Archive for August, 2011

Expanding Mediclaim Is Healthy Decision

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A new and more forward-looking phase is beginning in the field of medical insurance with the offer by some companies to include ayurveda, unani, homoeopathy and naturopathy in their coverage of patients. This departure from the customary focus only on allopathy as the form of treatment for which medical cover can be given is a welcome development. This is an acknowledgement of the fact that more and more people worldwide are turning to the traditional and non-invasive forms of healthcare.

One reason why patients rely on them is to escape from the side-effects of allopathy as a result of powerful drugs, which can have a debilitating impact, as well as surgical procedures, which are dicey in the case of the elderly. Yet, such patients were denied the facility of insurance protection apparently because of an ingrained bias against traditional medicine, which were not considered ‘advanced’ or scientific enough. Now that the coverage is being extended to policy-holders under the umbrella of complementary and alternative medicines, there will be satisfaction for those who depend on traditional treatment. Considering the name which India has earned for the so-called medical tourism, it is possible that in addition to those coming here for allopathic treatment and surgery, there will also be others who will be attracted by the availability of other, no less effective forms of treatment. Since ayurveda is the most preferred form among the alternative systems, hospitalisation will also be covered under the mediclaim projects for those opting for it. Apart from group policies, individuals will also be covered. The arrival of insurance for these systems will also mean that their medicines will become more standardised.

Source: expressbuzz.com

Cheapiest Mediclaim Policy

Five years ago, Jagdish Kumar (name changed)wanted to buy mediclaim for his family. He spoke to many agents to get information on different policies. He found it a challenge to get coverage for his parents at the budgeted premium. That is when someone suggested the family floater mediclaim as an option. The premium rates for family floater policies were a minimum Rs20,000 per year for Rs5 lakh sum insured (SI). Jagdish thought of settling for a lower sum insured, to remain within his budgeted premium. But then he happened to visit a nationalised bank for some routine bank work and discovered something startling. The bank was offering family floater mediclaim (including coverage for parents) for an annual premium of Rs12,000 to its customers. The insurance policy was from a government insurer. There were no medical tests; premium rates were not age-specific; there was no co-pay (the part of the medical expense to be borne by the policyholder); and no loading (premium increase) in future years due to claims. The bank manager was not hard-selling the product, unlike unit-linked insurance plans (ULIPs). It seemed to be a perfect match for his requirements and he signed up to ensure that his family is protected for healthcare costs. Soon, he realised that the insurance cards he was supposed to have received from his third party administrator (TPA) had not reached him. These cards were an important document proof for getting cashless services during hospitalisation. The policy was supported by only one TPA and, hence, there was no option of getting a TPA of his choice. It took a long time and a lot of calls and continuous follow-up with the TPA based in another city to get insurance cards. The next hurdle was at the time of policy renewal. The auto-debit feature did not work. Jagdish issued cheque payments before the expiry of the policy. The cheque had to be from the same bank as the policy was only for accountholders. In the following year, Jagdish did not receive a renewal letter. However, he remembered the expiry date and sent the premium payment well in advance. The insurer did send him an acknowledgement of the premium receipt each year and, hence, it was the proof of continuous policy coverage.

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Family Floaters: Do They Work?

Family floater policies are an enhanced version of the mediclaim policy. The sum insured value floats among the family members. Most of the policies will cover husband, wife and a couple of children; some may cover parents too. The coverage for the entire family is limited to the sum insured.

The family floater mediclaim from banks have a maximum sum insured of Rs5 lakh. The premium for family floater plans is typically less than that for separate insurance cover for each family member. Moreover, the premium of family floater mediclaim from banks is lesser than a family floater purchased directly from an insurance company by about 50% (in many cases).

If a family of four (two children) takes a family floater of Rs5 lakh, they can claim up to Rs5 lakh of medical expenses in one policy year. If one person is hospitalised and gets a claim paid for Rs3 lakh, there will be only Rs2 lakh worth of medical expenses that can be reimbursed in that year. The next policy year will start with a fresh Rs5 lakh.

A family floater makes sense for a family because, that way, each one in a family gets a big cover and the probability of more than one family member getting hospitalised in the same year is too low unless the whole family is travelling together most of the times in a year or has a history of medical problems that can happen concurrently.
Advantages:
•    It is less expensive than an individual mediclaim policy.
•    You can add your immediate family members like your spouse and kids. Oriental ‘Happy Family Floater’ will cover parents or parents-in-law too.
•    It is great for younger families with members having low health risk.
•    Instead of individual mediclaim of Rs3 lakh, if the family opts for a floater of Rs6 lakh, they will benefit if there is a big claim in a year of, say, Rs5 lakh.
Disadvantages:
•    Some family floaters like Star Health–Family Health Optima have a maximum age limit of 60 years. They may offer portability to a senior citizen mediclaim plan after the policyholder completes 60 years, but it is better to find a family floater that has maximum age of 75 years (or more).
•    Instead of an individual mediclaim of Rs3 lakh, if the family opts for a floater of Rs6 lakh, they will lose if total claims from different family members are more than Rs6 lakh, even if individual claims are less than Rs3 lakh.
•    Most policies are silent about renewal in case the proposer  dies. The spouse may be elderly at that age—and may not easily get an individual policy. Moreover, the PED waiting period will start afresh, unless continuous coverage is allowed for an individual plan by the insurer.
•    An elderly family—with higher medical needs—will benefit from individual mediclaim.

Source: moneylife.in

PPN for Cashless Mediclaim in Pune, Surat and Vadodra soon

Following the success of Preferred Provider Network (PPN) of hospitals to provide cashless transaction for health insurance policyholders in tier-I cities, the scheme will now be extended to newer tier-II cities like Pune, Surat and Vadodra.

“The PPN network would be introduced in these three cities in the next two to three months after the success of the second phase of the PPN network launch in Hyderabad in April this year,” said Segar Sampath, DGM, New India Assurance. Kolkata, where the scheme was originally scheduled to be rolled out in April this year, would also see a launch anytime now.

Once the scheme comes into force, health insurance policyholders in Pune, Surat and Vadodra will have to check if their hospital is among those identified to provide cashless treatment. Hospitals outside the list will not be able to offer cashless treatment and the policyholder will have to pay the hospital for treatment and get it reimbursed later from their health insurance company.

The concept of having a PPN list of hospitals was developed by the four public sector insurance companies — New India Assurance, United India Insurance, Oriental Insurance and National Insurance — after controversies arose about private hospitals charging more for patients covered by health insurance policies than those without it. It resulted in the four nationalised insurance companies losing over

Rs 2,000 crore last year, through higher claims.

The PPN network of hospitals was first launched in the four metros — Delhi, Mumbai, Chennai and Bangalore last year in July. In the second phase, the PPN scheme was to be rolled-out in Hyderabad, Kolkata, Chandigarh and Ahmedabad in April 2011. Kolkata missed the deadline and would see the scheme being implemented anytime now, according to Sampath.

“Today, the network covers about 860 hospitals across the country. Even large hospitals like Bombay Hospital, which did not want to be part of the network, have joined in,” Sampath said.

The list is finalised after negotiating with hospitals and arriving at standard rates applicable for different surgical procedures.

Source: mydigitalfc.com

Terror Insurance For Govindas

The looming fear of terror attacks has forced more than 400 govinda mandals in the city to secure insurance cover against such incidents.

And the insurance firm is more than happy to accommodate this product at the same premium.

“Organisers want govindas to build eight to nine tier human pyramids to break handis. Naturally, the risk factor increases so we got our members insured. This year, we also got terrorism insurance cover,” said Siddhesh Mangonkar, office bearer of the Gopal Krishna Krida Mandal Govinda Pathak at Bombay Central.

Earlier, govinda mandals would seek insurance cover for road mishaps and dahi handi-related injuries, even during practice sessions.

Oriental Insurance Company Limited, which is the only firm offering insurance covers to govinda mandals for the last seven years, will issue terrorism insurance this year. Gradually, other firms will also start the scheme for govindas.

“For the first time in insurance policy, we are covering terrorism insurance. Last year, a govinda had died in a road accident. Within a day, we approved Rs1.5 lakh to the mandal,” said Sachin Khanvilkar, administrative officer of oriental insurance Company Limited.

The insurance scheme is applicable from July 15 to August 23. To claim reimbursement, the govinda has to be admitted to a hospital and the insurance company has to be informed in writing. The firm will then send a cheque in favour of the govinda mandal, whose member is injured.

“As a part of premium, we charge Rs30 per person and give Rs1.5 lakh insurance cover. We pass the insurance claimed depending upon the seriousness of the injury,” Khanvilkar added.

Source :  www.dnaindia.com

NGOs to Study National Health Insurance Document

The Treatment Action Campaign and Section27, a public interest law centre, back the government’s efforts to restructure the health system through the national health insurance scheme, but there are some concerns regarding refugee, asylum seeker and non-citizen access, and the structure and governance of NHI, they say.

The two groups said in a joint statement on Friday that they plan to raise these in response to the publication of the green paper, a discussion document released for public comment.

What was required were measures to ensure transparency of tariff structures, reasonableness of prices, significant improvements in the quality of public health and a proposed office of health standards compliance.

“With this in mind, we commit ourselves to defending the [health] minister’s right, essentially a constitutional obligation, to take all reasonable evidence-based measures necessary to restructure the health system,” said Section27 and TAC, which lobby for comprehensive care for people with HIV-Aids.

According to some details of the NHI released on Thursday, everybody over a yet-to-be-determined income threshold would be legally required to contribute.

Money would come from four sources: the tax everybody contributes; mandatory contributions from individuals and employers; co-payments and user charges from individuals; and certain public-private partnerships.

The government did not intend abolishing private medical schemes.

A conditional grant would be allocated in the 2012 budget to fund NHI pilot projects, which would start that year at 10 selected sites. These would be selected based on the outcomes of a planned audit.

Details TAC and Section27 believed the green paper did not cover included information on the source of funds, the future role of medical scheme administrators, and what the benefit packages would be.

They also wanted to know where refugees, asylum seekers and non-citizens stood, as well as more information on the nature and governance structure of the NHI fund, which they believed did not have adequate structural and operational autonomy.

Business Unity SA supported the NHI’s “social imperative”, but warned the cost, design and institutional changes would require vigorous debate.

“If additional funds are to be allocated to public health, it is imperative that they be effectively used.”

The concepts contained in the green paper would affect household budgets, public finance and the labour market, so phasing in and consultation with the National Economic Development Labour Council was also called for.

The People’s Health Movement, an NGO that promotes “health for all”, and social justice movement the Alternative Information Development Centre stressed the importance of strengthening district health facilities.

“In line with the primary healthcare approach, this will require both active community participation and a collaborative intersectoral approach by a range of government departments and will require significant policy changes.”

They would study the green paper and decide whether it offered a comprehensive health service where nobody had to pay at the point of delivery.

Credit : www.timeslive.co.za