The inflation in medical costs and lack of
insurance cover are big fears for India, though with Health Insurance
Regulations which will standardize the products to a certain extent to reduce
uncertainty and problems in settlements.
With health insurance, a much needed respite is offered in
cases of medical emergencies - where room costs, doctor's fees, medicines and
services add up.
Health Insurance offers General Insurance companies good growth
potentials - premium collection in the health
insurance segment was Rs 11,777 crore in 2011-12 from Rs 9,944 crore of 2010-11
up 18 per cent in a year.
A survey conducted by Marsh India
Insurance Brokers - among 301 Indian organisations across sectors with a group
total size of 1.5 million people; the rise in medical insurance costs for
employers has outpaced the growth in salaries over the last five years. The
medical insurance costs rise at approximately 18% whereas salary costs for
employers rise only by 7-12% per year. This causes a serious issue for policy
In 2008 the government had
launched Rashtriya Swasthya Bima Yojana (RSBY) to provide Universal and
affordable health care. Beneficiaries will pay only Rs 30 as a registration fee
and the State and central government pay the premiums to the insurers.
Beneficiaries are covered for
hospitalization and illnesses for Rs.30,000, pre-existing conditions are also
covered and age is no bar for a scheme meant to cover 3 crore lives. Increasing
awareness of health benefits has resulted in a spate of complaints under the
Right to Information Act.
After the insurers outsourced to
TPA's or third party administrators there were complaints of delays in cashless
issuance, payment claims, dispatch of health cards.
This is when private sector
insurers like ICICI Lombard, HDFC Ergo, Bajaj Allianz, and Future Generali had
settlement teams for quicker and more efficient disbursal of claims.
To address this issue of rising
complaints, the Insurance Regulatory and Development Authority (IRDA) has
announced the introduction of health insurance portability, so that a
policyholder dissatisfied with the service and offerings of a particular
insurance company can move to another insurance company and not lose out on any
of the benefits.
Under portability, an insured
individual's health insurance policyholder (including family cover) can
transfer the credit gained for time-bound exclusions if the policyholder
chooses to switch from one insurer to another or from one plan to another of
the same insurer, provided the previous policy has been maintained without any
To bring about clarity in health
insurance products, IRDA has released comprehensive guidelines, the Health
Insurance Regulations, 2013.
The regulations list standardized
definitions of 46 terms commonly used in health insurance policies and 11
critical illness terms to bring uniformity in sales, claims and settlement
processes of insurers.
It becomes mandatory for insurers
to renew policies at least up to the age of 65 years. Nor can premiums be
increased and in case an increase is constituted the customer will be informed
three months in advance.
Insurers expect that with the
implementation of these regulations, there will be a standardization of health
insurance products offered by all insurers and that it will go a long way in
reducing uncertainty and conflicts in health insurance policies.
(IRDA Licence Number: 2710062 )
Deepa Nair, April 2013