Health Insurance launched | Bharti AXA General Insurance

Bharti AXA General Insurance has launched the Smarthealth Critical Illness policy.

Features:

· It promises to cover income loss or wealth depletion due to critical illness.

· The cover gives one the freedom to opt for an upfront payment towards cost of treatment to the extent of 5 lakh on the diagnosis of the illness. This is irrespective of the treatment or hospitalization costs.

· An individual plan for 26-35 years can cost 658-1,644 for a cover ranging from 2-5 lakh.

· In the case of a family floater option for the same age group, the premium is 1,464-3,650 for the same insurance cover.

Smarthealth Critical Illness covers 20 ailments, including those of heart, lung, liver and terminal illness.

What makes National Insurance third best?

In the HT-MaRS survey, customer satisfaction on customer servicing and interaction was measured using six parameters — product enquiry stage, purchase transaction, policy issuance, hospital network, renewal, and transparency. And the public sector National Insurance Company (NIC) ranked third, coming after private sector Tata AIG and ICICI Lombard.

There was also that little matter about it being the only state-owned company to feature at all among the top five in terms of customer satisfaction. The survey was carried out among 2074 medical insurance policy holders in eight major cities of India — Delhi, Lucknow, Kolkata, Mumbai, Ahmedabad, Chennai, Bangalore and Hyderabad.

While industry analysts said that the insurer had resorted to reasonable pricing, which went in its favour, insurance sector experts pointed out that claims settlement takes longer in NIC compared to its competitors, which might explain the third position.

“It takes about one to one-and-a-half months for settlement of claims in NIC,” said a leading third party administrator (TPA), on conditions of anonymity.

So what can public sector insurers do to get better in the area of customer satisfaction?

The four PSU insurers — National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance — which together manage about R6,000 crore of health insurance business, complain about being saddled with a commercially unviable claims settlement ratio of 115%. They have to say that the way TPAs function also has a major bearing on customer satisfaction, and forming a common TPA is one way of cutting down on costs.

“The four state-owned general insurance companies are looking to engage a third party administrator to ensure that customers are not put through any major trouble especially when we have no health regulator, the process is on track and we hope to have one soon,” said NIC chairman and managing director NSR Chandra Prasad.

TPAs are intermediaries between patients and insurance firms. Typically stationed at hospitals, TPAs take care of the administrative process of mediclaim policies. “This arrangement will provide economies of scale to the four insurers,” said Prasad. NIC has set a claim settlement target for 2010-11 at 90%. And as Prasad lets in, “We are focused on customer service more than profits and business models.”

As Amit Mitra, secretary general of industry body Federation of Indian Chambers of Commerce and Industry puts it, “The emphasis has to be on consumer awareness and satisfaction, provision of quality health care, improved insurance services and greater collaboration and trust between insurers and healthcare providers.”

Health Insurance | How to keep your insurance beneficial

Benefits of an insurance policy are obtained if your policy is going for the long term. The earlier you buy, the cheaper will be your life insurance premium. If you buy insurance at the right time, you surely don’t want to pass the benefits by missing your premium paying deadline because of a cash crunch or failing to notice.
The Insurance Regulatory and Development Authority (Irda) has provided a standardized window of opportunity for people to make up for late payment. In general insurance policies, especially health insurance, benefits get added for every year in which you don’t make a claim.
For unit-linked insurance plans (Ulips) and health insurance, the rules of reviving a lapsed policy have been standardized. A policy lapses when the premiums are not paid within the deadline or within the grace period of about a month after the main deadline. Here under are the current rules regarding the health insurance.
A health insurance policy needs to be renewed every year. It is obligatory on the insurer’s part to renew your policy, irrespective of the number of claims you may have made.
Till about a couple of years back, the concept of grace period did not really exist in the health insurance sector. Insurers considered any late payment as a break in the policy and refused to renew which was a cause for concern especially for senior citizens (as it meant no health insurance at all).
In March 2009, the sectoral regulator standardized this process. It made it mandatory for the insurers to clearly state the terms and conditions of renewal, including the age up to which a policy could be renewed. Insurers were also required to give indicative premiums of future renewals. Apart from these renewal norms, Irda introduced a window of a grace period of at least 15 days. So you got another 15 days after the due date to renew your policy.
But now: Though Irda has put in place the rules, they are still not followed to the last word.
In reality some state-run insurers give only a 7-day window. However, this is more a problem of internal communication and as a customer it means approaching the higher ups like the regional office or main office for a 15-day extension. The rules of the game are in favor of the policyholder so one should take all necessary measures to keep important insurance policies from lapsing.

Cashless mediclaim facility at 4 more hospitals

Fortis group of hospitals and Cumballa Hill Hospital in Kemps Corner have agreed to be part of the Preferred Provider Network (PPN) programme of public sector insurance companies for cashless mediclaim facility.

An official said, "Fortis group has 3 hospitals in the Mumbai Metropolitan Region at Mulund, Kalyan and Vashi. All the 3 will join the PPN network." - Manthan K Mehta

Vijay Shetty, director of Cumballa Hill Hospital, said, "The cashless facility to mediclaim policy holders will be comprehensive to patients within week."

Till now, Jaslok was the only major hospital in the island city to have joined this association.

General Insurance Public Sector Association (GIPSA) a group comprising 4 public sector insurance companies - New India Assurance Company Ltd, United India Insurance Company Ltd, Oriental Insurance Company Ltd and National Insurance Company Ltd, had decided restrict the cashless medical facility to hospitals approving to join the PPN to curb the mounting losses to fraudulent or inflated claims from July 1, 2010 onwards.

Apart from Fortis, the other major hospital in the network Jaslok Hospital, Jupiter Hospital Thane, MGM Vashi, Sterling Wockhardt, Vashi, Kohinoor Hospital, Kurla, Seven Hills, Andheri (E).

Need, importance and benefits of switching Health Insurance

Need: If you are not satisfied with the services of your health insurer, what should you do? Earlier nothing, but now from 1st of July thanks to Health Insurance Portability, you will be able to switch to another health insurer without losing any of the benefits that your current health insurer provides.
Importance: If you want to shift from one place to another, that is, relocating, there is a chance that due to lack of insurers’ office providing necessary policy service at the new location. Secondly, if you are shifting from one organization to another organization many times you lose health insurance cover due to lack of portability of the health insurance policies especially loss of Pre Existing Diseases (PED).
Benefits: It is essential to protect the policyholders against discontinuity and consequential loss of PED cover by making the health insurance plans portable across the insurance companies; thus IRDA has allowed health insurance to be portable from 1st July.
• The portability will ensure that the policyholder is not tied to one single insurer throughout his life for fear of losing the cover of PED.
• Policyholders who have chronic illnesses like cataract, hysterectomy etc can “carry forward” the credit gained for pre-existing conditions in terms of waiting period enjoyed with previous insurance company, as per the new portability guidelines. (For example if under a previous policy, the condition was excluded from coverage for two years and under a new plan with a different insurer the exclusion period for the same condition is three years, the new health insurance policy can only exclude the condition from coverage for one extra year).

Is it possible to switch my health insurance provider

Yes. Health insurance portability facilitates one to switch your service provider if you are not happy with their services without compromising on policy terms. This will increase competition thus help you well-priced and more quality services. In fact it is going to be possible from the 1st of July 2011, just 4 months away!
Sanjay Datta, the head of health at ICICI Lombard General Insurance said, "It is more like mobile number portability. Waiting period of customers will be removed".
This is going to bring immense relief to unsatisfied health insurance customers. And, portability is going to make the health insurers very competitive thus making them serve their customers better.
Bharti AXA General Insurance CEO and Managing Director Amarnath Ananthanarayanan said, "There will be increased competition in the sector and better quality of service. Overcharging and variation in rates of premium would be reduced".
The Insurance Regulatory and Development Authority or IRDA – the sectoral regulator has issued guidelines has made it compulsory that pre-existing diseases (PED), which are covered by the existing insurers, would also be covered by the new insurer. Also the insurance companies will have to provide all records and claims history of the customer to the new insurance company.
To quote IRDA - "It is essential to protect the policyholders against discontinuity and consequential loss of PED cover by making the health insurance plans portable across the insurance companies".
Datta said, "Customers can now choose to shift their insurers in a hassle free way as there would be lot of choice of them and would also ensure better quality of service from the insurance companies by increasing competition".
Max Bupa Health Insurance CFO Neeraj Basur said, "This will bring in more transparency and will also allow insurers to assess the risk and provide underwriting at the point of sales".
Insurers say that though group insurance policies would be easily portable, individual policies could take some time; as, group policies offered by different insurers are mostly similar in nature but individual policies work out differently according to individual customers. Also, it will take time to ensure satisfaction after portability of individual health insurance due to dissimilar benefits and features of individual plans. The long and short of it is at least there is a chance to change your health insurer and get better service.

Rules to handle more than one health policy

Recent statistic shows that due to shooting healthcare costs and increasing awareness people are buying health insurance policies. Many buy a separate plan despite being covered by their employers under group medical health policies as this ensures coverage in case of job loss or while switching jobs.
Tips to manage multiple policies
It is indeed a wise decision to invest in an individual cover. You need to keep in mind a few details while making a claim when you have more than one health cover. This is due to the contribution clause in your policy which states that if you have purchased insurance policies from more than one insurance company, all the insurers will share the payout in the ratio of the sum assured.

Firstly it is important to be open while buying a health cover which is usually not the case. As Anthony Jacob, CEO, Apollo Munich Health Insurance says, “While signing up for an insurance policy, the individual is under an obligation to declare if s/he is already covered under any other health policy. If s/he acquires another policy during the course of the first one, s/he is required to intimate the latter”. Even Sanjiv Bajaj, managing director, Bajaj Capital agrees that “No attempt should be made to withhold the information as it could go against you during processing of the claim. It is best to be transparent”.
Applicability of this clause depends on a variety of factors; this is why this clause is not always clear.
Following is a list of scenarios a policyholder with multiple policies may encounter at the time of making a claim:
Group & individual cover combo
You have to inform both the companies when you make the claim unless the terms and conditions of the two policies vary hugely. For instance, pre-existing illnesses is covered under one policy while for some plans this cover is extended only after 3-4 policy years. So, if a claim is regarding pre-existing illnesses which is made before completion of the waiting period, issuer of the individual claim will not share the payout.

For other claims, like in case of cashless claim though one company has to be contacted and provided details of the second policy. From thereon, the two companies will coordinate and settle the claim so both the companies need to be informed.


Two reimbursement policies
Excluding critical illness covers, most general insurers offer only reimbursement policies – the ones which undertake to pick up the expenses you may have incurred during hospitalization.

Life insurers also offer reimbursement covers as well as fixed benefit policies. If you have bought two reimbursement covers, the contribution clause will come into effect as the operating principles of the two policies are the same.
Reimbursement & fixed benefit policy combo
Fixed benefit covers offered by life insurers hands out a predefined sum upon hospitalization. In this combination, both the companies will settle the claim you are eligible for so you can make the claim under both policies separately.

This is a good combination, as the claim amount from the reimbursement cover will pay for hospitalization expenses while the fixed benefit dole can be used to fund post-hospitalization recovery costs.
Two policies from one insurer
This will be similar to buying an individual policy from the same insurer that provides your group cover.

You need to find out first about the accounting procedures, as the insurer could insist on dividing the disbursal between two policies, even if both are issued by it.
Two polices serviced by common TPA
If the claim servicing of your health insurance policies is handled by the same TPA (third party administrator), the time taken reduces significantly as time needed to transfer the documents from one TPA to another is saved.

Different TPAs, means more paperwork as well as you may need to ask for a certificate from the TPA in possession of your original bills, stating that the documents have been retained for verification of the claim made. This, along with photocopies of the relevant documents, has to be submitted to the other TPA for processing at its end.
Double protection
o In case of similar principle health policies, the claim payout will be shared between the two. The disbursal will take place in proportion of the sum assured under the two policies.
o However, in case one policy covers pre-existing illnesses while the other doesn’t, and the claim relates to such an ailment, the former will pick up the entire amount.
o If one policy is reimbursement-based and the other is a fixed benefit one, you can claim the entire eligible amount under both policies. You will be better off informing both the insurers while making a claim.
o It also makes sense to retain copies of all the bills. The insurers or the TPAs will then co-ordinate with one another and pay out their respective share.
Conclusion: Even if it is little extra work or few complexities involved, you should opt for an additional individual cover; mainly because, group cover stop with your employment. Besides, if you were to buy an individual mediclaim when you are working, you would have also crossed the milestone of four policy years, which is the waiting period for covering pre-existing illnesses.