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.

SBI Life introduces ‘Hospital Cash' plan

SBI Life Insurance has launched its latest health insurance plan ‘SBI Life Hospital Cash'. The plan provides fixed daily allowance to the insured for every day of hospitalisation.

“Our foray into health insurance is also aimed at addressing the issues of rising healthcare costs and acute under-penetration of health insurance in India,” said Mr M.N. Rao, MD and CEO, SBI Life Insurance.

Hospital Cash's daily hospitalisation cash benefit is available for a fixed policy term of three years and offers the flexibility of premium payment options, with collection on a yearly, half-yearly or quarterly basis.

It provides policyholders with a 100 per cent fixed payout from the first day of hospitalisation without any deductions.

The cover can be renewed till the age of 75 years.

In case the insured person is admitted into an ICU, the amount receivable by the policyholder is twice that of the Hospital Cash's regular cash benefit.

An additional fixed lump-sum of Rs 10,000 is payable to policyholders covering two or more family members under the plan in case the insured person is admitted to the ICU.

Bonus up to 40 per cent of enhanced sum assured without increase in premium, discount of 2.5 per cent on premium on renewal of policy, family rebates up to 10 per cent and premium guarantee for three years are additional features of the plan

Health cover doesn’t fit the ayurveda bill

Are you suffering from diabetes, arthritis or any other chronic disease and opting for ancient forms of medicine? The good news is insurance cover is available for such patients. After some insurance companies began recognizing ayurvedic treatment, many are going ahead with cashless transactions or 80% reimbursements for chronic diseases. Not just that, Karnataka has recognized 15 ayurvedic hospitals for its employees who can undergo treatment and even claim reimbursement.

The Ayush department is in the process of drafting specifications of ayurvedic treatments that can be reimbursed like any other mainstream one. "This can help employees get treated anywhere they like," said Ayush director G N Srikantaiah.

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It is also evolving standards for alternative medicine hospitals so that they can be covered by private insurance companies.

But ayurvedic hospitals feel private insurance companies are still restrictive in terms of coverage. At Soukya holistic health centre in Whitefield, 25 cases of 80% coverage have been made after some insurance companies began covering alternative medicine. "It was a little tough as the parameters of our treatment do not match that of mainstream medicine and diseases. Neither do we have standard pricing. But nowadays, people are coming to us for long-term chronic diseases that could cost up to Rs 1.5 lakh. These are comparable to surgeries in English medicine," said Dr Isaac Mathai, director of Soukya.

Soukya is in the process of getting a certificate from the National Accreditation Board for Hospitals and Healthcare Providers (NABH), so that the process of insurance coverage becomes smoother. At Soukya, the diseases mostly covered by insurance are chronic longterm conditions like arthritis , spondilytis, neurological diseases and even cancer. "Anything chronic should be covered by health insurance providers ,'' added Dr Mathai.

Insurer cannot arbitrarily refuse policy renewal

Healthcare is costlier than a stay in a five-star hotel. Clearly, it is beyond the means of the common man. One-time hospitalization can wipe out a lifetime's savings. So, mediclaim policy, as a welfare measure to bring the cost of decent healthcare within the reach of the average citizen, was introduced. Yet, insurance companies, which willingly accept premium year after year, are reluctant to settle legitimate claims. They look for excuses to reject these.

Often, insurers arbitrarily refuse to renew a policy, when it becomes evident that the claims ratio would go up. This, clearly, is not permissible, as held by the Supreme Court in the case of Biman Krishna Bose versus United India Insurance & Anr.

Biman Bose and his wife, Alka, had a mediclaim policy with United India Insurance. Alka fell ill, and was hospitalised. After discharge, a claim was made for reimbursement of expenses, amounting to Rs 8,243. Although all the necessary documents were submitted, yet even this meagre claim was not settled. This, despite repeated reminders.

So, the insured filed a complaint before the Kolkata district consumer forum. The ding-dong legal battle spanned four years and four tiers of courts till the Supreme Court finally intervened, directing the insurer to pay the claim, as also awarding Rs 20,000.

One would have expected the matter to have concluded here. But, unfortunately, when the policy became due for renewal, the insurer refused to renew in vengeance.

Once again, the insured felt compelled to take legal action. A writ petition was filed in the Calcutta high court, and the second round of battle ensued.

The High Court allowed the writ, set aside the insurer’s refusal, and directed the policy be renewed.

The insurer, however, contended the policy had lapsed, as, during litigation, the renewal premium had not been paid. So, the division bench, while agreeing with the view taken by the single judge, directed the insured to subscribe to a new policy, holding that renewal was not possible.

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This order defeated the very purpose of litigation, because, in case a fresh policy is taken, all pre-existing diseases are excluded. Also, claims in respect of certain diseases contracted within the first 30 days of the new policy are excluded. So, Bose appealed to the Supreme Court (SC).

The SC observed the insurer is bound to act fairly and reasonably. Renewal cannot be refused on irrelevant and extraneous considerations, or in an arbitrary manner. Refusal to renew merely because the insured had approached the courts against the rejection of the claim is not justified.

The SC further observed the initial renewal premium had been paid by the insured, but wasn’t acknowledged by the insurer. Even during the intervening years of litigation, there arose no occasion to deposit the premium.

Accordingly, it held the refusal to renew as unfair and arbitrary, and directed the policy be renewed from the date it fell due for renewal.

It also ordered to further renew the policies for the subsequent expired years, if the premium had been paid. The insured was also awarded costs of Rs 5,000.

Since then, the SC has now held that refusal to renew a policy amounts to victimisation, unfair practice, and high-handededness.