Oriental Bank widens focus to include Mediclaim policy

Oriental Bank of Commerce today entered into a memorandum of Understanding with Oriental Insurance Co Ltd for selling Mediclaim policies to the bank's customers through its pan-India network.

Oriental Bank Mediclaim policy is cash-less family floater covering the members of the beneficiary's family. The policies are available for Rs 1 lakh to Rs 5 lakh. For a policy of Rs 5 lakh, the premium is as low as Rs 6,705 a year.

The memorandum of understanding was signed by Mr. R.M. Sharma, General Manager, Oriental Bank of Commerce (OBC), and Mr. A.K.Saxena, General Manager, Oriental Insurance Co, in the presence of Mr. Nagesh Pydah, Chairman and Managing Director of the bank, and Mr. R.K. Kaul, Chairman and Managing Director of the insurance firm.

Mr. Kaul noted that this policy has some features that are unique for OBC's customers. “This product will be available for all OBC customers up to the age of 79 years. Also, no medical check up will be required.”

So far, Oriental Bank was not looking at general insurance products as a source of “revenue” for the bank. However, there is now a change in its revenue model and OBC has decided to also focus attention on general insurance products for increasing its fee-based income.

“This product was a long-felt need of our customers. Oriental Bank Mediclaim policy will fill the gap in our bouquet of products and services. This should help us in our fee-based income and also in bolstering CASA. This will be a great opportunity for us to build our Current Account Savings Account (CASA) deposits,” Mr. Pydah said.

All Metro and urban branches of the bank have been mandated to sell minimum 250 policies in the next six months, he said. The six-month target has been pegged at 175 policies for semi-urban branches and 75 policies for rural branches.

Disclose agreements between TPA and hospitals

The agreements between public sector health insurance companies and hospitals, including those with third party administrators, should be disclosed to ensure transparency in delivery of medical services to an insured person, Central Information Commission has held.

The Commission rejected the arguments put forth by Oriental Insurance Company that the agreements are between the Third Party Administrators (TPA), to whom the processing of claims is outsourced by the insurance companies and the hospitals and since the TPAs are not public authority, there is no obligation to disclose these agreements.

Information Commissioner Deepak Sandhu held that funds for implementation of health insurance policies is paid by the respondent (Oriental Insurance) which is collected as premium from its customers.

"Therefore this argument is without merit," she said directing the company to disclose the information. However, the Information Commissioner agreed that some portions of these agreements could be severed as it could adversely affect commercial interests of the company.

Sandhu was hearing the plea of an RTI applicant who had sought information from Oriental Insurance on the issue and list of hospitals across the country which provides cashless treatments facilities.

“The disclosed portions would serve to provide greater transparency in respect of the medical services to which the insured are entitled and therefore lend itself to better service been provided to the insured," Sandhu held in her order and also directed the company to place on its web site the names of hospitals which provide cashless treatments.

Get the right health insurance cover under portability

Until portability was allowed for health insurance, customers were wary of shifting to a new insurer, even if they were unsatisfied with the existing one. The fear was the loss of accumulated loyalty benefits or having to begin the waiting period for existing diseases afresh. But now, with the option of health portability in place, they can right their wrongs. However, it would be wise to keep a few factors in mind before shifting to another insurer.

“Customers can only take the policy in totality. So it’s important to understand the benefits offered under the existing health policy and to match those with the plan one wishes to port to,” says Apollo Munich Health Insurance CEO Antony Jacob.

Those planning to port their services should look for an insurer with a good track record in claim settlements and a large network of hospitals. Besides these, there also are other conditions that should be looked up to avoid being in a spot when making a claim.

WHAT TO LOOK FOR IN A NEW INSURER

Claim-settlement record and network of hospitals for cashless facility Lifelong renewals. Insurers cannot refuse renewals to aged customers Additional premiums, co-pay and sub-limits Incentives for prudent usage of policy Flexibility to increase cover with age Wellness support facilities

Additional loading: Typically, if you have a hospital cash cover, you can opt only for a similar cover with another insurer. Going by the apples to apples logic, there may not be a wider scope for added premiums or loads on renewals.

But insurers say every portability request is considered as a new application. So, if a customer is considered a high-risk person under an insurers’ underwriting norms, he may be asked to pay a higher premium or extra loading. In such cases, unless the insurer is offering a better cover, you should not port your services in haste.

Co-pay and sub-limits: Companies often ask customers to share the risk burden, and levy conditions like co-pay or sub-limits on treatments. Under co-pay, a customer pays a percentage of the total cost, while under sub-limits, he pays anything above the pre-decided cost limit for treatment. For instance, Bajaj Allianz General Insurance levies the co-pay structure, if the customer goes to a non-network hospital.

Customers could look at insurers that reward customers for prudent usage of the cover. So, for instance, Apollo Munich encourages shared accommodation or hospitalisation under its ‘Easy Health’ policy. As an incentive, depending on the slab applicable, it offers Rs 300-500 per day hospital cash to policy holders.

“The cash perks attached to them mean lower price on the product in the long run,” adds Jacob.

Renewals: While insurers have been following 70 years as the average age after which they refuse covers to individuals, customers should now insist on lifelong policy renewals.

“There is no official regulation from the Insurance Regulatory Development Authority (Irda) on the age limit and insurers have been told that they cannot refuse health policy renewals. This, in effect, makes lifelong renewals a must,” says Suresh Sugathan, head (health administration team), Bajaj Allianz General Insurance.

Increase in cover with age: Given the rise in medical inflation, your current cover may be insufficient at a higher age. While you may plan to bridge the gap by buying a new policy, companies are sceptical about covering those in the higher age bracket, as medical risks rise significantly with age.

“Customers should, instead, approach their existing insurers, as they are much more open to upgrades from own customers, subject to the necessary medical tests,” adds Sugathan.

Doing this will also help a customer skip the waiting periods applicable on new policies.

Wellness support: A number of companies now offer wellness support to their customers through helpline set-ups for health tips, medical camps and newsletters. These are value additions and part of awareness campaigns insurers undertake.

But, experts warn, one should take into account the kind of support offered, since the costs involved are met by insurers in premiums. “How many people would really follow the advice dispensed by a doctor on the other side of the phone helpline,” asks an official.

It would be better to see if the new insurer has tied up with hospitals and offers discounted rates for out-patient procedures not covered in the basic policy.

HDFC Ergo to provide $15m cover to Formula 1

Private general insurance company HDFC Ergo, in collaboration with the Delhi-based Ace Insurance Brokers, will provide an insurance cover of USD 15 million (Rs 67.5 crore) to the Formula 1 Race, which is being organized in the Capital from the month end, the company said today.

"The insurance cover would protect the Formula 1 Grand Prix event against adverse weather, non-appearance of several teams, riots, strikes and civil commotion leading to cancellation of the event, its postponement or relocation," it said in a statement.

HDFC Ergo, which is a 74:26 joint venture between the mortgage leader HDFC and Ergo International AG, is the lead insurer for the event, it added.

Commenting on the deal, Anuj Tyagi, Head, Corporate and Rural & Agri Business of HDFC Ergo said, "insuring such a high- profile event in a country like ours is a great learning experience."

As per the company, the organisers would write off the costs including deposits, advertising, printing costs, and booking fees among others in case of cancellation of the event.

"A policy like event cancellation insurance policy is a savior for the organisers because it pays any irrecoverable cost or expense, which have been or will be incurred in connection with the event, following a cancellation, interruption, postponement or relocation due to any of the insured perils," Director of Ace Insurance Brokers, Anil Arora said.

Comprehensive Health Insurance from Apollo Munich

Everybody wants to have complete health protection. The problem arises when they choose a health policy for themselves. There are very few numbers of people who know how to make a right choice. Majority of people buy the plan that is recommended by their friends or relatives, thus ignoring their healthcare needs. A person should try and buy a comprehensive health insurance policy so that there are no issues before him/her at the time of medical emergency. These policies help a person to enjoy life under the complete coverage.

Apollo Munich, a joint venture between the Apollo Group of Hospitals and Munich Health, has taken all the above said parameters in mind and has designed products, looking into healthcare needs of people. It has brought a variety of products to help Indian citizens seek medical treatment with ease. An insured need not have to worry for the medical expenses while seeking quality healthcare. There are products for people of all income groups.

India’s first 360 degree product, called Maxima, is the most comprehensive health insurance plan designed by Apollo Munich. It offers wide coverage, which includes inpatient as well as outpatient treatment, maternity expenses, optional critical illness cover, outpatient treatment for pre-existing diseases etc. There is no doubt that the premium associated with this plan is quite high but it is far too less than the coverage offered with this plan. There is coverage for pharmacy costs, diagnostic tests, doctor’s consultations, up to a certain limit. It is, therefore said that Maxima makes medical treatment almost free for an insured.

Looking into other products brought by the company, Easy Health has gained much popularity. In the recent survey, in which various health insurance products in India were compared on basis of their price and features, Easy Health gained the topmost position for being the best medical insurance policy. It is one of the 5-star rated products. One good aspect of this product is that there are three variants and a person can buy the one, as per his/her health needs and budget. This plan also offers complete health coverage at cost-effective price.

Both these products, mentioned above, come with a lifelong renewal facility such that its customers can enjoy the coverage for the entire life. Regular renewal also helps them to enjoy continuity benefit. So, a person can enjoy life under the coverage of these plans.

Govt med insurance only for general ward patients

Only patients admitted in a general ward will be eligible for the government sponsored cashless health insurance for inpatient treatment for primary and secondary illnesses in government and private hospitals in Goa. If a patient is admitted in the ICU, the "Swarnajayanti Aarogya Bima Yojana" card will not serve to pay for treatment.

The card has a ceiling of Rs60, 000. Admitting this, health minister Vishwajit Rane said, "The scheme is for primary and secondary illnesses and one doesn't need ICU admission for these illnesses." Doctors, however, differ with the health minister's view. "Treatments under the scheme include major surgeries such as nephrectomy (surgery to remove part or entire kidney), abdomino perineal resection (removal of anus, rectum, or colon), commando operation (surgery for first degree malignancy of the tongue) and other such treatments, in which patients in a majority of cases need to be admitted in the ICU. Also what about patients who come to the hospital for primary and secondary care but later develop complications and need to be shifted to the ICU?" Association of Private Nursing Homes spokesperson Dr Govind Kamat said. Dr Mithun Mahatme of Mahatme Nursing Home, Bicholim said, "The intent may be good but implementation is not practical. The insurance is for admission in a general ward.

What happens if an emergency patient comes and the general ward beds are full? Also, the rates quoted are low due to which we would be forced to cut corners which won't be in the patients' interest." Though private hospitals have shown discontent with the rates, ICICI Lombard, that will run the scheme, claims that Manipal, R G stone, Wockhardt and SMRC-Vivus hospitals (all corporate hospitals) have agreed to the terms and the company is in final talks with a several other hospitals as well.

Pvt hospitals roped in

FISG-ICICI Lombard GIC Vice-president Birendra Mohanty said, "The implementation of the scheme has already begun and we have roped in more than 10 private hospitals in the network, along with three public hospitals. We are in negotiations with other private hospitals." Kamat, however, said, "The hospitals named by the insurance company are not members of our association. As far as we know, except for one member, none of the others have entered into an agreement with the insurance company. We have also called a meeting of all the members on Sunday to decide the future course of action." Goa has about 110 private nursing homes.

Rane added, "We want the association of private nursing homes on board. They do have some apprehensions but that will be resolved by ICICI." ICICI Lombard's "scope of services" clause states that the package will include "bed charges (general ward), nursing and boarding charges, surgeons, anesthetists, medical practitioner, consultants fees, anesthesia, blood, oxygen, OT charges, cost of surgical appliances, medicines and drugs, cost of prosthetic devices, implants, X-ray and diagnostic tests, food for patient etc". It also includes expenses incurred for diagnostic tests and medicines one day before admission and up to five days after discharge from the hospital.

Transportation expense from the patient's residence to the hospital is also covered and would be reimbursed in cash by the hospital to the patient on providing proof of expenditure. The maximum amount payable to the patient for transportation would be `100.

All you need to know about health insurance portability

Now, policyholders, who are dissatisfied with their current health insurers, have the freedom of switching to other insurers who offer a better deal without losing the continuity benefits. But before switching the health insurers, know the fine prints.

Firstly, when a customer shifts to a new insurer, he will have to undergo all underwriting procedures just like a new policyholder. The loading for porting will be decided only after the completion of medical risk assessment.

Bajaj Allianz General Insurance, head-underwriting, TA Ramalingam says, “The new insurer has the right to reject your policy based on its underwriting guidelines, which may differ from your existing insurer. So customers need to be cautious before planning to switch.”

Why would anybody shift to a new insurer? Of course, to get a better deal compared to the existing health one. So, compare the sum insured available with the new insurer that you intend to shift.
It is always better to switch the plans that are similar in nature. Otherwise, the policy will end up in opting either lower cover or higher cover.

The policy holder has to inform the new insurer about the time regarding the choice of switching. According to Irda guidelines, insurers need to be informed 45 days before renewing the existing policy. If the request for the portability is made after 45 days, the insurer may reject the request.

Waiting period for certain illness varies from insurer to insurer. Hence, it is important for the policy holders to check the time period for pre-existing diseases. Besides the specific exclusions, other terms and conditions need to be scrutinised well before shifting.

“Take a conscious decision on shifting. Service levels of the insurers would be the most important criteria while changing your insurer. People would like to shift to an insurer who has excellent service levels especially in claims settlement,” says Shreeraj Deshpande, head-health insurance, Future Generali India.

The earned bonuses so far with the existing insurer may change as per the new portability guidelines. Ensure that you get existing benefits and additional benefits while porting your health insurance policy.

It is advisable to compare the product constructs such as internal sub-limits and co-payments. Also the policy holder should be aware about the age band pricing and how people of higher ages are treated while porting.

“With the implementation of health insurance portability, insurers will have to enhance their service capabilities and engage in constant innovation to service their existing and potential customers. It is expected to bring in new benchmarks in delivery mechanisms and product innovation in the industry,” say Damien Marmion, chief executive officer, Max Bupa Health Insurance.