A ‘premium’ relief for diabetes, hypertension

Mumbai: New India Assurance—India's largest non-life insurer—has decided to stop charging additional premium for those with diabetes and hypertension under its revised health insurance policy. The state-owned insurer has also withdrawn a clause from its policy that excluded cover for ailments caused by tobacco consumption. 

    The move will come as a relief to a significant chunk of India's urban population and will also eliminate disputes arising out of wrongful rejection of claims. The company has decided to include tobacco-related ailments because the exclusion was causing hardship to a lot of policyholders and also because it amounted to rejection of claims on account of lifestyle. The new health insurance policy, however, continues to exclude cirrhosis of liver caused by alcoholism. 
Drunk driver liable for insurance claim 
    An insurance firm has been told to pay the insured sum to the widow of a biker killed in an accident despite the presence of alcohol in his blood. The order held that a claim can't be denied on the basis of a exclusion clause the insured was not informed about. P 6 All renewals from Aug under new terms 
Mumbai: The New India Assurance company's decision to stop charging extra premium for diabetese and hypertension patients will come as major relief for urban policy holders. 
    "Under the new policy there will be no difference in rates for a standard proposal and someone with diabetes or hypertension," said G Srinivasan, chairman, New India Assurance. He said that one of the reasons for the decision was the high incidence of people with such conditions. However, the earlier practice of having a four-year cooling period for pre-existing conditions will continue. This means that if a diabetic buys a policy, the coverage for diabetes-related hospitalisation will begin only after four years. 
    The new 2013 mediclaim policy now allows health insurance up to Rs 8 lakh as against Rs 5 lakh earlier. "Senior citizens will also be given a one-time option to increase their sum insured if they have had two claim free years," said Segar Sampathkumar, head of health insurance at New India Assurance. 
    The new policy has come into effect from July for new sales and all renewals from August 2013 will be under the new terms. TOI had earlier reported on the increase in health insurance charges by all the state-owned insurance companies from the current fiscal. Following the revision prices have gone up by on an average around 23%.

Cong clear loser, but BJP still far from victory: Poll Regional Bosses Could Emerge As Major Force

We could end up with a Lok Sabha in which, for the first time, the single largest party has less than one-fourth of the 543 seats and no front has even a third. That is what would happen if elections were held now, according to a Times Now-CVoter opinion poll. It projects that the NDA would win 156 seats with the BJP getting 131 of them, while the UPA would win 136 with the Congress pegged at 119.      The poll estimated that the 'Third Front', which includes the Left, SP, RJD, TDP, BJD and some other regional parties, would win 129 seats and the 'Fourth Front', including the BSP, Trinamool Congress and AIADMK, would win 122. In short, there could be a fairly even four-way split, though the Third and Fourth Fronts are not really firmly established, at least as of now, and others  may also morph in the coming months. Poll gives Sena-BJP 26 seats, 17 to Cong-NCP in Maharashtra      If the predictions of the Times Now-C Voter opinion poll come true, the SP, BSP, Left, AIADMK and Trinamool would each have between 22 and 33 seats, possibly giving them a crucial role in the formation of the next government in New Delhi.      With the two big national parties put together not winning even half of the seats, the regional bosses would really be able to call the shots in such a scenario.      Among the bigger states, the poll projects SP and BSP between them winning threefourths of the 80 seats in UP, with the SP picking up 33 and the BSP 27. The Congress, which won 21 seats in the state in 2009, is projected to win just five in 2014 and the BJP is estimated to gain just a couple of seats to get 12.      In Maharashtra, it's advantage NDA and bad news for Sharad Pawar's NCP, if the poll has got it right. It estimates that the Shiv Sena will win 15 seats of the state's 48 seats and the BJP 11, the same as the Congress. The NCP is projected to get just 6 seats, Raj Thackeray's MNS opening its account with 3.      In Andhra Pradesh, a state in which the Congress won 33 of the 42 seats in 2009, the CVoter poll projects it will win a mere 7. Jagan Reddy's YSR Congress, a party that didn't exist in 2009, is estimated to win 14 seats and the Telengana Rashtra Samiti 11, leaving just 7 for Chandrababu Naidu's TDP. Of course, the AP numbers could change dramatically once the formation of Telangana is announced, as expected soon.      In West Bengal, Mamata Banerjee will continue to fly high despite her alliance with the Congress having broken up since the last elections. The poll projects that the Trinamool Congress will win 22 of the state's 42 seats and the Left will win 17, a gain of two seats for each of them, while the Congress tally will drop from 6 to 2. In Bihar, the break-up between Nitish Kumar's JD (U) and the BJP seems to be hurting the former more. In fact, the poll projects that the BJP will emerge as the single largest party in the state winning 14 of the 40 seats, Lalu Prasad's RJD coming a close second with 12 and JD(U) in third place at 11.      For the full report log on to www.times of india.com

DOUBT OVER CLAIMS U’khand power plants face insurance hurdle

Mumbai: Private hydel power projects in Uttarakhand facing a shutdown due to floods may find it difficult to recover their losses from insurance companies. According to underwriters, their liability would be limited to actual physical loss to the structure and loss of profits arising out of the physical loss.      The hydel power companies that have been affected by the Uttarakhand floods include Jaiprakash Power Ventures, Lanco Infratech and GVK. Last month, Jaiprakash Power Ventures informed BSE that it was forced to shut down barrage operations at Vishnuprayag following the Uttarakhand floods. Similarly, Lanco Infratech, which had its project on the Mandakini river, was also affected because of the floods.      Insurers say that the informal estimates provided by the company of their losses run into hundreds of crores. But the trigger for these losses has been the deposit of debris and boulders upstream without any major physical damage to the dam structure itself.      "During the onset of monsoon, Uttarakhand, including district Chamoli where Company's 400 MW Vishnuprayag Hydro-power plant is situated, has witnessed very heavy rain causing unprecedented flood of very high intensity with excessive silt, boulders and other materials in the Alaknanda river, resulting in disturbances to river protection works and leading to shutdown of the barrage operations and power generation with effect from June 16, 2013," the company had said in its statement to BSE.      "From what we have heard, the structure of the dam is intact. The loss is because of millions of tonnes of debris and boulders being deposited upstream which has made the dam non-operational. Loss of profit cover kicks in only if business is interrupted due to a physical loss to property that is covered under the main policy," said an industry official.      In its statement to the exchange, Jaiprakash Power had said while the company is taking effective steps to restore generation, assessment of damages due to the flood would be made on restoration of commutation and connectivity to barrage site. "Unprecedented floods in river Alaknanda has resulted in Force Majeure event for 400 MW Vishnuprayag Project, commercial aspects of which shall be addressed in accordance with Power Purchase Agreement between Uttar Pradesh Power Corporation and the company. As prudent practice, 400 MW Vishnuprayag project is also covered under Industrial All Risk Insurance Policy."

‘Pay insured even if death not a mishap’

Mumbai: A consumer forum has brought to book an insurance company that denied the accidental death claim of a south Mumbai resident on the grounds that the death of his father due to a fall at home was not accidental and was caused by disease-related giddiness.      The firm was told to pay the victim's son the insured sum of Rs 5 lakh with an interest of Rs 1.20 lakh and Rs 23,000 towards litigation costs. The forum cited a national commission order which said it would be an accidental death even if an insured suffered a fit and drowned or fell in front of a train and died. P 6 Big aid for crash victims starts Mon Dipak Kumar Dash TNN  New Delhi: The country's first cashless treatment of road accident victims, which ensures free treatment in the first 48 hours, will be launched next Monday with the 200-km stretch from Gurgaon's 32-lane toll plaza to Jaipur bypass of NH-8 to be the pilot corridor.      A trial run has been conducted on this stretch for the past three weeks involving over 70 volunteers trained by AIIMS as first responders. The programme, to be launched by the road transport and highways ministry, aims to shift crash victims within 20 minutes to a nearby hospital. Sources said more than 50 hospitals have been networked to admit injured people immediately and provide treatment.      According to various studies, the survival chances of crash victims go up by 50% if they are provided treatment within an hour. Over 1.4 lakh people were killed in road accidents in India in 2012.      As part of the cashless scheme, medical expenses of the first two days will be borne by the government. This will ensure quick and hassle-free treatment of theinjured. However, there is a maximum cap of Rs 30,000 for free treatment.      "We want to roll out the cashless treatment plan for the entire country. Insurance companies will be interested in this since their outgo on account of third party claims will reduce if we are able to check the total number of fatalities," road transport minister Oscar Fernandes said.      The recent global report on road safety by WHO claimed that the number of seriously injured being rushed to hospital was as less as 11 in every hundred in India.      Ten advance life-support ambulances have been deployed on the pilot stretch. "These would be stationed at an approximate distance of 20 km from each other, thus serving 10 km on either side. The average response time will not be more than 20 minutes," said Birendra Mohanty, vicepresident of Financial Inclusion Solution Group at ICICI Lombard.      Officials said a toll free number (1033) to call an ambulance or report an accident had been activated and a call centre was engaged to take care of all such emergency calls.

MONEYMAKEOVER Invest in equities to meet long-term goals

Value Of Investment In Debt-Based Instruments Is Eroded By Inflation,      Joypratip Sengupta, 33, currently lives in Ahmedabad with his wife Ishita, 30. He was born in Kolkata and completed his schooling and engineering in Bangalore. He did MBA from Ahmedabad and works in the private sector. Ishita, who was born and brought up in Kolkata, has completed her PG in hospitality management. Joypratip's father initially ran a business and later opted for a job. His mother was a principal in an educational institute.  What is the couple  saving for?  They are planning to buy a house worth Rs 45 lakh in a year. They wish to provide Rs 2.40 lakh annually to support Joypratip's parents. They couple also wish to buy a luxury car worth Rs 11 lakh after 3 years and plan to go on a foreign trip after a year. These costs will be revised based on inflation.  Where are they today?  Cash flow: The couple's annual gross inflow from all sources is Rs 45.50 lakh against the total outflow of Rs 21.81 lakh. The total outflow includes routine family expenses, insurance premiums, EMI on a loan on a property owned by his father, rent for a house they are currently living in and regular savings. EMI works out to 3% of their take-home income.  Net worth: The couple's total assets are worth Rs 1.20 crore, including personal assets worth Rs 1.02 crore, which comprise house owned by father, car and jewellery. There is an outstanding liability of Rs 5 lakh on the property owned by his father. The net worth comes to Rs 1.15 crore. Contingency fund: The balance in the savings bank account and FDs (less than a year) is Rs 9 lakh against the mandatory monthly expenses of Rs 1.30 lakh. This is approximately seven months' reserve.  Health & life insurance:  The couple have a health cover of Rs 5 lakh each. They are also covered by Joypratip's employer for medical expenses. Joypratip has a life insurance of Rs 56 lakh and Ishita Rs 1 lakh, respectively – this is mainly by way of investmentoriented policies.  Savings & investment: The couple's balance in the savings bank account and FD (less than a year) is Rs 1 lakh and Rs 8 lakh, respectively. Invested assets include EPF worth Rs 6.5 lakh and the cash value of insurance policies is Rs 2 lakh.  Fiscal analysis: The couple is saving a substantial part of their total income. Considering the annual expenses and all assets, their existing life and health covers are inadequate. The outstanding loan represents 4% of the total assets. There is no exposure to growth-oriented asset classes like equity and gold. In the long run, this will result in erosion of wealth due to inflation.  The way ahead  Contingency fund: They should maintain a contingency fund of Rs 3.90 lakh, of which Rs 25,000 must be held as cash in hand and the balance in a fixed deposit linked to a savings bank account. The surplus funds must be invested to provide for other goals. Health & life cover: Keeping in mind the future responsibilities, lifeinsurance for Joypratip and Ishita must be increased by Rs 2 crore and Rs 75 lakh, respectively, by way of term plans.  Planning for financial goals  Home buying: This can be fulfilled by making a part payment from the surplus funds available in fixed deposits and annual surplus from income. The balance can be funded by taking a home loan. Since, Joypratip and Ishita are young and have no dependents, they should target to be debt-free in 7-10 years maximum.  Parental responsibility:  This goal can be achieved from the annual income. As a precaution, they should open an FD and keep aside one year's reserve to ensure support to parents is not affected even if there is income turbulence.  Retirement planning: They should start an SIP of Rs 30,000 per month in an equity mutual fund and increase the amount by 10% every year once the goal of buying a house is achieved.  Planner's eye T he majority of couple's assets are in debt-based instruments, which appear safe because, unlike equity and gold, there is no daily number which tells us how much of the value is lost to inflation. On the other hand, equity and gold seem risky because we get to see their price movement daily. However, in the long run they have the potential to grow. Therefore, one must invest in equity and gold for financial goals that are over 7-9 years away. Joypratip Sengupta with wife Ishita

DO HEALTH INSURANCE BENEFITS PROVIDED TO EMPLOYEES NEED AN OVERHAUL? ANKITA SHREERAM EXPLORES

46 per cent of employers have a difficulty in understanding healthcare needs and selecting a suitable package for employees. Moreover, 45 per cent face a challenge in executing preventive healthcare programmes and want insurance companies to be a partner in the whole healthcare process. These are a few of the takeaways from the 'Trends in Employee Benefit Programme – 2013' research conducted by ICICI Lombard General Insurance Company Ltd. 

    In 2013, a total of 5.05 million claims were settled, as compared to over eight million claims in 2011 and 4.3 million in 2012. One of the causes for lower settlement of claims seems to be a gap in communicating these benefits to employees. Loop Mobile organises camps at the beginning of the year, where each department is provided with complete information on health insurance, so that employees don't have to go through multiple levels while settling claims. "A multi-pronged communication approach is adopted to communicate the health benefits - an annual communication containing highlights of the cover is communicated at the beginning of the year. Special weeklong road-shows are conducted in coordination with insurance service providers to create awareness. For ease of access, the policy details and process are also communicated via our internal employee portal," reveals Vikram Tandon, head of HR, HSBC India. 
    Organisations could try reaching out to employees and widening communication channels in order to understand their needs. "During the renewal of the mediclaim policy, we reach out to employees to take their feedback. We review their suggestions and accommodate them based on feasibility," says Venkataramana B, president (group HR), Landmark Group. "We face challenges on expectations of employees in terms of coverage for extended families and in managing changes arising out of divorces/ remarriages/adoptions, etc," says Ramesh Shankar, executive vice president and cluster HR head at Siemens Ltd. 
More than 50 per cent of employers surveyed consider increasing healthcare cost to be a major concern. This is also compounded by the fact that the incidence rates of critical illnesses have increased by 65 per cent in the last three years. "Till the year 2006, non-life insurance products in India such as fire, motor, property, etc, were under the tariff regime. Hence, general insurers usually offered health, personal accident and travel policies at heavy discounts along with other products to gain a competitive edge in the marketplace. With the introduction of de-tariffing in the health insurance segment, companies were encouraged to create scientific rating methodologies and adopt better risk management practices and independent pricing for each line of business. Alongside, the insurers also revised their cost structures in order to offer innovative products and services to the customers," explains Antony Jacob, chief executive officer, Apollo Munich Health Insurance. 
With rising focus on preventive healthcare and early detection of ailments, 43 per cent of employers are administering wellness initiatives. Siemens Ltd provides a preventive health check-up plan for workmen, staff and executives once in every two years. So what is the ideal sum that employers can offer as health insurance? "There are two aspects to this," says Sanjay Datta, chief, underwriting and claims, ICICI Lombard GIC. "It depends on your population mix and the ratio of critical and non-critical diseases. The sum has to be enough to cover 
all non-critical diseases. The sum for critical diseases, however, would have to be configured." Thus, there is no one magical sum that can fulfil the needs of every employee, but organisations must ensure that every one of their employees are aware of how much cover they possess, and do not hesitate to avail of it. 
    ankita.shreeram@timesgroup.com AVERAGE SUM INSURED OF THE 500 RESPONDENTS WHO WERE SURVEYED ACROSS INDIA, 43 PER CENT HAVE A SUM INSURED OF LESS THAN TWO LAKH RUPEES, WHICH IN VIEW OF RISING MEDICAL COSTS, COULD BE QUITE INADEQUATE. HSBC India: An overall employee medicalinsurance plan, which covers the employee and immediate dependents with a floater cover of six lakh rupees; Siemens Ltd: 60,000 to five lakh rupees, depending on the grade of the employee; Loop Mobile:Three levels ofinsurance coverage, which ranges between two to five lakh rupees for FY'13-14;Landmark Group: 50,000 to seven lakh rupees; Matrix Cellular Services:Upto ten lakh rupees.

HEALTH INSURERS HAVE REVISED THEIR COST STRUCTURES IN ORDER TO OFFER INNOVATIVE PRODUCTS AND SERVICES TO THEIR CUSTOMERS" 
ANTONY JACOB, 
CHIEF EXECUTIVE OFFICER, APOLLO MUNICH HEALTHINSURANCE 

DURING THE RENEWAL OF THE MEDICLAIM POLICY,WE REACH OUT TO EMPLOYEES TO TAKE THEIR FEEDBACK.WE REVIEW THEIR SUGGESTIONS AND ACCOMMODATE THEM BASED ON FEASIBILITY" 
VENKATARAMAN A B, 
PRESIDENT (GROUP HR), LANDMARK GROUP

FOR EASE OF ACCESS, THE POLICY DETAILS AND PROCESS ARE ALSO COMMUNICATED VIA OUR INTERNAL EMPLOYEE PORTAL" 
VIKRAM TANDON, 
HEAD OF HR,HSBC INDIA

DISCOUNTED HEALTH CHECK-UPS CREATE A SENSE OF SECURITY AND GREATER ENGAGEMENT WITH EMPLOYEES" 
PARIJAT THAKUR, 
VICE PRESIDENT - HUMAN RESOURCES,MATRIX CELLULAR (INTERNATIONAL) SERVICES PVT LTD

THE SUM HAS TO BE ENOUGH TO COVER ALL NON-CRITICAL DISEASES.THE SUM FOR CRITICAL DISEASES, HOWEVER,WOULD HAVE TO BE CONFIGURED" 
SANJAY DATTA, 
CHIEF – UNDERWRITING AND CLAIMS,ICICI LOMBARD GIC

IRDA may allow banks to be insurance brokers

Mumbai: Banks may get to play the role of insurance brokers soon, which will make them more accountable for the policies that they sell to their customers. TheInsurance Regulatory and Development Authority (IRDA) is actively considering changes to its broking norms that will permit banks to register themselves asinsurance broking entities. 

    At present, banks are selling insurance products by acting as corporate agents ofinsurance companies. Under the present arrangement, they are not registered by the insurance regulator and they are accountable only to the insurance companies. The insurance companies, in turn, are liable for any mis-selling by banks. As corporate agents, banks are allowed to represent only one life and one non-life company. 
    Of late, they have been allowed to represent an additional healthinsurance company. If they are allowed to register themselves as brokers, they will be allowed to sell policies of all companies and will be registered by IRDA. As registered entities, they will also be more intensely regulated by IRDA and the risk of mis-selling will expose their own balance sheets. 
    "What we have seen is that banks generally sell policies to their own customers. Therefore, their primary responsibility should be towards their customers. Unlike a corporate agent, a broker is a representative of the customer," said T S Vijayan, chairman, IRDA. He confirmed IRDA is working on regulations to permit banks to become broking firms. 
    The life insurance industry has made a representation to the insurance regulator, stating that a bank should be allowed to sell policies of five companies. Under the present arrangement, the bank does not need any special permission to sell policies. Nor does its becoming a corporate agent have any implication on its balance sheet. All this will change if a bank were to become a corporate agent. 
    Allowing banks to become brokers would require an overhaul of regulations for brokers because current norms require that broking activity cannot be done departmentally by a financial services firm and anyone wanting to get into this business will need to float a separate company for the purpose. 
    Meanwhile, IRDA has not detected any major irregularity in the banks that were exposed in a sting operation conducted by a web portal earlier this year. Although a couple of instances of procedural lapses have been detected, these have been rectified and it is unlikely that any major penalty will be imposed.

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