Tag: health insurance

Pick the right health insurance plan

Personal Finance

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The Covid-19 pandemic has made people realise that we must be prepared to deal with medical emergencies. While having a good health insurance policy may seem simple, there are a few intricacies involved in finding a good plan. Here are some key factors that one should look at when buying a good comprehensive health cover for yourself and your family.

 

Check sub-limits

Sub-limit is a cap put by an insurer on medical treatment, doctor consultation fee, ambulance charges, and hospital room rent. Sub-limit means that if you incur charges on say medical treatment beyond these caps, the policyholder will have to bear the expense. However, many health insurance policies come with no sub limit. Choose one such plan, despite a little higher premium.

Co-payment clause

Co-payment clause means that you are agreeing to pay a certain percentage of the claimed amount. Suppose your policy has a co-payment of five per cent, it means you are agreeing to pay five per cent of the total claimed amount while the remaining 95 per cent will be paid by the insurer. It is always better to go for a policy with a no co-payment clause.

Waiting period

Before you buy a health policy, you must also look at the waiting period. Say, someone buys a health policy without checking the specific waiting period related to specific diseases. Within a month, that person is diagnosed with uterine fibroids but, she can’t claim for hospitalisation as her policy has a two years waiting period for the disease.Normally, there are two widely prevalent waiting periods across all the policies. One, a normal waiting period of one month when you buy a new health insurance policy. For the Covid-19 coverage the waiting period is 15 days. Two, pre-existing illness waiting period which varies across insurers and policies(two to four years).

Network hospitals

In order to avail cashless treatment during any emergency, one must check the insurance provider’s hospital network. At a network hospital, your insurer and the hospital together will take care of the expenses related to the treatment. You will enter the picture only when the hospitalisation expense will shoot up beyond your sum insured limit.

Claim settlement ratio

To ensure that there is minimal probability of your claim getting rejected, one should look at the claim settlement ratio of the insurer. This ratio shows how many claims have been settled/rejected by the company. You can also check the time taken to settle claims.

OPD cover

One must know that a regular health insurance policy does not cover you for OPD expenses like doctor’s consultation fees, different tests and X-rays, though these expenses can cost a considerable amount. So, it is important to buy a health cover that provides coverage for OPD expenses. An OPD cover assists the insured to claim expenses incurred other than on hospitalisation. Under OPD cover of your policy, you can claim expenses without a waiting period and make multiple claims within the same year until the limit is completely exhausted.

The writer is Head, Health Insurance, policybazaar.com

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Max Bupa Health Insurance targets ₹5,000 cr by FY25

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Max Bupa, a leading standalone health insurance, which has been growing at a CAGR of over 30 per cent, expects to close 2020-2021 at about ₹1,700 crore of gross written premium (GWP). It is targeting ₹5,000 crore of GWP by 2024-2025.

In an underpenetrated private heath insurance segment in the country, the company sees itself playing a much bigger role as it spreads its reach in the market by inducting agent advisors and networking with more hospitals.

The country’s private health sector’s business size, estimated at about ₹56,798 crore in 2020, is expeced to grow to about ₹1,00,000 crore by 2025. To address the growing demand, Max Bupa is expanding its presence in over 45 additional cities this year, and plans to take the total count to over 200 offices in two years.

Krishnan Ramachandran, MD and CEO, Max Bupa Health Insurance, said: “Covid-19 has made people cognizant of the fact that health insurance can go a long way in ensuring good medical care and maintaining one’s financial health. Post the Covid-19 pandemic, the health insurance industry witnessed conversion of demand translating into purchase.”

“As a trusted health partner, Max Bupa’s goal is to sustain this awareness and reach out to maximum markets in the next two years to get more people under the ambit of health insurance. Max Bupa is opening offices across 45 additional cities this year, and we plan to take the total count toover 200 offices across India in the next two years.”

Interacting with the media here today, the MD said: “The company is strengthening its presence in the country and in Telangana by opening new branches.” Max Bupa is opening two additional branches in Hyderabad, and aims to provide health coverage to over 2.5 lakh people in the next five years in Telangana. It plans to on-board more than 8,000 agents by 2024-25 and targets to clock ₹150 crore gross written premium over the next 5 years.”

The Covid-19 pandemic has made people realise the importance of health insurance in safeguarding against exorbitant medical expenditure while availing appropriate treatment. This has helped generate new business.

Bhabatosh Mishra, Director of Claims, Underwriting and Products, Max Bupa Health Insurance, said: “Max Bupa is betting big on the emerging Tier II and III markets for its expansion journey. As we expand to newer markets, our plan is to increase penetration of health insurance and significantly raise awareness about its benefits.”

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Bharti AXA General launches Health AdvantEDGE

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Bharti AXA General Insurance, a joint venture between Bharti Enterprises and AXA, has rolled out a new health insurance plan, Health AdvantEDGE, that provides holistic protection against mounting expenses related to medical exigencies and other healthcare services.

Bharti AXA Health AdvantEDGE also offers wellness benefits as a key differentiator in the domestic health insurance market. It is specially designed to support the healthcare and wellness needs of customers. It offers reimbursement benefits for treatment under Ayurveda, Unani, Homeopathy, Yoga and Naturopathy.

This health plan offers a restore benefit that automatically reinstates the basic sum insured in case it is exhausted within the policy year. If the policyholder uses up the entire sum insured and falls ill even if it is for the same illness or condition during the same year, the company will restore 100 per cent basic sum insured. This ensures that the policyholder has requisite coverage at all times, thereby, minimising the need for multiple policies.

In a statement, Managing Director and Chief Executive Officer, Bharti AXA General Insurance, Sanjeev Srinivasan, said: “We are living in unprecedented times where our physical health and well-being has never been more crucial than it is now. Amid the ever-rising medical expenses, ensuring protection of one’s financial health should be of paramount importance. . We are confident that our health offering will adequately prepare individuals and families against uncertainties surrounding medical exigencies and rising healthcare expenses.’’

This new-age health plan provides holistic cover right from pre-hospitalisation to post-hospitalisation, in-patient and daycare treatment. It comes with 60 days pre and 90 days post-hospitalisation cover, and sum insured ranging from ₹2 lakh to ₹3 crore, with cashless facility and seamless claims procedure. This allows customers to focus on their treatment, rather than worry about which room to choose against their insurance coverage.

Another feature of this plan is a guaranteed cumulative bonus of 20 per cent in a claim-free policy year. This feature ensures that the cumulative bonus does not reduce even if there is a claim. It also extends optional maternity benefits to female lives insured between the age of 18 to 45 years, opting for a three-year policy term.

The plan covers persons in the age group 91 days to 65 years, provides hospital cash benefits, air and road ambulance with an additional premium.

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How to get your insurance complaints addressed

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Insurance products, be it life, health or motor-related can be somewhat difficult to understand in terms of coverage, exclusions and other aspects such as sub-limits, co-payments and no claim bonus. While the awareness about insurance products is slowly improving, it is still low compared to the same in developed nations. This leaves room for misrepresentation, mis-selling and sometimes even fraud.

For instance, recently some “policyholders” of Bajaj Allianz General Insurance company tried to make a claim on their motor insurance policy. But the insurer didn’t settle their claims as the policies held by them were fake. Though the insurance company claims to have taken the necessary steps against the fraudsters, it was the “policyholders” who were left in the lurch. While these individuals will have to fight it out in court, others who hold a genuine policy have recourse in case of any issues.

So, if you are an aggrieved policyholder, here is how you can file a complaint.

First step

If you have any issue or a complaint against an insurer, the first step is to inform the respective insurance company’s grievance redressal cell. All life and general insurance companies provide details contact personnel (phone number and email address) on their website and the policy document. You can reach out to insurers through their digital platforms as well. With offices/branches of insurers temporarily were closed or working at minimum capacity, post pandemic , insurance companies have taken initiatives to encourage policyholders to access their services through digital touch points such as WhatsApp, mobile apps, chatbots and e-mails.

Alternatively, you can directly connect with the insurer and raise a complaint by calling the toll-free number provided on the website and in the policy document.

Insurers update you on the status of the complaint through SMS or email.

Time limit

The insurer should acknowledge the complaint within three days and provide a solution within 15 days or as per the time limit set by the insurance regulator, IRDAI. The regulator has defined the maximum turnaround time (TAT: time taken for completing a task or process) for different services provided by the insurers. For instance, the maximum TAT for life insurers when it comes to settlement of maturity claim or survival benefit or penal interest not paid is 15 days. Similarly, TAT is 30 days for settlement of death claims without investigation requirements and is six months in cases with investigation. You can get the details on TAT from the websites of the respective insurers or IRDAI.

A few insurers such as Digit Insurance provide detailed TAT for each of their services. For premium-related issues, the maximum TAT is 10 days. These issues include premium paid but the receipt not received by the policyholder or premium charged wrongly by the insurer.

If your issue is unresolved at these levels, you can write to the grievance redressal officer of the respective insurer. Again, the contact details (email/phone) will be available in your policy document and on the insurer’s website.

Escalation

If your complaint is still not addressed within the time limit or you are not satisfied with the resolution offered, you can contact IRDAI directly. You can register your complaint in one of the three ways.

First, call the toll free number (details available on the IRDAI website as well on the insurers’ websites). Two, send an e-mail along with the resolution offered by the insurer, if any, along with your policy document or policy number and other relevant supporting documents, if any. Three, you can register your complaint online and keep track of it using Integrated Grievance Management System (IGMS). Alternatively, you can write to the regulator’s grievance cell along with the requisite documents. For this, you need to fill the complaint registration form (available online on IRDAI’s website) and post the same to the Consumer Affairs Department- Grievance Redressal Cell, IRDAI.

Beyond this, you have the right to lodge your complaint with the insurance ombudsman or a consumer/civil court. The details of the insurance ombudsman are available on the respective insurers’ websites and your policy document. You can approach the office nearest to you.

If both parties agree for mediation, the ombudsman gives a recommendation within one month from the date of complaint. Otherwise, the ombudsman passes judgement within three months from the date of receipt of all requirements from the complainant. Keep in mind that you must approach the ombudsman within a month from the date of sending a written complaint to the insurer (to which there is no reply) or within one year from rejection by the insurer.

However, before you escalate the matter with IRDAI or the ombudsman, you must first write to your insurer.

Do note that, you don’t have to pay a fee for making a complaint.

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Lower non-Covid health claims silver lining for general insurers

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Faced with muted growth in premium and high Covid claims, general insurance companies are hopeful that lower number of non-Covid related health insurance claims as well as the falling Covid cases will help them improve their balance sheets.

According to data with the General Insurance Council, 8.03 lakh Covid related claims amounting to ₹12,184.09 crore were filed by January 11, 2021. Of this, 6.26 lakh cases worth ₹6,109.81 crore had been settled while 1.77 lakh claims are pending.

“Health claims are still under control and are being offset by lower number of non-Covid claims,” noted an executive with a general insurance company, pointing out that many people are still postponing elective surgeries.”

‘Still manageable’

“Covid related claims were becoming a bit worrying for the industry. But since a large number of elective surgeries are getting postponed, it has helped to offset the loss. Otherwise, it would have gone beyond control but retail claims are still manageable,” he noted.

Also read: Ayushman Bharat crosses 1.5-cr mark in hospital admissions as non-Covid-19 treatments resume

According to industry estimates, about 15 per cent of Covid patients require hospitalisation and intensive medical care and file claims. The average claim amount is estimated at about ₹1.5 lakh.

“Typically natural catastrophes are built into projections but something like a pandemic is usually not factored in. Right now there is a decline in cases but the concern is about a second and third wave as is being seen in many European countries,” noted another insurer, adding that a large number of patients are also being advised home quarantine.

More clarity will be available in coming weeks as many of the listed general insurers start to report their third quarter results.

Also read: Strong winds of change set to sweep health insurance sector

Meanwhile, non-life insurers registered 2.7 per cent premium growth in November 2020 but there are concerns about softening in health insurance premium. According to GIC data, health insurance premium grew by 12.96 per cent between April and November this year.

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Should you go for Care Health’s new rider plan — Care Shield?

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Care Health, earlier called Religare Health Insurance, launched a rider cover — Care Shield — in December 2020. The rider can be purchased with the company’s existing health plans Care, Care Freedom (diabetes cover) and Care Advantage (₹1- crore sum insured (SI) cover). A rider is an add-on insurance cover that comes with the basic policy for an additional price.

We review if the rider, Care Shield, is worth the money or only a cosmetic change that agents are using as a selling point.

What’s on offer

Care Shield comes with three features. One is Inflation Shield, which gives the benefit of increased SI at the time of renewal as per the Consumer Price Index (CPI) inflation rate for the previous policy year. The idea is to help policyholders afford higher medical costs.

The second feature is Claim Shield. Here, the insurer promises to cover costs of 60-plus items, such as belts, braces, buds, crepe bandages, gloves, leggings, masks, oxygen mask, spirometer, thermometer and ambulance equipment, which are used during treatment.

The third feature is No-Claim Bonus Shield where, if the policyholder has not made any claim in the previous year, the insurer will give her a reward when the policy is renewed.

This is through a bump-up in SI (by 60 per cent) at no extra cost. According to the policy brochure, this feature also ensures that any low-value claim (< 25 per cent of SI) does not lead to any erosion of the accumulated No- Claim Bonus (NCB).

For example, for a ₹10-lakh policy, if there is a claim of up to ₹2.5 lakh, there is no reduction in NCB.

Our take

Care Health’s base plan — Care — is a good product with a competitive premium. The policy allows pre- and post-hospitalisation cover of 30 days and 60 days, respectively, covers all day-care procedures, and allows claims of up to 10 per cent of SI for domiciliary hospitalisation (insured person is considered hospitalised even when she is home).

However, there is no great benefit in the Care Shield rider. First, the increase in premium offered through Inflation Shield is linked to CPI and not medical cost inflation. While CPI increases by 4-5 per cent, medical inflation is in double digits.

So, one can’t expect much relief from a CPI-linked SI increase. The insured will have to anyway increase the SI under her base plan if she wants to be covered sufficiently to ride over the inflation-linked spike in healthcare costs. It is prudent to calculate the inflation-led cost increase for at least 10 years while taking a health insurance cover and opt for a higher SI at the first instance of buying a health insurance policy.

Once you sign up for a small SI, to increase it at a later point, you will have to again undergo medical tests and it will have to be cleared by the underwriting team of the insurance company. At that stage, if you have any health complications, you may not get a higher SI.

The Claim Shield feature under Care Shield will help you save 5-7 per cent of the out-of-the-pocket expenses. However, note that most insurers today cover these costs even without a rider, unless it is a Covid-19 claim.

The last feature — No Claim Bonus Shield — is also not as great as the company claims it to be. Many insurers today allow doubling of SI if there are no claims on the policy, and also do not reduce the SI when a claim is filed irrespective of the value of the claim.

Examples here include Health Companion of Max Bupa and Lifeline of Royal Sundaram. For an SI of ₹10 lakh, a 35-year-old male will have to pay an annual premium of ₹7,004 for Care (excluding GST). If he buys Care Shield, too, the premium will increase to ₹8,265 — a 18 per cent higher outgo. This is expensive for the limited benefits the rider promises.

If you are looking for a higher NCB (doubling of SI in five no-claim years) and SI-restored benefit, you can go for Royal Sundaram’s Lifeline.

The premium is expensive but worth the features — the annual premium for a 35-year-old male for a ₹10-lakh SI comes to about ₹10,500.

Or if you want a larger cover of, say, ₹1 crore, you can consider the health policy of Max Bupa — buy it as a base policy of ₹5 lakh and a super top-up of ₹95 lakh.

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Strong winds of change set to sweep health insurance sector

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Marked by innovation and digital push, 2021 will witness major winds of change in health cover, according to industry experts.

“The new trends seen last year will continue with new types of coverage such as the launch of more single disease products like ‘Covid-19 Benefit Policy’ or single disease critical illness etc,” Rakesh Jain, ED and CEO, Reliance General Insurance, told BusinessLine.

Apart from health due to the increasing number of catastrophic events, parametric cat policies (which pay at the occurrence of a triggering event rather than having to claim a specific insured property loss) may also find application for future viral outbreaks.

“The health insurance sector looks set for a full-scale makeover, which is a good sign, and one can be optimistic about the industry’s growth in the next few years due to these developments,” he added.

A game-changer

The Covid-19 outbreak and the requirements it generated can make the pandemic a game-changer for the industry, going forward. “Post Covid-19, I see excellent opportunities through service offerings such as e-pharmacy and telemedicine making way in 2021,” said Mayank Bathwal, CEO, Aditya Birla Health Insurance.

According to him, there will also be a paradigm shift in the functioning of the health insurance industry in the days to come. When it comes to servicing customers, one can expect more dependency on digital technologies such as Chatbots, AI-based voice assistants, and robust phone apps that provide essential information at the customers’ disposal.

More than anything, the entire industry is heading towards a more user-centric approach, and this is the approach that is likely to be the greatest strength of the industry in the years to come, feel experts.

In the last eight months, Covid had considerably changed lives globally; and in India, this not only includes the behaviour but also the business.

There has been an increase in the demand for health insurance by consumers as they have become more health-conscious. The increase in demand has been fuelled to a significant extent by the younger generation, say industry sources.

There has been a promising 30-40 per cent uptake in health insurance adoption across industry players.

However, there is still significant untapped potential. Citing a recent survey, Bathwal says insurance penetration in the country was 3.78 per cent in FY20, which is low compared to the global average of 7.23 per cent. Of this, the non-life segment only amounts to 0.97 per cent.

Standardisation

In this entire transformation, IRDAI has also played a pivotal role in standardising the exclusion of health insurance policy to eradicate the confusion among insured in different policies.

The basic standard health cover product, Aarogya Sanjeevani, has made a mark in 2020. The standard health cover policy has been offered by general and health insurers for a sum between ₹1 and ₹5 lakh from April 2020. Going forward, Arogya Sanjeevani can provide a further boost to the health insurance portfolio.

The regulator also rose to the occasion by introducing standard Covid-19 basic products, Corona Kavach and Karona Rakshak, to be offered by non-life and life insurers mandatorily for a period of nine-and-a-half months.

Digital push

The lockdown in 2020 also taught the insurance sector that still there is huge scope for insurers to invest in technology.

Digital claims settlement process has reduced the turnaround time for claims settlement. Digitalisation in the insurance sector is resulting in reduced costs, lower error rates and increased customer satisfaction.

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Health insurance purchases rise by about 50% during Covid-19: ICICI Lombard survey

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Health insurance purchases have risen by about 50 per cent during the ongoing Covid-19 pandemic than previously, especially amongst younger people, according to a recent survey by ICICI Lombard General Insurance.

“The prime motivation to buy health insurance is to cover the expenses during an emergency. Covid-19 and the fear of job loss have motivated respondents to buy health insurance in the last six months across cities,” revealed the survey titled Evolution of Health Insurance – A Covid-19 Perspective and #RestartRight.

Recent industry data has also shown a sharp rise in the demand for health insurance with sales between April and November registering a near 13 per cent growth.

Also read: Life insurers may sell indemnity based heath cover soon; IRDAI forms panel

While 60 per cent of the respondents had purchased health cover more than a year back, as many as 27 per cent had bought it in the last six months to one year, and 14 per cent had bought it in the last six months.

It also found that demand has increased significantly amongst the younger population due to concerns over the pandemic while for the middle age group, tax benefit is also one of the major motivations.

Tax benefit was the key focus for 51 per cent of the respondents in the age group of 31 to 35 years and 44 per cent of those surveyed between 36 and 40 years. In contrast, Covid-19 was the prime focus for 30 per cent of those purchasing health insurance in the age group of 25 to 30 years.

A total of 1,922 interviews were conducted for the survey, which took place between October 30, 2020 and November 10, 2020. This included 1,548 owners of health insurance policies and 374 persons who did not have health cover.

Significantly, it also found that persons who didn’t have a health cover resumed fewer activities post relaxation of the lockdown compared to insured persons.

While 78 per cent of the overall respondents had resumed grocery shopping, in other categories of activities like going to the office, dining out and consultation with a doctor, people with health cover were more active.

The survey also found that there has not been much change in the type of policy and preference behaviour post the pandemic, with 54 per cent of the respondents purchasing individual policies and 46 per cent buying family floaters.

As many as 74 per cent of the respondents who had purchased health insurance wanted to enhance the sum assured or coverage. The average health coverage is ₹5 lakh, which is expected to increase to an average of ₹8.9 lakh.

Also read: State insurance schemes have failed the poor: Report

Following the pandemic, customers across cities have become more independent and have started purchasing health insurance through websites and mobile apps.

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Benefit illustration must in health insurance plans: IRDAI

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A clear benefit illustration should be made an integral part of sales literature of health insurance products issued on a floater basis, according to the insurance regulator.

In a circular on benefit illustration in health cover, the Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to provide benefit illustration to customers in six age groups beginning from 20 or lower age bracket to over and above 66 years.

This should be attached to every health insurance product’s customer information sheet, the regulator said.

The insurers should also provide a customised benefit illustration in a prescribed format to help them make out the difference between different plans.

All insurers must adopt these norms on or before April 1, 2021, the circular said.

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How you can maximise your health insurance

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Given the consistent increase in hosptial expenses, the medical insurance you have today may become insufficient after a few years. To ensure that you have sufficient cover even a few years down the line, you can choose to enhance your existing sum insured (SI) in a cost-effective manner. In addition to the restoration or NCB benefits offered by the insurer, there are two options. One, you can upgrade your existing policy with a higher SI. Two, you can buy a super top-up plan. Here is what you should know about SI enhancement.

 

Enhancement of sum insured

If you already hold a health insurance policy, you can enhance your SI at the time of renewal. Accordingly, your premium outgo will also increase and widen the scope of coverage. But if you find the premium outgo to be high for the increase in SI, then you can consider a super top-up cover.

A super top-up plan is similar to a regular health cover where the policyholder gets covered for hospitalisation and other medical expenses. It is different only in terms of coverage initiation. That is, a super top-up will cover you once hospitalisation expenses exceed a certain limit known as ‘deductible’. Let’s understand this with an example. Assume you have a total cover for ₹3 lakh in your base health policy and you choose to purchase a ₹5 lakh super top-up product which has ₹3 lakh as deductible. Now, during a policy year, you make a first claim for ₹1 lakh. This gets covered in your base policy. Your second claim is for ₹2.5 lakh. Now, ₹2 lakh gets covered by your base plan and the balance ₹50,000 comes from your super top-up plan. The super top-up plan comes into use as you have crossed the remaining deductible limit of ₹2 lakh.

Key points

Though sum insured enhancement or super top-up plan is cost effective and widens the coverage and benefits, there are certain points to keep in mind. First, all the waiting periods – initial, pre-existing disease and disease specific waiting period will continue to apply on the increase SI.

Second, other conditions, including co-pay and deductible, if any, will also apply on the additional sum insured.

On the positive side, as super top-up plans are similar to a health plan, they comes with benefits such as cumulative bonus, restoration of SI, and wellness programme.

Sum insured as reward

Most health insurance policies in the market offer built-in options to increase or restore your SI every year without any additional premium. Under this feature (known as restoration feature), the insurer fully reinstates the original SI once the entire health cover is used up during the policy year. Some insurers reinstate original SI even after partial exhaustion of (original) SI.

No-claim bonus or NCB is another feature through which the insurer increases your SI without any increase in your premium . However, the increase in SI comes with a limit, say, 10 or 20 per cent increase in base SI every year, usually up to 100 per cent of SI, if there is no claim filed by the policyholder.

You can even opt for the NCB rider over and above the in-built NCB in the policy for additional costs.

Your choice

Though insurers reward you with an increase in SI, it has its own limitations in terms of reinstatement of SI and having a claim-free year mandatory for NCB. The pace of increase may be slower as well. Therefore, between additional increase and a super top-up plan, you can choose what works for you, based on the additional premium you have to pay and the coverage and other benefits.

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