LIC Jeevan Arogya – In Good Health medical cover for your parents

Escalating medical expenses are a cause for concern not only for the elderly, but also for those in their middle age. As health awareness increases not just regular insurance companies, but life insurance companies too are coming up with new health policies.

LIC has recently launched Jeevan Arogya, a non-linked health insurance plan that provides health insurance cover against specified health risks, with benefits such as daily hospital cash benefits, major surgical benefits and day care procedure to meet medical emergencies. In the event of any major illness suffered by the insured, the plan allows waiver of premium for the subsequent one year.

WHAT'S ON OFFER

* Guaranteed coverage for the policyholder up to the age of 80 and his family including parents and parents-in-law against medical expenses incurred due to hospitalisation.

* Financial protection in case of hospitalisation and surgery

* Automatic increases in cash benefits every year at 5 per cent

* Fixed benefits to the individual irrespective of the cost incurred

* No-claim benefit of five per cent, for three claim-free years

* Flexible premium payment options with rebates and discounts for higher premium

* Sum insured increases by 5 per cent a year, to the maximum limit of 1.5 times of the initial sum insured.

* Fixed premium for first three years, irrespective of the claims. Age at entry is the base for all future premiums till the policy is in force.

* Riders such as term insurance and accident benefit. The overall cover under the plan inclusive of the two riders is Rs 10 lakh.

* Tax benefits under section 80D available for all health insurance.

HOW IT WORKS

Individuals can choose the amount of daily hospital cash benefit (HCB) as per their estimated requirements. The plan allows a minimum of Rs 1,000 per day and maximum of Rs 4,000 per day to cover the daily cost of hospitalisation. For instance, for a family of six with parents above 70 and principal insured at 40 for a sum insured of Rs 2 lakh each the premium will works out to a maximum of Rs 31,502(before any rebate).

Daily hospital cash benefit: If the principal insured or any of the persons covered under the policy are hospitalised due to accident or sickness and stay in hospital for more than 24 hours in non-ICU ward an amount equal to HCB will be paid for 30 days in the first year and 90 days from the second year. In the event they stay in an ICU an amount equal to twice the HCB will be paid for 15 days in the first year and 45 days from the second year. This will be within the overall limit for each year.

Major Surgical Benefits (MSB): 100 times of the HCB or applicable daily benefit with an increase by five per cent from the second year onwards. For instance, if the HCB is Rs 2,000 in the first year, it will increase by five per cent to Rs 2,100 (daily cash benefit) from the second year onwards. MSB benefit will be available for minors also. The total number of surgeries covered under the plan is 140. The sum insured is payable based on the categorisation of surgery and it varies from 40-100 per cent.

Day Care Procedure (DCP): In the event of the insured undergoing for any of the 140 day care procedures LIC has specified, the amount paid will be equal to five times of the daily benefit and it will be allowed three times a year and 24 times for whole of the policy.

Other surgical procedures: In the event of the insured undergoing surgery not listed under the above options, and is hospitalised for more than 24 hours then two times the daily cash benefit will be paid for 15 days in the first year and 45 days in the subsequent years.

Quick cash facility: An advance of 50 per cent of the major surgical amount will be paid to the insured for the specified surgeries. To avail the benefit insured has to inform the LIC or the facilitator for the claims. After the latter processes the request LIC credits the eligible amount to the policyholder's bank accounts.

OUR TAKE

With health insurance plans netting large losses for general insurance companies, they have imposed many restrictions on insuring older family members. Hikes in premia too have been steep. Individuals finding it difficult to include their parents/parents in-law in their existing policies may find this plan suitable to their needs. However, LIC Jeevan Arogya has a cap on entry age at 75.

You should also note that a health policy offered by life insurance companies can only supplement health policies offered by general insurers. The health policies are an indemnity plan - the hospital expenses are reimbursed up to a maximum sum insured without any limitation. The health cover offered by life insurers are benefit plans and the cover is restricted by various conditions.

The advantage under the Jeevan Arogya is that pre-existing diseases are covered after two years, against the usual four-year waiting period . However, the premia during the initial years are higher compared to the top-up plans offered by the general insurer. But an individual signing up for this plan at an early age has the potential to save on premium later .

This plan is ideal for self-employed professionals, people with a family history of critical illness and for those above 65 who do not have a medical cover.

Health insurance scheme for beedi workers a poll device

The general secretary of Gondia CPI and district president of AITUC Hauslal Rahangdale flayed State government's health insurance scheme for beedi workers in the district as a gimmick in view of the coming municipal elections in Gondia and Tiroda.

The government had in a recent notification included Gondia in a list of 21 districts which have been selected for the health insurance scheme for beedi workers. The insurance cover is of Rs 30,000 on payment of a principal amount of Rs 30 per year. The criterion for the scheme is that the workers should come under the BPL category and also the insurance will cover only five members of the family. Government has asked the district administration to issue smart cards for this purpose. The work for which is going on war footing according to the staff of the hospitals earmarked for the scheme. Approximately 50 thousand such cards are to be readied by June 30.

Houslal Rahangdale said that when National Health Insurance Scheme for those under BPL category already exists in the state since 2008, the propriety of a new scheme only for beedi workers is totally unnecessary and the motive behind the move is questionable.

He said that according to a government circular dated August 27, 2010 the information about such workers is supposed to be collected by the insurance company appointed by the Nodal Officer. So the move to deploy the staff of the government beedi workers hospitals for this work is a mystery. As per information the Nodal Officer had appointed Tata AIG Insurance Company for this propose but according to local labour officer one MD India Insurance Company is doing this work on behalf of Tata and it appears to have passed this work on to the medical officers due to political pressure, Rahangdale said.

After studying all these aspects Rahangdale asked, why the government did not come out with a simple package of Rs 30 thousand for a family which becomes member of this insurance scheme or work towards providing additional facilities to the existing hospitals for the beedi workers from the funds which will be collected from the beedi workers. Rahangdale pointed out that the whole scheme is eyewash and demanded enquiry into this scheme.

ICICI Lombard associates with Air India Express

ICICI Lombard is collaborating with Air India Express to provide travel insurance solutions to overseas and domestic travellers. This would enable customers to take advantage of Group Travel Insurance (Overseas) for a period as short as 15 days or their return to India, whichever is earlier.

The policy covers customers travelling abroad against possible risks and situations such as medical expenses caused by hospitalisation arising out of accidents, loss from trip delay, loss or delay of checked-in baggage, loss of passport, etc. Talking about the tie up, Neelesh Garg, executive director, ICICI Lombard General Insurance said, “Our partnership with Air India Express brings together a comprehensive, cost effective travel insurance cover at the time of ticket purchase along with the ease of instant online policy issuance. The product coverage has been carefully designed to meet the needs of Air India Express’ guests and has a convenient claims settlement process.“ The company has also tied up with Europ Assistance, a leading global assistance provider to provide hassle free claim settlement.

Tata AIG General Insurance wins awards at Indian Insurance Awards

At an awards ceremony organized by India Insurance Review, Tata AIG General Insurance bagged 2 prestigious awards, 1 each in the health and general insurance category.

India Insurance Review and Celent presented the India Insurance Awards 2011 - the awards were presented to the Indian insurance industry in a glittering ceremony held at the Intercontinental Hotel in Mumbai this evening.

The jury consisted of Mr S B Mathur, Secretary General, Life Insurance Council; Mr S L Mohan, Secretary General, General Insurance Council; and Mr Vepa Kamesam, Managing Director, Institute of Insurance and Risk Management (jointly promoted by IRDA and AP Government).

Tata AIG General Insurance Company (TAGIC) was awarded the Company of the Year Award 2011 for Health Insurance and Best Product Innovation Award 2011 in the general insurance category for the year 2010 – 2011.

TAGIC was awarded the Company of the Year Award 2011 for Health Insurance segment during the Indian Insurance Awards. This award was to recognize the company that stood out amongst its peers in terms of Revenue growth, Profitability, Innovation & Customer service.

Mr.Gaurav Garg, MD of Tata AIG General Insurance Company said “The award reinforces our perception as a strong health insurance company as evidenced also by the HT MaRs Customer Satisfaction Survey (results published in March, 2011) which ranked us as No.1 in customer service satisfaction and No.2 in claims settlement satisfaction. This perception is likely to be buttressed by our imminent entry into the mediclaim space as we await IRDA’s approval for the Mediprime product. It is a testament to our wide and strong product range of benefit based secondary medical insurance products that have not only delivered a profitable business line but also awards from the industry and a high degree of customer satisfaction. Our dominating presence in the Overseas Travel Insurance which is perceived as an Overseas Mediclaim also contributes in no small bit to our position.”

Tata AIG’s current health insurance portfolio consists of the following products

Wellsurance (Executive, Family and Woman version) – A comprehensive, fixed benefit hospitalization, surgical and critical illness plan that offers guaranteed insurability at renewal for whole life.

Accident and Sickness Hospitalization Cash Plan – pays a fixed daily hospitalization cash benefit based on number of days of hospitalization

CritiCare – Pays a fixed lumpsum benefit in the event of diagnosis of any of the select critical illnesses.

TAGIC was also recognized with the Best Product Innovation award amongst General Insurance players in the Indian Insurance Awards. The recognition was for Private Client Group Home secure Policy that was launched in August 2009. It is a unique product catering exclusively to the High Net Worth client’s need of insuring their high value possessions such as paintings, valuables, work of art, jewelry, collectibles etc. It offers packaged cover for the entire home contents including above items with first in the market covers such as hole in one expenses, loss in value for fine art, pairs and sets, etc.

Additional services are offered along with the insurance cover e.g vulnerability assessments, transit supervision, conservation and storage assistance.

Tata AIG General Insurance Company provides insurance solutions to individuals and corporates. It offers a complete range of general insurance products including insurance for automobile, home, personal accident, travel, energy, marine, property and casualty as well as several specialized financial lines. Tata AIG believes in offering innovative and relevant insurance solutions in the retail and commercial space. Each product offering is backed by expertise and an unparalleled claims service.

Tata AIG’s products are available through various channels of distribution like agents, brokers, banks (through bancassurance tie ups) and direct channels like Tele Marketing, Digital Marketing, worksite management etc. Tata AIG has its operations in 59 cities.

Bharti AXA General Insurance crosses 100,000 claims

Addressing some of the biggest apprehensions Indian customers share with regard to insurance related matters, Bharti AXA General Insurance has consistently focused on improving service delivery mechanisms as a key differentiator to enrich customer experience. As a part of that, the company has paid over 100,000 claims since inception.

North and West together contribute to about 75% of the claims by number, with the bulk of the rest coming from the South. As with other multi-line players, the Motor & Health products contribute to 97% of the claims. In keeping with its strong commitment to taking insurance to every Indian, the Company operates a 24X7 call centre for claims notification and manages claims through a decentralized organization with empowered personnel & processes in order to ensure prompt decision making at every level. This enables a customer to claim anywhere irrespective of the branch from where he purchased insurance. In addition to tying up with an extensive network of over 3500 hospitals and 2000+ car garages for cashless settlement of claims, the Company is focusing on streamlining its internal processes through the use of process improvement initiatives such as Six Sigma in order to benefit the end Customer. Click to apply Health Insurance

The company firmly believes that Information Technology has a huge role to play in delivering superior claims service and is investing more in the development of a customer & partner centric IT platform to achieve this objective. Additionally, the Company continues to leverage AXA's global expertise to invest in developing the technical and soft skills of its claims staff with a view to resolving claims in a Fast, Friendly & Fair manner. Keeping the customer at the center Bharti AXA has already paid over 93% of the claims that have been reported while some are under process. As a result of focus on customer centricity the number of all complaints recorded as a percentage of the customer base has been significantly below 1%.

"We are extremely excited to reach this landmark in our history and the credit goes to our employees and partners who work tirelessly & passionately to help our customers when they need empathetic support in an adverse situation. We rely strongly on customer advocacy and view each customer as a long-term client. What especially differentiates us is our ability to provide claims consultancy at the very beginning of the client relationship rather than at the occurrence of the loss. With every achievement our responsibility and accountability to our customers & society at large also increases. We are working with added vigour to become the Preferred General Insurance Organization in India by focusing on our core attitudes of being Available, Attentive & Reliable." said Rajagopal Gopalan, Head, Operations and Claims, Bharti AXA General Insurance.

"While we are growing as a company and have crossed 550cr of GWP for the year 2010-11 and plan to grow at over 60% this year we continue to focus on Re-defining general insurance in India by delivering superior customer & partner experience." said Dr. Amarnath Ananthanarayanan, CEO & Managing Director, Bharti AXA General Insurance

BPL insurance plan hit by payment delays

The government’s flagship health insurance scheme for below poverty line (BPL) people, Rash­triya Swasthya Bima Yojana, is in trouble as about Rs 250 crore premiums due to insurers is pending with state governments. In turn, claims worth Rs 96 crore made by hospitals have to be settled by insurers as of April 15, 2011. RSBY is subsidised by state and central governments in the ratio 25:75.

Insurers and their third party administrators have complained to the centre about delay in premium receipts. The centre, in turn, has pointed to the longer time taken by them to settle claims.

The government has held discussions with chai­rmen and managing directors of insurance companies and TPAs in Raipur during May 2-5 to resolve outstanding issues. Labour ministry has also begun one-to-one meetings with chiefs of insurance companies and TPAs beginning last Friday, said Anil Swar­up, joint secretary in labour and employment ministry.

“Delay in payments to insurers is a problem. It happens as the payment has to be made in advance and also since RSBY has expanded very fast. The bu­dgetary requirements have increased and processes take time. However, in so­me cases, 100 per cent premium has been received by insurance companies yet the claims are not settled to hospitals,” Swarup said.

“We have raised the issue at national and state-level workshops emphasising the need for state governments to expedite payment to insurance companies. There has been quite a lot of improvement in states like Punjab, Kerala and West Bengal that have set up mechanisms thr­ough which money is housed with a state nodal agency and is paid to the insurer,” said Swarup.

“The central government has just recently cleared all pending bills of insurance companies. It is now only the dues from the state governments that are pending,” added Swarup.

G Srinivasan, chairman and managing director of government-owned United India Insurance, said, “Rs 50 crore to Rs 60 crore is outstanding with the governments in the last four to eight months. We are talking to the governments to get timely payment and are not contemplating withdrawing from the scheme.”

A senior official of Oriental Insurance said, “The premium booked by us last year was Rs 150 crore of which Rs 40 crore is still outstanding.”

ICICI Lombard has to receive Rs 27 crore premiums from the central government while Cholamandalam MS General has Rs 50 crore pending.

Alok Agarwal, executive director at ICICI Lombard, said, “We are talking to RSBY coordinators in expediting the payment. We are not considering withdrawal from the scheme.”

Even though RSBY requires that insurance companies settle claims in 21 days, government-owned insurers have not been able to settle even 50 per cent of the claims in the past three years.

Data with Financial Chronicle show that four government-owned insurers — New India Assurance, Oriental Insurance, National Insurance and United India Insurance — have yet to settle more than 50 per cent of the claims on April 15, 2011. Among private insurance companies, ICICI Lombard has 35.31 per cent claims pending while Tata-AIG General has 28 per cent. However, companies like Star Health and Allied Insurance, Apollo Munich and Iffco-Tokio have no pending claims.

“The inertia in government companies is more. Private players, on the contrary, are more innovative and have evolved systems for faster claims settlement,” said Swarup.

State insurers and private insurers have a market share of 50 per cent each in RSBY. Overall, the scheme has been profitable for insurance companies. There are 11 insurance companies that have insured RSBY beneficiaries.

Budget allocation for RSBY in 2011-12 was Rs 279.94 crore. This is significantly lower than the actual spending of Rs 445.89 crore in 2010-11. The fall comes despite extending the coverage of the scheme to include unorganized workers in hazardous mining and associated industries.

RSBY was formally launched on October 1, 2007 and became operational on April 1, 2008. So far, more than 2.34 crore smart cards have been issued and nine crore people have been covered. The scheme is running in 25 states. It provides a cover for hospitalization charges of Rs 30,000 for a family of five.

Indian IT cos slow to tap into the healthcare vertical

Indian IT majors have been slow to tap into the healthcare services vertical, which has in recent years emerged amongst the fastest growing verticals after banking , financial services and insurance ( BFSI). Being less affected by the recession and more open to IT spends, the healthcare space has grown in importance.

There is no Indian IT company in the top 10 healthcare service providers list brought out by Healthcare Informatics, a healthcare advisory outfit, for 2010. Global IT majors like Dell, CSC and Cognizant now have over $1 billion revenues coming in from their healthcare IT practices. Cognizant, thanks to its erstwhile parent Dun & Bradstreet, which also owned IMS Health, has a strong lineage in the healthcare practice. CSC has an over three-decade experience in healthcare IT.

In contrast, Infosys does not even report healthcare revenues, as it is not significantly large. For TCS, Wipro and HCL, healthcare in 2010 contributed less than 10% of total revenues, and ranged between $200-500 million.

But Indian IT majors are now looking to catch-up with their global peers in the $100-billion global healthcare IT market. Wipro recently made a leadership change and is recruiting senior healthcare experts to tap into the space.

India's largest IT services company TCS recently announced that it is aggressively looking for healthcare acquisitions in Japan and Germany.

Chaitanya Ramalingegowda, director for globalization advisory in Zinnov Management Consulting, said that Indian companies need to build domain expertise in the space to tap into it. Infosys CFO V Balakrishnan agrees that compared to other verticals, domain expertise in healthcare is vital due to the various regulatory compliances and complex nature of the space. He added that the company's US subsidiary set up in 2010 is building a strong healthcare management team with local talent and is getting closer to potential customers.

Acquisitions are one way that global IT companies have in the past penetrated into the space. Dell through its acquisition of Perot Systems, a leader in healthcare IT, has been able to make significant gains.

Gopi Natarajan, CEO of BPO/KPO firm Omega Healthcare, said that the major healthcare IT outsourcers are insurance firms, pharma companies and service providers like hospitals. He added that the market is highly under penetrated and opportunities are huge as only 2% of total costs in the healthcare sector go towards IT.

According to Abhishek Shindadkar, IT sector analyst at ICICI Securities, the US healthcare reform bill will throw up more healthcares IT outsourcing contracts. The country is the biggest outsourcing market for healthcare IT services followed by UK and APAC.

The new US law seeks to expand healthcare coverage by expanding medical aid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide healthcare benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, and establishing health insurance exchanges.