, executive director, ICICI Prudential Life Insurance: "The online channel lowers the costs of processing and servicing, which we pass on to customers." 
    Online term plans have become a huge hit with buyers. Every 18 minutes, an online term plan is bought in the country. In the past six months, the seven life insurance companies that offer such term plans have issued more than 14,500 policies with a combined cover of roughly 9,100 crore. This is almost equal to the total cover offered by all new policies sold by the newest five life insurance companies (Star Union Dai-ichi, Shriram Life, IndiaFirst, DLF Pramerica and Sahara Life) in 2010-11. 
    The large cover offered by online plans is good news for an underinsured country like India. The average life insurance policy - issued in 2010-11 offered a cover of 1.93 lakh. 
    — ETW, December 20, 2010

CHOOSE THE RIGHT INSURANCE

Every insurance policy is designed to meet a specific need. Find out the policies that will suit you at different stages of life

    The phone rings. It's a wealth manager with an offer of a triple benefit investment plan. You can save tax, grow wealth and even enjoy life cover. The best part is that the plan guarantees the highest NAV achieved during the next seven years. Even if the markets fall in later years, you get the historical high rate. 
    Before you latch on to this golden opportunity, ask yourself three questions. 
Do you need life insurance? 
How much cover do you need? Finally, does the plan fulfill your financial requirements? 
    Your answers could help you take a better decision on what experts say is the lynchpin of any financial plan. 
    Buying life insurance is a national pastime in India. After bank deposits, it is the most favoured destination for household savings, accounting for almost 25% of the wealth of small investors. Noidabased software professional Gaurav Tiwari has bought 12 endowment plans in the past nine years. 
    Much as Indians love to buy life insurance, they are not buying the cover they really need. Tiwari's dirty dozen gobbles up 71,000 in premium every year, but offers a cover of 14.4 lakh. This is very low, given that he has outstanding home loans of 11 lakh. But it is better than the national average of about 1.16 lakh per policy sold till now. The figure is improving but has a long way to go. The average life insurance cover of policies sold in 2010-11 was 1.93 lakh. "Investors need to strike a balance between the risk cover and investment in their insurance portfolios. Most of the time, there is a skew towards investment, while insurance gets neglected," says Deepak Sood, CEO and managing director of Future Generali Life Insurance. 
    At the root of the problem is the advice given to the investor by the insurance agent. Till a little over a year ago, Ulips were being peddled as the best investment you could ever make. But after the new guidelines issued by Irda in September 2010, agents have started pushing traditional policies. A distributor earns 30-40% commission from selling a traditional policy compared with 8-12% from a Ulip. 
The essential covers 
The basic purpose of insurance is to serve as hedge against risks. Therefore, pure protection plans should be the foundation of your insurance portfolio. A term plan, for instance, is your protection against the risk of early death. It provides the family of the policyholder with a corpus that can replace his income. Experts say that a term plan should be an individual's first life insurance policy. "It is even more important than a bank account," says T.R. Ramachandran, managing director and CEO of Aviva Life Insurance. 
    The earlier you buy a term insurance plan, the better it is for you. At a young age, when your health is in fine fettle, the premium is unbelievably low. At 25, a man will pay about 7,500 a year for a cover of 1 crore for 35 years. As he grows older, the premium shoots up exponentially (see charts). If he buys the same cover 10 years later for 25 years, the premium is higher by 50%. Within the next 5 years, it will shoot up by another 50%. 
    A term plan alone isn't enough to cover the basic risks that life throws at us everyday. You also need a medical cover to guard against high expenses due to an illness or injury.Health insurance is perhaps more important than even term insurance because the chances of someone in the family requiring medical care is higher than a person dying. Also, while the term plan covers only the breadwinner, the medical policy covers the entire family. 
    It helps if you have medical insurance from your employer, especially if you are well-settled in your job. If you intend to switch jobs, you may need to buy a medical insurance plan on your own so that there is no break in the cover when you change jobs. 
Covering against disability 
The roads are full of idiots. Unfortunately, even the best tyres can't avert accidents. According to the World Health Organisation, India is the road accident capital of the world. The National Crime Records Bureau statistics show that every three minutes, an Indian dies in a road mishap. An equal number of people is grievously injured. An accident can leave a person bed-ridden for months. Worse, he may be disabled for life. Why only extreme road mishaps? You can get hurt even at home—miss a stair, slip in the bathroom, trip in the garden. Are you covered against the income loss due to a disability even if it is partial or temporary? 
    A personal accident and disability cover is inexpensive but very critical. You can choose the extent of the cover you want. While the basic policy will cover death due to accident, you can enhance the scope of the policy to include permanent disability or even a temporary one. The wider the cover, the higher it costs (see table). Incidentally, the cover comes bundled with a comprehensive home insurance policy. 
    The size of the cover depends on your income. The New India Assurance Company, for instance, restricts the cover to 72 months' income. Also, the disability must result in loss of income. If you break your leg and proceed on paid sick leave from office, you can't make a claim.

Centre mulling universal health insurance scheme

New Delhi: India may get a universal health insurance scheme, to be partially funded by the government, which would allow those registered under it to avail healthcare facilities in both public sector and privately-run hospitals. 

    According to Montek Singh Ahluwalia, deputy chairman of the Planning Commission, such a scheme could be developed on the lines of Rashtriya Swasthya Bima Yojna (RSBY), which is restricted to the poor and for select groups. 
    "Having a universal health insurance to cover all citizens is one of the ideas the government is working on. The modalities are being discussed," said Ahluwalia. He was addressing the India Heart Conclave, recently organized by The Times of India in association with Abott Vascular in New Delhi. 
    Ahluwalia said the expenditure on health is likely to be increased to 2-3% of the GDP in the 12th Five Year Plan to fund various schemes and speed up infrastructure development. At present, public spending on health is less than 1% of the GDP, which is among the lowest in the world. He stressed the need for public-private partnership (PPP) to augment affordable healthcare. 
    Delhi health minister A K Walia, Cardiological Society of India president-elect Dr Ashok Seth, chief cardiologist and chairman of Medanta Medicity Dr Naresh Trehan, cardiologist Dr KK Aggarwal, Fortis Healthcare MD Shivender Mohan Singh were among those who attended the heart conclave to deliberate on necessary actions to tackle cardiological disorders that are growing to epidemic proportions. 
    "In Delhi, 7-8% of the urban population is suffering from cardiac disease. We are opening more super-specialty hospitals to tackle the increased burden," said Walia.

A Non-life Plan is the Best for Accident Cover

Life cos give a limited protection. General insurers offer higher cover, health benefits with an accident plan

    Shopping for an accident cover is not an easy task. Most individuals, faced with several plans and too many optional covers, find it difficult to zero in on a cover that would be ideal for them. Add to that the confusion about accident covers from life insurance companies and non-life insurers, and most people are ready to call it quits. 

According to experts, the problem can be tackled if individuals spare a little time to understand what they really need from an accident policy and what the policy really offers. 
"In case of an accident, an individual may be exposed to three important risks – loss of income, loss of health and loss of asset. Your insurance policy should take care of these losses," says Sumeet Vaid, founder and CEO, fFreedom Financial. 
Here is a scenario to bring home the point quickly: say an individual meete with an accident while driving a car and is hospitalised for a couple of weeks. Naturally, it means loss of income and spending money on the treatment of injuries. Then, of course, the car may need repairs. The motor insurance policy will take care of the car. And the individual's accident cover should take care of treatment as well loss of income. So, now, get into your car and start shopping for the cover. 
COVERS WITH LIFE POLICY 
"Under the current regulatory framework, life insurance companies cannot sell accident cover as a standalone policy. But they offer it as a rider with the life insurance policy at a nominal cost, making it easier to purchase," says Aneesh Khanna, senior vicepresident – head, marketing and product management, IDBI Federal Life Insurance Company. However, the stipulation that the premium payable for riders other than health insurance benefits cannot exceed 30% of the premium payable towards the basic sum assured limits the amount of accident insurance you can buy. Consider the example of an individual with a life insurance cover of . 1 crore and an accidental death cover of . 20 lakh. If the person meets with an accident and dies, his survivors will get . 1.2 crore as death benefit. The biggest drawback, as you can see, is if you live to tell the tale of the accident, you will not get any money for hospitalisation expenses or to compensate you for your loss of income. 
GENERAL INSURANCE – GROUP 
POLICIES 
Most individuals get to know about personal accident insurance for the first time when their employer offers it to them as an additional benefit. Many companies, banks and credit card companies are increasingly buying group personal accident insurance from insurers these days. 
"Buyers can pick and choose the benefits and link them to variables such as annual salary or credit limit on the credit card," says Sanjay Radhakrishnan, zonal vice-president, west, Bharti Axa General Insurance Company. 
For example, a bank may give a personal accident insurance to all its credit card holders or bank account holders. Sometimes it is a fixed sum payable on the death of the credit card holder and sometimes it can be variable, say three times the credit card limit. In some cases, it is an optional benefit available to customers of the bank, and customers can buy it by paying a premium. 
"Group personal accident insurance plans are customised as per the needs of buyers – employers or banks — and not as per the needs of the covered – that is you. The terms and conditions that govern the policies are also not communicated in detail to the insured person in many cases," points out Sumeet Vaid. 
INDIVIDUAL PLANS FROM NON-LIFE INSURERS 
There are many options that cater to your specific needs. It starts with a basic cover that offers a fixed sum if the insured person dies in an accident. It also offers money if the insured loses limbs. For example, if the insured loses a hand, he/she is entitled to get 50% of the sum assured. The comprehensive insurance package also covers temporary total disability, pays for broken bones, allows modification of house, etc (see table). A word of caution, though. There are no standardised solutions here. Each company will have different benefits and different definition of each cover. It is essential to read through the policy wordings to understand it better. 
HOW TO CHOOSE 
As you can see, accident cover benefit with a life insurance plan can't be your total solution to problems arising from an accident. "Life insurance companies offer limited sum assured for an accident cover as an additional benefit with the life cover. But general insurance companies offer far higher cover with many health-related benefits in a single policy," says Sumeet Vaid. 
Also, it is always better for you to buy an individual cover even if you have a group cover from your employer. An individual plan would rescue you if you meet with an accident when you are in between jobs. Your group cover will be over the moment you leave the organisation. And you will get the benefit of the group cover offered by your new employer only after you join the new company. There is also another compelling reason to go for an individual cover separately. "Being a benefit policy, even if you have two covers – the first, a group cover, and the second, an individual cover – both personal accident insurance policies will pay in case of an unfortunate event," says Sanjay Radhakrishnan. 
As you can see, your decision should solely depend on your needs. For example, a young employed executive who typically takes public transport may want to buy a cover that pays in case of a terrorist attack and offers double the sum assured in case of an accidental death while travelling in a public transport. A salesman, who has to travel a lot, may want to buy comprehensive cover as he is exposed to higher risks. "You may choose to purchase additional benefits such as hospital bills' reimbursement arising out of an accident and hospital cash benefit," says Sanjay Radhakrishnan. These can be looked as supplementary covers, when you are young and have a small sum assured under your medical insurance policy. 
TOMORROW Factors You Need to Look Into While Choosing a Home Loan

In insurance, moment of truth comes at the time of settling claims

BHARGAV DASGUPTA MD | ICICI Lombard 

Career | Began with erstwhile ICICI in 1992; has held key leadership positions in diverse business areas; set up ICICI Bank's international ops; took over his current role in May 2009 
Achievements | Made ICICI Lombard a key player in govt's universal health insurance programme 
    The general 
insurance 
business 
m ay b e 
rocky but 
it's alsoon a roll.Even after 10 years, few companies are making money 
in itbutthathasn'tstopped 
the industry from growing 
at a very health 30%.Not bad 
since most sectors are currently facing a slowdown. Despite that growth, the general or non-life business is only a tenth of the life insurance industry. Also,unlikelife,it never got good valuations because it was felt that you could only lose money in a business where the biggestdrivers—health and motor—were still unprofitable. 
    So when we met up with the ICICI Lombard head honcho Bhargav Dasgupta, referred to as BDG, the comparisons were bound to capture a good part of the initial conversation. In keeping with ICICI group's philosophy, the current size of the industry is never seen as a constraint, and so naturally Dasgupta is quite gung-ho about his business.Theoptimism perhaps is also driven in equal measure by its position as the market leader – it's the largest non-life and health insurer. With health insurance portability around the corner, it is well placed to draw customers from PSU insurers,butDasgupta is non-committal abouthisstrategy.Hedoes talk about another strategy though. He is not that focused on increasing topline or increasing profits as he is on growing the industry itself. Besides, he also feels that by bargaining down prices with healthcare providers, thehealth insurance business can become profitable. 
    Dasgupta, a sports enthusiast (plays tennis to keep fit), opens up quickly enough, much like the open-space architecture of his newly purchased office in CentralMumbai'sPrabhadevi—now the company's headquarters.Butitcouldbe a bittooopen for some people as we notice executives facing job interviews and prying eyes within that architectural theme. 
    The 45-year-old banker, who has been with the ICICI group from the start, suggests that the non-life industry is still in its early stages. "Although the industry was opened up 10 years ago, liberalization happened only three years back when companies were granted the freedom to design and price products. This has resulted in competition and innovation," he says. He forecasts a 20% growth for the Rs 40,000-crore non-life industry. 
But is the business feeling the slowdown heat? He replies in the affirmative and describes how he got to see it coming much before it became a reality when the engineering insurance slowed down—a sign that new projects were not taking off. Slowdown in car sales could also be a bit of a dampener, but he also feels that it's unlikely that people are going to take less health insurance. His theory being people seldom ignore education of their children and the family health. 
An optimist, he feels insurance will gain popularity when customers see companies paying on time. "The moment of truthiswhen itcomestoclaims," he says. Dasgupta is a big believer in universal health insurance where he sees technology as a tool to provide cover to the poor. As part of that belief, ICICI Lombard has come up with a portable device for issuing biometric smartcards. The device enables the company to issue group policyholders cards which not only provides a photo identity but also stores information about the policyholders. Naturally,when thebusiness revolves around service, an executive's success is also bound to be measured in terms of the difference they make to the life of a consumer. So one of Dasgupta's earliest successes came when he was heading international business in ICICI Bank where the bank managed to improve efficiency by offshoring most of its operations to India. Thisenabledthebankto provide a better return to depositors. He believes speed and accuracy of claim payment along with employeeengagementwouldbethe determinant of growth of an insurance company.

Better late than never- Plan for Health Insurance Policies for your parents, if you have not already

Mediclaim policies are not a luxury anymore; it has become a necessity in today's world.  With inflation more than 9% in India, middle class Indians are finding it very difficult to make both ends meet. And the cherry on the cake is the rising medical expenditure, which has increased more than 10% in the last 4 years. And now with 5% service tax on health care introduced in finance minister Pranab Mukherjee's Budget, the burden of medication and treatment will toll heavily especially on the middle class.

The average Indian spends about Rs 117-Rs 120 per month on medicines etc. It might seem to be a small amount of money to us, but for a person from the lower middle class family, this amount may become a huge burden, especially if it tends to rise. It might constitute about 20-30% of his income. Then invariably, the health care is sacrificed and proper treatment and care is not taken. 

Thus, to ensure proper treatment and a healthy lifestyle, a comprehensive health policy needs to be taken. Most of us either has a health insurance policy from our company or is contemplating purchasing one. But have you thought about your parents? They are the ones who would need maximum health care and has highest chances of hospitalization. Hence caring about them is of utmost importance.

Thankfully there are some insurance companies who have thought about them and have designed special health insurance policies for the Senior Citizen.

There is National Insurance Varistha Mediclaim for Senior Citizen. This plan is a very good plan for the senior citizen from 60 to 80 years of age and it takes care of all hospitalization expenses till an extended age of 90 years. This is a specially designed plan for Senior Citizen and hence it covers for pre-existing diseases just after one year of claim free renewal. You need not wait for 3-4 years for it to be covered like in normal health insurance policies. Pre-existing diseases like Hypertension and Diabetes will be covered from the inception on payment of additional premium. There are other benefits in this plan as well like Cumulative Bonus and cost of Health Check-up is also available on claim free years. This plan also covers Critical Illnesses.

Another popular Senior Citizen Health Insurance Policy is Star Health Senior Citizen Red Carpet Plan for 60 to 69 years of age but can be continued forever. This plan also covers pre-existing diseases from the second year of operation and it also covers major surgeries and other treatments. Some diseases are however covered from second and third year of operation and there is no requirement for pre-medical tests in this plan.

There are other plans like Max Bupa Heartbeat Health Insurance Plan which can be availed for your parents as well and it has no age limit. In this plan, both your parents can be covered together under a family floater and can be taken at any time and can be continued till death. In fact, you can avail Max Bupa Heartbeat Family First Health Insurance Policy for each and every member of your family irrespective of their age under the same plan. In this plan, even your parents-in-laws can be included.

Thus, like it is never too late to plan for your house, car or umpteenth honeymoon, it is never too late to plan for your health insurance policy as well. Since health is wealth; its proper care is of extreme importance. And now, it is in your control to en sure that you take the best efforts to take care of the people who matter to you, especially since your parents have done their best to take care of your health; it's your turn to pay them back by doing your bit the best!

INDIA MEDICLAIM: Insurers must reveal non-PPN hosps

Mumbai: All public sector health insurance companies will have to disclose the names of hospitals that are not part of the Preferred Provider Network (PPN)—introduced in July 2010—for cashless services and they will also have to cite the reasons for taking them off the old list.     The Central Information Commission passed such an order recently, saying under the Right to Information (RTI) Act, insurance firms will have to reveal all hospital names as people might have bought a mediclaim policy before the PPN system was introduced and going by the list provided by the insurance company at that time, they might still hope to avail of the cashless facility in places 
that have since been deleted. 
    Four public sector insurance firms, New Indian Assurance Company, Oriental Insurance Company, United Indian Insurance and National Insurance Company, started the Preferred Provider Network system on July 1 last year. Under it, the companies offer a fixed rate for 42 kinds of treatments covered under the cashless mediclaim policy. A hospital under PPN will have to offer treatment to a policy holder according to rates fixed by the companies. The new system was implemented to prevent over-billing by hospitals, which the insurance companies claim, was a major reason behind huge losses suffered by them on health insurance portfolio. 'It's appellant's right to know all hosp names' 
Mumbai: Citing the reason behind asking public sector health insurance firms to divulge the names of hospitals which are not part of the Preferred Provider Network (PPN) for cashless services, information commissioner Deepak Sandhu said the firms' obligation could not be restricted to merely specifying the premium amount required to be collected from a policy-holder. Insurance companies, working in a non-transparent fashion, do not divulge all the facilities available to a policy holder by deleting some of the names from their old list of hospitals providing cashless facility. "But it is the appellant's right to know the names of all the hospitals available to them as well as the reason for deleting some of them from the cashless facility list," Sandhu added. 
    RTI activist Chetan Kothari, whose plea brought about the order on July 27, said, "A year ago, I filed an application at the public information office of the New Indian Assurance Company's Tardeo branch, asking why hospital names were not published and the reason behind excluding certain clinics from the facility. Instead of replying, the PIO transferred my application to the first appellate authority and that too, after 30 days. The appellate authority directed the PIO to provide me with the information, but he did not conduct any hearing as prescribed under the RTI Act. Finally, when the data was given out, it was incomplete." 
    Kothari than filed a second appeal before the CIC. "The public sector insurance company had not even provided names and addresses of the chief PIO and the appellate authority on the notice board in its office. Taking strong exception, the CIC ordered the firm to take corrective measures."

Ayurveda, unani under mediclaim umbrella

Till some time back, health insurance policies used to cover only allopathy treatment while ayurveda, homeopathy, naturopathy and unani treatments were left out. Despite having a comprehensive health insurance plan in place, individuals who preferred such systems had to pay out of their own pockets. 

    These policyholders can now breathe easy as some insurance firms have started including such alternative forms of treatment under their cover, especially ayurveda. "Ayurveda being the most prevalent of the alternative systems, we have designed a product to cover treatments under ayurvedic hospitalization," says S S Gopalarathnam, managing director, Cholamandalam MS General Insurance. 
    While some insurers only offer it under their group policies, others have started offering the facility to individuals. PSU insurer New India Assurance and standalone health insurance provider Star Health and Allied Insurance are some of the companies that have started covering ayurvedic treatments under individual policies. ICICI Lombard General Insurance covers it under government scheme and Future Generali Insurance offers it to corporate group insurance buyers. 
    "Our policies do not cover any other line of treatment other than allopathy. However, in group policies, if requested, we do offer tailor-made packages to corporate clients to cover ayurvedic treatment subject to certain conditions," explains Shreeraj Deshpande, head,health insurance, Future Generali. BOOSTER SHOT No standalone cover for alternative treatments 
    Some insurance firms have started including alternative forms of treatment like ayurveda under their cover. How did this need to cover alternative forms of medicine in health insurance arise? Gopalarathnam, explains, "During various focus group discussions with customers and agents, we found that for chronic ailments like spondilytis, arthritis and epilepsy, many people preferred alternate streams of treatment such as ayurveda, siddha and homeopathy etc." 
    Though the coverage has been expanded, there are curbs on the amount and situations under which it can be claimed. 
    New India Assurance's extends cover to individuals undergoing treatment with the help of Ayurvedic, homeopathic and Unani systems of medicine. "Such claims will be covered only to the extent of 25% of sum insured. Also, they need to have availed of the treatment at a government hospital to be eligible for the claim," informs Segar Sampathkumar, deputy general manager, New India Assurance. 
    Similarly, Star Health also covers non-allopathic treatment, except Naturopathy, costs under its Unique Health Insurance Policy, "up to 25% of sum assured or a maximum of Rs 25,000 per occurrence, per year." 
    Chola Individual Health line Insurance policy provides coverage for ayurveda during hospitalization, prior and post hospitalization. A policy holder can get treated in any of the government registered ayurveda hospitals across the country and claim if hospitalized for more than 24 hours. 
    Naturopathy treatments are excluded in all policies, while few cover unani and homeopathic. This is because other forms of treatments have no standard treatment protocols and highly varied costs thus making it difficult to actuarially compute the cost to be covered. Even under ayurveda, select procedures are covered to ensure people do not misuse a policy for a basic rejuvenation procedure. 
    "We do not cover the unani system of medicine. Under ayurveda, hospitalization for panchkarma (five actions) meant to purify the whole body by eliminating accumulated toxins, is covered on a case to case basis," explains Deshpande. 
    It is important to note that there is no standalone cover available for covering alternative treatments. You will have to buy a standard health insurance cover from these select insurers and others who start offering the non-allopathic coverage. 
    Before you head for alternative treatment and make a claim, see whether the treatment is listed in the insurance policy document. Insurers are particular about the specific treatments covered. "Snehan and Swedan are payable only when these procedures are done as a part of pre-panchkarma preparation. Comfort treatments involving steam bath/ sauna/oil massages are excluded," Deshpande adds. 
    Similarly Gopalarathnam says, "We have identified about 40 common ailments for which ayurvedic treatments are prevalent and widely used, which we cover for treatment across any government registered hospitals."