Health expo to unveil low-cost medical equipment

The Indian healthcare sector has emerged as one of the most progressive and largest service sectors in India. The public sector however is likely to contribute only around 15% to 20% of the required $ 86 billion investment.

"The corporate India is, therefore, leveraging on this business potential and various health care brands have started aggressive expansion in the country," said Dr EV Ramana Reddy, secretary to the department of Health and Family Welfare, at the inauguration of a three-day long exhibition, Healthex, on Friday.

“Various state governments are collaborating with the private sector through PPP to improve efficiency and decrease the inequity in the health system. Community health insurance initiatives have also been undertaken in terms of Yeshaswini Scheme in Karnataka,” said Dr Reddy.

The country's vision 2020 should include the delivery of affordable healthcare system even to the rural people. Preventive healthcare is another aspect that should be focused on and doctors should gear up to educate patients, he added.

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On the healthcare development in Karnataka, he revealed that the healthcare landscape is changing rapidly with corporate and foreign hospitals setting up centres to offer high quality healthcare. Moreover, the government is also promoting India as the global healthcare destination to offer holistic treatment. Now, private and public hospitals need to synergise their efforts to promote India as the healthcare destination worldwide, said Dr Reddy.

The Indian healthcare industry is undergoing a rapid expansion and in order to survive the healthcare market competition and growth, hospitals are continuously updating themselves on current issues, challenges, and the best methods to reach out to and serve their patients better, he said.With several innovations in the healthcare sector, there is a need for both private and public sector to work jointly.

"The rapid technical changes in the recent past and the commitment of the Army Medical Corps Services to provide a cradle-to-grave service have encouraged diversification in the unexplored fields in military medical services,” said Air Vice Marshal Pankaj Tyagi, principal medical officer, Headquarters Training Command, Indian Air Force.

Rs.150-cr for new insurance scheme

A sum of Rs.150 crore has been allotted initially against newly-formulated Chief Minister's Comprehensive Health Insurance Scheme, Finance Minister O. Panneerselvam announced in the Assembly on Thursday.

The old insurance scheme of the DMK regime was terminated, but to benefit patients in the bridge period between suspending the old scheme and launching the new one, a sum of Rs.100 crore was separately allocated, Finance Secretary K. Shanmugam said in his post budget briefing.

The government will focus on improvement of primary health care facilities in urban areas. The 60 centres already sanctioned under the National Rural Health Mission, will be shifted under the administrative and technical control of the Directorate of Public Health. Further, the Finance Minister announced that Urban Primary Health Care centres will be set up in 75 more small urban towns. A super-speciality centre, at a cost of Rs.100 crore, would be set up in Annal Gandhi Government Hospital, Tiruchi.

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Additionally, infrastructure and equipment upgradation has been planned for district hospitals and poison treatment centres at a cost of Rs.55 crore, under the Tamil Nadu Health Systems Project. Also, under public-private partnership agreements, diagnostic facilities at the major hospitals will be improved, and state-of-the-art computer aided laboratories established in all districts in a phased manner. A ‘Hospital on Wheels' scheme will be launched to provide door-to-door health care services far-flung areas to begin with. Sanitary napkins will be provided free of cost to rural girls through the ICDS network and village health nurses. A sum of Rs.46 crore has been provided for this.

Emergency transportation provided through the 108 ambulance service will further be extended to offering inter-facility transfer for all emergencies. Additionally, special vehicles will be put into service in tribal and hilly areas, and one vehicle will be provided per district for transporting new born babies.

IndiaFirst Life forays into health insurance

IndiaFirst Life Insurance on Wednesday forayed into the health insurance segment by launching a new product and said it expects to garner about 10 per cent of its total premium within next three years.

The company, a joint venture between public sector lenders Bank of Baroda and Andhra Bank along with UK-based investment firm Legal & General, also said it aims to sell at least 1 lakh health insurance policies within that period.

"As a line of business, health offers the best potential in the insurance sector. We have today launched out first plan -- IndiaFirst Money Back Health Insurance Plan -- and in the coming days, we will come out with more offers," IndiaFirst Life Insurance Managing Director and Chief Executive Officer P Nandagopal said.

The Money Back Plan would offer protection to customers for up to 10 years. The minimum premium payout of the customer would be Rs 10,000.

The health insurance cover would be a minimum for Rs 1.5 lakh and maximum of Rs 10 lakh.

"Health insurance, along would pension and micro- insurance, would be our three focus areas and we expect 10 per cent of our total business to come from health insurance within three years," Nandagopal said.

We also aim to sell at least one lakh health insurance policies in next three years, it added. The plan would offer health cover as well as savings option to the customer.

A part of the premium, depending on the age and health of the customer, would be credited into the buyer's policy account and this money would be invested in various funds to get optimum returns.

"The plan offers a comprehensive health cover for the entire family along with the investment flexibility to grow wealth by investing in different funds under a single plan," Nandagopal said.

"Our aim is to grow by 40 per cent year-on-year and be among the top six players within three years in the life insurance segment," he said.

IndiaFirst Life Insurance, which started operations in March 2010, currently has total premium of over Rs 1,000 crore.

A large population is without health insurance, as the industry has reached only 4.22 per cent of Indians. Around 14 crore people in urban areas remain untouched by any form of health insurance.

Choose your health cover with care

Check for renewal ceasing age, co-pay norm and sub-limits before opting.

A health insurance policy is a ‘must-have’ according to financial planners. Yet, picking up the right health insurance is not an easy task, given that there are 23 health insurance companies. Consider the six to eight life insurers offering health benefits and customers can be spoilt for choice.

While cost is certainly a deciding factor when choosing a plan, here’s a checklist of what else to consider.

Renewal ceasing age: Customers buying insurance rarely look at the age of policy renewal. The renewal ceasing age is the one when the insurer, no matter how long you have been with it, will refuse to renew your policy. For instance, health policies from ICICI Lombard cease at age 70.

Obviously, the higher the renewal ceasing age, the better. Most companies now offer higher or even lifetime renewal policies to customers.

Co-pay options: Typically, as health risks rise with age, companies ask customers to chip in. Besides higher premiums, customers may also have to co-pay for the policy. Companies follow different parameters to decide when they will convert the policy to a co-pay scheme.

For instance, Star Health Insurance begins co-pay once the renewal ceasing age sets in. So, customers could extend their period of coverage by changing their existing plan to a co-pay scheme. Bajaj Allianz General Insurance asks to co-pay if the customer goes to a non-network hospital.

Exclusions and PEDs: These two factors are the most painful ones. An exclusion is a statement in an insurance policy which describes a condition or type of loss not covered under it. Like, hospital cash plans do not cover dental treatment or surgery, pregnancy-related treatment, childbirth and so on.

KG Krishnamoorthy Rao, MD & CEO, Future Generali General Insurance, says, “Check for the coverage in terms of the inclusions and exclusions. These are mentioned in the policy brochure. And, if it does not cover something, you can either opt for other plans or take a rider.”

Another important feature, pre-existing disease (PED), may or may not be covered in health policies. PED is an illness or medical condition diagnosed prior to buying the policy. Nowadays, most companies cover PED with a lag of two to four years.

Sometimes complications arising from already existing diseases may also not be covered for the first four years of the policy. Senior citizen health plans exclude many ailments and, in many cases, need to be topped up with a rider.

Sub-limits: Check, Krishnamoorthy warns, to check for the limit on payments against the health plan. Health insurers reimburse those expenses that have been incurred reasonably. This is one way for insurers to restrict payments, especially when they think there is overcharging by hospitals. Typically, policies have a cap on the hospital room rent, operation theatre, ambulance charges and so on. For instance, ambulance charges on Bajaj Allianz Health Guard are only up to Rs 1,000.

All other charges, too, are reduced in proportion to the room rent cap. This is primarily because the charge structures levied by hospitals varies by the type of room chosen by you. But insurers are trying to do away with it. ICICI Lombard Family Protect Premier does not have sub-limits or a cap on room charges.

Policy issuer: According to health insurance experts, there isn’t much to debate here. “A traditional plan from health insurers should be the first medical policy that you buy, as these are exhaustive. Those from a life insurer can be an additional buy,” says Mahavir Chopra, head of e-business and retail, Medimange.com.

Traditional policies from health insurers or indemnity plans settle claims on a cashless basis or they may reimburse your bills. Life insurers who offer benefit plans or Hospital Cash Benefit Plans pay a fixed amount as soon as the illness is diagnosed.

Policies from life insurers offer restrictive covereage. They also have limits on the amount paid per day and the number of days the benefit can be availed. Say, you are supposed to be paid Rs 25,000 for a surgery; you will get it. But if the actual expense rises to Rs 40,000, you will bear the extra Rs 15,000.

Insurers can’t walk out of convention mid-term: IRDA

In a move that will benefit health insurance customers, IRDA has said that companies can not cancel insurance policies in the medium term. The move, sources say, is in response to complaints from policyholders of health insurance contracts that were terminated before the end of a year due to higher claims.

In a circular to all companies on this week, the Insurance Regulatory and Development Authority said not political, either fresh or renewal can be sold with a clause contrary to the rules of cancellation. The rules allow cancellation if there is fraud, misrepresentation or nondisclosure of a material fact of the insured.

However, the industry says it would be unusual not to have a cancellation clause. "Historically and internationally has been the practice of having a facility of cancellation available to both the insurer and the insured after giving sufficient notice to use other arrangements," says G Srinivasan, President, General Insurance Public Sector and head of U.S. Insurance Company in India. He said the termination clause was important in cases where the cover was based on reinsurance support from reinsurers also include a similar clause.

Pavanjit Singh Dhingra care insurance brokers said the cancellation of insurance policies due to adverse claims violated the trust policyholders. In the past there have been cases in which the offer to increase its topline, insurance companies, have acquired a group of practices is very low. However, after burning their fingers high claims have not used the escape clause.

"It is incumbent on insurers to do their homework and purchase appropriate and bear the risk of the contract. What is the purpose of insurance if the insurer can move away from risk, at its discretion? Sometimes insurance companies have been ruthless in underwriting policies and cancellation or attempted to renegotiate the terms of the insurance period which is totally unfair, and we welcome this action to protect policyholders, "said Dhingra.

Health Insurance is the Need of the Hour

Health insurance has become a necessity in today’s world. There are several reasons for an individual to have the protection of health insurance

Of all the risks which an individual household faces, health risk probably poses the greatest threat to lives and livelihoods. Everyone needs medical care sometimes and health falls with age. Sedentary life styles, hectic work schedules, long working hours and eating habits are leading to silent diseases causing rise in the number of people suffering from obesity, diabetes and cardio-vascular diseases. As per a Government of India report of 2006, morbidity rate for males is 8.5 per cent (rural) and 9.1 per cent (urban) and for females 9.3 per cent (rural) and 10.8 per cent (urban).

The other important risk faced by individuals is the risk of accident. As per a report in the National Medical Journal 2.5 million persons were hospitalised due to road accidents in 2005 and it is projected to be around 3.5 million in the year 2015.

There has been high escalation of medical costs due to advancement and high tech intervention in health, diagnosis and therapeutic procedures as well as prescription drugs. We live in a system of patent protection-a legal monopoly to pharmaceuticals that has been making the new drugs expensive and increasing the cost of care.

The explosion of knowledge in genetic engineering, biotechnology, nano-technology, medical informatics and gene therapy will further escalate the costs for most people.

As per a study of NCAER in association with Max New York Life Insurance Company, the average medical expenses of an Indian household is 6.5 per cent of the annual income and it increases sharply to around 37.4 per cent in case of major ailments. According to a study “India Knowledge @ Wharton Report” around 65 per cent of people remain in debt for life due to their expenditure on major health problems.

Health insurance is the ticket to healthcare and the best mechanism to finance healthcare to protect one’s savings, avoid debts and miseries.

National Insurance has been a major player in the health insurance segment in the country. It has in its basket 18 types of health policies to cater to the needs of the different segments of the society. In addition, the company has also been involved in the implementation of Rashtriya Swasthya Bima Policy in 50 + districts in the states of Haryana, Bihar, Assam, Tripura, Mizoram and West Bengal.

For the year 2010-11, National Insurance completed a health insurance premium of Rs 1681 crores out of the industry’s total health insurance premium of Rs 11,137 crores mobilised by 22 multi-line non-life and three mono-line health insurance companies. The company issued 14.47 lakh of health insurance policies covering 2.39 crore of persons. It paid 4.11 lakh number of claims amounting to Rs 1399 crore during the year.

Health insurance is the fastest growing non-life insurance segment and it is estimated to grow at a CAGR of 35 per cent during the next four to five years. Increased awareness, expanding aspiring class, rise in health costs, government initiated schemes like RSBY for the BPL population, construction workers and street vendors etc., have given a big boost to the health insurance segment.

The company has geared up to play a significant role in this high growth business through planned participation in the different segments like government schemes, retail and wholesale. Though losses has been a cause of concern in this business to all the players, the company plans to manage it sustainably by initiating a number of measures like proper monitoring of TPAs, creation of health cells in regional offices commanding high volumes of health business, emphasising on investigation and fraud control etc.

Health policies by life insurance companies will not be portable

Your plan to switch your existing health insurance policy from a non-life insurer to a life insurance company may not be possible, at least for now. The insurance regulator is likely to confine the portability of health insurance policies to non-life insurance companies.

“To start with, only mediclaim policies offered by general insurance companies will be portable. Health insurance policies offered by life insurance companies, which are much more complex in nature, will not come under it,” said a senior official of the Insurance Regulatory and Development Authority (Irda).

One of the primary reasons for not extending the facility is that the term of the policies offered by general insurance companies is one year. However, for life insurance companies, it is long-term, raging between three and 15 years. Portability allows a policyholder to shift the policy offered by one insurer to the other, while keeping the terms and conditions of the cover unchanged.

“Most health plans offered by life insures are indemnity policies or benefit policies, which are associated with lump sum benefits at the end of the term, subject to certain pre-specified conditions. Hence, it is very difficult to port credits, since these policies require completely different underwriting techniques,” said a life insurance company official.

“More than 90 per cent of the health insurance business is confined to the general insurance industry. Policies offered by general insurers are fixed-benefit plans and are renewed annually. This is different from plans offered by the life insurance companies. So, portability between health products offered by life and non-life insurance companies is not feasible,” said a senior official at a state-owned general insurance company.

In short, for mediclaim policies, there are no survival benefits or life covers. So, general insurance companies would not be able to service these kinds of health insurance plans, he the official said.

Another aspect is the pricing of the policies. “One of the important issues is how to price the benefits. Different companies offer different benefits to add exclusivity to their products. For instance, in the case of portability, one has to forgo some benefits. Thus, the policyholder might claim some discount, which the insurer might not allow,” said an actuary in a life insurance company. Top Engineering Colleges

Last week, the insurance regulator decided to postpone the execution of portability of health insurance policies by three months to October 1, as industry officials sought more clarifications from the regulator.

In a bid to facilitate data sharing among insurance companies, Irda had embarked upon providing a web-based facility for insurers to feed in all relevant details on health insurance policies issued by them. This data would be accessible by the company to which a policyholder wishes to port his policy. “Such a system would enable the new insurer to obtain efficiently data on history of health insurance of the policyholder wishing to port. It is necessary to enable the smooth running of the system,” Irda had said.