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03.08.2014
Today only, save on used books and help us reach 15,000 books sold to double the donations. How to Complaint against Insurance Service Providers?How good is LIC's Jeevan Arogya Health Insurance? There is a Roundtable discussion … [More]Why do Hospitals overcharge Cashless Health Insurance Claims?
In the past few years, the growth in business and associated competition has resulted in an urgency amongst Insurance companies to ambitiously build large revenue, scale their distribution network, branch network and hence their operations. The product essentially is a Hospital Cash Benefit Product with additional lumpsum benefits for surgeries.The product being a defined benefit product pays fixed amounts as per the policy conditions irrespective of the actual costs. LIC Jeevan Arogya, seems to be the most comprehensive Defined Benefit Health Plan from any General or Life Insurer, till date. Though it covers all surgeries, the claims would be limited to the fixed amounts defined in the list under the policy, whereas, in a good indemnity based Standard Health Insurance policy, there would be lesser limits and restrictions, ofcourse, subject to terms and conditions.
There are some products marketed and sold as Health Insurance (Aegon Religare Life, Tata AIG General are the popular ones) which provide a daily cash benefit for the no. Important Note: Do not confuse the above with products that have specific limits on Room Rent. Premium in Health Insurance increases as per increase in your age, but, there’s something about the no.
Note, the average premium in the chart is the average of premium paid by a person between the age of 30 and 65. Health Insurance industry is witnessing huge changes both in products, price as well as processes, being an insider, it is sensible to have an expert on your side, who updates you on changes, their impact on your coverage and suggest change in course, in case necessary.
I refused to renew the policy with this company, and heroicly pledged not to deal with this organization ever. Cut to today, I recently received a call from my Broker, the health insurance company had removed the No Claim Bonus of Discount completely from my renewed policy this year, without citing any reasons at all. In this world of extreme transparency and hyper competition, I am amazed at this unusual apathy shown by the best of world Health Insurance Companies in India. I understand all that, but looking at the rampant changes you have been making in the policy wordings and process, I am really in a fix. So, How do I predict the policy conditions and plan my post retirement healthcare expenditure? Would you continue to guarantee lifetime renewals, or would you add restrictions on co-pay, remove no claim bonus, remove all large hospitals from the cashless network or worse, spike the rates by 500% every year, when I am growing older?.
The initiative to bring in a process and guideline to enable portability is a welcome step by IRDA.
Portability will empower unsatisfied consumers to move to an Insurance Company of their choice. On the other hand, portability are not likely to help policy holders in the older age bands (say, 50 and above) and policyholders who suffer from pre-existing ailments.
Once and if the proposal is accepted, the waiting period credits would have to be given in the new policy. What happens if the customer applies for an increased sum insured in the new ported policy?
Get Information on Health, Health Insurance, Weight, Diet, Skincare, Baby Health, Parents Health, Sex Life etc. Aegon Religare Life recently launched this product with full page advertisements in Mainstream Print Media.
This is unlike most Mediclaim products where payment modes are either annual, or minimum quarterly.


However, there is a provision for Cash Advance upto 50% of Claim for Admissible Major Surgeries. Moreover, if there is a large claim under Other Surgeries (which are not listed), you would lose out substantially in such policies. With the rocketing trend of Healthcare expenditure, there are only 2 ways you can save yourself from any Health related expenditure killing your savings in India.
A product which takes almost double the median premium, and offers unnecessary frills, which you dont actually need, is a strict no no. Remember, your core goal, when you buy Health Insurance is to save yourself from mounting healthcare costs right through your life.
Treatment wise limits basically cap the amount you can claim for a particular surgery under the policy. Copay is basically is the share of admissable claim that the customer would have to pay from her own pocket.
Room Rent Limits, to an extent, make sense both for the customer, as well as the Insurance Company, as they categorize people paying a higher premium in the higher eligibility bracket. Since this is a long term product, you should look at the maximum available cover you can afford. If it is a new company, you could look at the history of the promoters and their businesses. Remember, you need to somewhere take responsibility of not covering your parents, earlier in their life, and not completely blame Insurance Companies for not covering them, now.
These have not been considered as they do not make a very big impact on the decision to purchase a long term Health Insurance product in India. I had a cover in my dad’s policy, but my calculations showed that I was not covered adequately.
How do I assure myself, that the terms would be favorable for someone like me who bought his policy at 26, paid you premium, without claims for 14 years, from someone who is 40 that time and is buying a fresh policy??
The circular released displays great intent on the part of the regulator to free the customer from being stuck with the same insurer, fearing loss of benefits of continuity, thus kick starting a competitive health insurance environment.
Especially in the Retail segment, Portability will bring in more competitive environment and better service experience. Insurers could slash premiums in the lower age bands to attract portability of existing customers. The new insurance company taking up a case exposing itself to a significantly higher risk of claim, without enjoying premium for the past claim free period, which the earlier insurance company enjoyed. The sum insured in the expiring policy cannot be the basis of what the new insurer will be ready to accept.
The underwriter of the insurance company continues to hold the discretion to deny a proposal. Urgency of building a "quick" team has resulted in huge holes in the operations and responsiveness process with Insurance Companies. With Healthcare Inflation in India being around 20% every year, this is a very low cover, if you are looking at a long term coverage. Hence, as mentioned time and again, you could buy this as an add on product to your Standard indemnity based Health Insurance product sold by General Insurance Companies. 1) Ensure your family lives a healthy lifestyle and pray, that you get no disease 2) Get a Health Insurance.
These hospital costs could be for accidents as well as sickness, of course subject to a long list of terms and conditions.
We have all traditionally lived with routine medical expenses like Consultation expenses, Dentists bills, Medicine bills, and such costs are therefore manageable by most of us, unlike a huge hospitalization bill which could eat way more than a couple of months’ salary or savings.


A product, which ceases renewal, while you are still alive and need it more than any time before, is a BAD product. Moreover, if you or any of the family members contract a new disease in the interim, the ailment would excluded for the upgraded amount.
Future rise in premium due to loading, change in premium charts have not been taken to consideration. Generally, a company or set of promoters known for their ethics and excellent governance, venturing out into Insurance would be a decent bet. You need to settle for a product, best affordable to you, even if it has co-pay, exclusions and other restrictions.
So in effect senior citizens and people with pre-existing ailments (especially chronic ones) would not benefit a lot from portability.
This requires insights into the overall insurance contract (called policy wordings) over and above price comparison. Have a look at the rate charts, and you will be surprised to see good jump in premiums after one crosses the age of 45 yrs. I am well read, and hence fairly aware of basics of financial planning and securing my future. He did a good job, helping me compare various mediclaim policies available in the market, and took me through how this whole mediclaim thing works. Insurers, leave other complex issues, are not equipped to port their own policy smoothly from one intermediary to another even in the same divisional office!  Owing to empanelment of multiple TPAs at every divisional office of Govt. In the portability scenario in the long run, Insurance Companies will have to win their renewals through better service, responsiveness and claims experience. In fact, due to an already existing policy being declared for portability, the underwriting could demand additional claims history information for the past policies from the customer. In addition to the existing Grievance Mechanism in Insurance Companies and the Ombudsman, IRDA has been continously working on creating a convenient infrastructure for Insurance Consumers to make complaints. Either you need to yourself get into comparing the features in detail, or take help of an unbiased health insurance advisor.
As per a very recent report on Healthcare in India by Tower Watson, the medical inflation in India is rocketing anywhere between 17 to 20% annual. And yes, I should feel fortunate, that second time on, you atleast did not increase the premium by 500%. Companies, there doesn’t seem to be a global customer-wise health insurance database readily available to retrieve past claims information, even within the same company.
Rule out all products, say, which do not cover your family members for a reasonable lifetime. Such limits would cap your claim, even n when you have a large sum insured under the policy. OK, I understand Medical  inflation, but I am sure it wouldn’t have been grown more than 50%, then how was the remaining 450% increase in premium to be understood?
As medical science progresses and becomes more accessible to the common man, Life expectancy in India will move higher from the current average of around 70.
At first, I was sure, the premium mentioned was a printing error, but when I realized it was correct, I felt cheated and went berserk.



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