Loading ...Addressing the distinguished gathering at Moneylife Foundation Seminar aptly titled “Health Insurance for all”, J Hari Narayan, chairman, IRDA (Insurance Regulatory and Development Authority), he took up the topic whether sensible health insurance is possible in India. On the issue of prohibiting banks from selling insurance, Mr. Hari Narayan said that this is not feasible in India, though countries like Canada do have such stringent policies. Issues relating to life insurance, mis-selling, bancassurance, lapsed policies and poor grievance redressal were also discussed.
Health insurance is a cause of concern for everyone. With rising medical inflation and annual hike in health insurance premium, quality healthcare seems to be a distant dream, except for the elite who can afford the expensive hospital treatment or pricey health insurance premiums, the activists said.
Interacting with Mr. Hari Narayan on the forum, Mr. Harsh Roongta, CEO, Apnapaisa.com raised a very pertinent point of standardization of policy wordings in policies by all insurance companies with particular reference to exclusions and pre existing diseases as customers find it very difficult to interpret.
The Forum revealed that one of the most common issues insurers face are rising health insurance premium, inability of senior citizens’ to increase sum insured, TPA (third party administrators) and intermediary issues and restrictive mediclaim policies. This was followed by perpetually discussed topic of claim rejections. There were complains that more and more claims are getting rejected for impractical reasons and cashless facility restricted to few hospitals.
On this Mr. Hari Narayan pointed that the system was working well, by and large. He pointed out that last year out of the 47 lakh claims received, 9.4 lakh claims were rejected. He pointed out that 80% of the claims are met and the industry has paid out as much as Rs. 5,885 crore. More than half the claims were settled within 30 days. He pointed out that the most frequent claims are from fever due to unknown origin followed by cataract.
He asserted that sensible universal health cover for masses is certainly a possibility in India. The government-initiated products like RSBY (Rashtriya Swasthya Bima Yojna) has done well for the masses with premium as low as Rs. 400 per family for a cover of Rs. 30,000 sum insured. They cover primary and secondary health care. Arogya Shree is another success story in Andhra Pradesh which covers tertiary health care i.e. covering only if any procedure is performed. A product, which is a combination of two can be promoted to masses for bulk penetration. This can be offered to certain section of society at nominal cost.
The other half of the population, which is at a higher income level can buy this product at a higher rate, which will still be much lower than an individual mediclaim product. The product may be up to certain sum insured. If anyone needs higher sum insured, they can buy ‘top-up’ policy to cover over and above the sum insured, which is offered by this mass product, Mr. Hari Narayan informed.
The last question of the forum came from Mr. Roongta who asked why critical illness policies are so sparingly available. And if available they are for very low sum assured, what to say of the fact that these are very difficult to get.
To this Mr. Hari Narayan agreed and said yes the critical illness policies are critical for citizen’s well being and these will be looked into.
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but hangover still persists, particularly when the issue is of reaching out to Finance Minister, Mr. Pranab Mukherji, who is just 8-days away from presenting the Union Budget.
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