Surge in non-Covid health cover claims, average ticket size: ICICI Lombard CEO

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In a breather to non-life insurance companies, Covid-related health insurance claims have dropped with the ebbing of the second wave of the pandemic.

However, there has been a rise in non-Covid-related health claims and their average ticket size has risen significantly, said Bhargav Dasgupta, Managing Director and CEO, ICICI Lombard General Insurance. If this trend continues, it could impact health insurance premium.

Average ticket size

According to Dasgupta, the insurer has seen a 20 per cent increase in the average ticket size of these claims over two years, from 2019-20 to now, which is about 10 per cent compounded growth.

“As Covid claims have come down, the frequency of non-Covid health claims has gone up. Some of the other infectious diseases have spiked this year such as malaria, chikungunya and dengue. Also, there was some amount of backlog of the elective surgeries that have now caught up in this quarter,” he said in an interview with BusinessLine, adding that the ticket size of claims has gone up for similar ailments.

“We’ll have to see if it’s a temporary increase or permanent in nature. This could perhaps be because of additional RT-PCR tests that hospitals have do or some more procedures that they’re following, but hopefully that will stabilise,” he said, adding that if healthcare costs continue to increase at the level they are going up it could start impacting the premium for customers.

Dasgupta said that the insurer increased pricing on its corporate health portfolio, but is on the wait-and-watch mode on retail health insurance.

“On the retail side, we have to go back to the IRDAI and seek price increase. As of now, we’ve not done that. This is just one quarter data; we want to wait for this fiscal and see the data and then decide. We are not using the Covid spike to ask for a price increase because that would not be fair on customers,” he stressed.

Between April and September 2021, the insurer received 72,059 Covid-related health claims and 2,38,409 claims for non-Covid cases.

Dasgupta, however, continues to be confident about growth prospects, and said there is a structural increase in the demand for health insurance.

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Who needs an insurance cover against vector-borne disease

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Recently, the insurance regulator, IRDAI, came out with a standalone standardised health cover for vector-borne diseases – Mashak Rakshak. Insurers are being encouraged to introduce this product from April 1, 2021.

Vector-borne diseases are transmitted through carriers such as mosquitoes, fleas and bugs. Malaria, dengue and chikungunya are some common vector-borne diseases. According to the World Health Organisation, over seven lakh people die every year globally on account of such diseases. So, this cover can address specific disease-related needs of people, particularly during the monsoon season when the infections rate is high.

While there are already a few players in the market offering a standalone vector-borne diseases cover, IRDAI’s standardised product can make policy selection easier for people. But should you go for the standardised plan, given that vector-borne diseases are also covered by regular health insurance policies? Here is a look at product features and its suitability.

About Mashak Rakshak

IRDAI’s standardised policy, Mashak Rakshak, like the other standalone products in the markets is a fixed benefit policy. That is, 100 per cent sum insured (SI) will be paid to the policyholder on positive diagnosis of any one of the vector-borne diseases. The policy provides coverage against seven vector-borne diseases – dengue, malaria, filaria, kala-azar, chickungunya, Japanese encephalitis and zika virus. If an individual is diagnosed with any one of these infectious diseases, as confirmed by a doctor, then the complete sum insured will be payable, provided, the individual is hospitalised for a minimum continuous period of 72 hours. Upon the payment of SI, the policy terminates.

Also, if a policyholder is diagnosed with filaria (commonly known as elephantiasis), the benefit is payable only once in a lifetime. Even if you renew the policy, you will not be covered for the same disease. Whereas, in the case of other vector-borne diseases, the policyholder will be covered after the renewal as well. In other words, you can get the benefit under this policy more than once in a lifetime.

Further, the policy will pay two per cent of the SI on positive diagnosis through laboratory examination and confirmation by a doctor on first diagnosis during the cover period. Do note that, this diagnosis cover is applicable only once a year for each disease.

Mashak Rakshak provides an individual as well as a family floater option. Family includes self, spouse, dependent children and dependent parents. The minimum SI is ₹10,000 and goes up to₹2 lakh. The policy provides coverage only within India while existing policies like Bajaj Allianz’s M-Care provides coverage both within and outside India. Mashak Rakshak is an annual policy with lifetime renewability. The minimum entry age is 18 years and maximum is 65 years.

The minimum waiting period in case of Mashak Rakshak is 15 days. However, if you benefit from the standard cover and renew it, a cooling off period of 30 days will be applicable from the date of previous admission of claim. The plan offers the option to port also.

Other standalone products

There are a few insurers who offer a standalone vector-borne disease cover in the market currently. These includes Bajaj Allianz General Insurance (M-Care plan), HDFC Ergo Health’s Dengue Care (also offers Mosquito Disease Protection plan but it is offered as group policy) and Future Generali’s Future Vector Care. These are benefit policies and the coverages is more or less similar to that under Mashak Rakshak. However, there are differences in SI offered and the premium. For instance, Bajaj Allianz’s M-Care provides five SI options — ₹10,000, ₹15,000, ₹25,000, ₹50,000 and ₹75,000. The premium ranges between ₹160 and ₹1,200 for an individual policy.

Similarly, the waiting period also differs. While the initial waiting period remains the same (15 days) as Mashak Rakshak, in case of recurring occurrence of the disease, the waiting period could change. For instance, in Future Generali’s Future Vector Care, an individual is subject to 60 days’ waiting period in case the insured person is suffering from any one vector borne disease at the time of taking the policy or within 60 days prior to applying for the policy. Similarly, in case of M-Care, a waiting period of 60 days is applicable for that particular ailment and 15 days for other diseases, if the policyholder opts for the policy after the occurrence of and cure from, one of the seven vector borne diseases.

Our take

A vector-borne disease policy is most suitable for those living in proximity to canals or where there is stagnant water ( breeding ground for mosquitoes and fleas). However, your regular health policy will also provide cover for vector-borne infections — OPD (treatment in the outpatient department, if included in the policy) as well as hospitalisation. So, having a comprehensive health plan is always better.

While standalone vector covers including M-Care, Dengue Care and Future Vector Care can be taken by anyone, even those with pre-existing disease conditions, IRDAI’s standardised cover is silent on this. According to Amit Chhabra, Head-Health Insurance, the regulator has not specified on the policy issuance to those with pre-existing conditions and it depends on the underwriting guidelines of the insurers.

But having a standalone vector-borne disease cover can be advantageous too. When you are hospitalised for one of the seven vector borne diseases, you will get the benefit from the policy and can also claim hospital expenses (if any) under your regular health policy.

A standalone vector-borne disease cover is not a must-have. But if you don’t have a regular health insurance plan and are at risk of catching a vector-borne disease, you can consider buying a policy.

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