| Source – Vyasamoorthy, P |
| Some Suggestions for Improving Health Insurance Schemes
Dr P Vyasamoorthy Advisor, ICICI Knowledge Park , Hyderabad 500078 See the power point presentation on Improving Health Insurance Schemes We shall see today….. • Categories of Medical Insurance Schemes • Health Insurance requirements of Senior Citizens • Seniors’ Health Problems • Most-known Mediclaim Policy: Some details • Private Health Insurance Products –Bajaj, ICICI Lombard, Royal Sundaram, Cholamandalam etc • Recent Announcements / introductions • Innovative Methods for funding Health Insurance • Suggestions & Ideas to improve Health Insurance
Categories of Health Insurance • Voluntary health insurance schemes or private-for-profit schemes; • Employer-based schemes; • Insurance offered by NGOs / community based health insurance, and • Mandatory health insurance schemes or government run schemes : namely ESIS, CGHS etc.
Seniors Health Requirements • A recent study shows that elders are prone to: –Cough –Joint pain –Hypertension –Cardiac problems –Diabetes –Urinary problems –“Bed – ridden” OR low mobility
Mediclaim • Sum Assured: 50K to 5 lacs • Age admissible: 5 – 100 years; fresh entrant up to 70 years. Children from 3 months to 5 years admitted if both parents are also covered. • Hospitalization Expenses covered • No health check up needed • Bonus for “no claim” – 5 % cumulative • Domiciliary treatment – allowed in special cases; not available for pre- and post hospitalization treatment in a large number of exceptions! • Automatic renewal via Citibank credit card; no transaction fee for seniors. • Whole family covered? Yes at a 10% discount • What is not covered? Not allowed in first year are: Cataract, prostatic hypertrophy, hysterectomy, hernia, fistula, sinusitis etc • TPA provides low – cost health check up • One has to be very careful in reading the fine-print of Mediclaim Policy. There are exclusions (not claimable within certain period ex: knee replacement 5 years. Upper limits & sub limits. • Non allopathic treatment: upto 25K – 20% of sum assured
Private sector Entrants • Bajaj Allianz General Insurance Company Limited • National Insurance Co. Ltd. • ICICI Lombard General Insurance Co. Ltd. • The Oriental Insurance Co. Ltd. • United India Insurance Co. Ltd. • Reliance General Insurance Company Limited • Royal Sundaram Alliance Insurance Co. Ltd. • TATA-AIG General Insurance Company Limited • Cholamandalam MS General Insurance Co. Ltd.
ICICI Lombard • Provides maximum features • Ages : 5 to 80 years • Cover: 15000 to 500000 • 30 days pre-hospitalization & 60 days post hospitalization covered • No claim bonus: 5% • Cashless facility • IT benefits on par with other schemes • External mobility Aids & appliances (10K) • Accupressure/Ayurvedic/Homeo : 5K • Recovery benefit: > 10 days in hospital: 10k • Floater cover to all members of the family • EMI for premium payment • Free & compulsory Health Check-up • Hospital Daily Allowance Rs 250 per day • Nursing Allowance: Rs 300/day for 5 days • Local Road Ambulance: upto Rs5000/- • Premium for Seniors: 2 members – 2 lakhs cover – Option 1 – Rs 24800 per year; Option 2 – 18300/- per year. (costliest!) • Pre-existing diseases are covered subject to certain sub-limits (ex: Appendix – after waiting for 5 months – upto Rs 10K)
Innovative methods of funding Health Insurance • Delhi : Union Urban Development Ministry decides, instead of renewing lease of land for hospitals (in return for 25% beds being reserverd for the poor), to auction the land at market value and utilize the profits for health insurance funding. • Appolo Hospital Venture: Nearly 60000 villagers in Chittor (AP) benefit through a health insurance scheme financed at Rs 1 per day per family • Corporate benevelance: Biocon with the help of ICICI Lombard & Narayan Hrudalaya organises Health Insurance for 6 lakh villagers in entire Anekal Taluk • Karnataka Government launched Yashaswini scheme for farmers; Rs 5 per day per family – 2.5 million beneficieries. • Andhra Bank introduces Swasthya Bima Policy – Premium Rs 140 per year. Tagetted towards SHGs. Coverage upto 10000/- plus transportation & lunch expenses. • Andhra Bank – Another scheme for Seniors: LIC & United India Insurance policy – both life & health (hospitalization) covered. Term deposits quality as premium. No medical check up. • GOA: Govt has bought health insurance from GIC for ALL permanent residents of Goa having annual income below Rs 50000/- for hospitalization needs.
Suggestions for Improvement • Subsidized premium: Government, past employer etc; higher premium in earning years and lower premiums in old age • Policy to be portable across insurers • Income Tax Rebate • NGOs to be encouraged to promote heath insurance • Entry or Exit Age restrictions must go • Premiums must be reasonable and affordable. • Measures to promote better health like health check –up etc to be built into Insurance schemes • Smokers & alcoholics to be charged extra premium. • No-Claim Discount to be increased • Unreasonably High Claim policy holders to be penalized. • Senior Citizens Associations – SHG – Group Insurance facilities • Exception List to be short • Special schemes for Senior Citizens taking care of Heart, BP Diabetes fractures, prostate etc needed.
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