Finally ‘Dhanvantri’ acted which aims to bring smile on the faces of billion of Indians who are exhausted with the current practices going in the unorganized and cramped health system. This time, IRDA, the current Dhanvantri was under no mood to relent despite some unhappiness shown by some general insurers.
Life Insurance industry has long been under sharp attack as the product easily favoured distributors, a win-win situation for manufacturers and distributors. This is very recent that IRDA awoke and has been cleaning the rotten system, starting with the ban of Highest NAV guaranteed ULIPs. Similarly, general insurance especially health are under sharp attack from all participants except insurers due to unfriendliness posed to policy holders during the emergency time.
Last week, IRDA released the draft paper of Health Insurance Regulations 2012 to protect health insurance policy holders’ interest which aimed to bring transparency in the monopolistic system. Among the most noted, any person up to the age of 65 years would be able to buy health insurance which may continue as long as the person remains alive and he renews it continuously without a break. Even more, the insurer or TPA needs to settle the claim process within 30 days without fail. If the claim is rejected, it should be properly reasoned in writing. Currently there is no defined settlement time bound and every insurer takes its own comfort in settling claims.
The draft also talks about the portability of existing health policy to another health insurance company without losing any benefit; this must happen at least 45 days before the premium renewal date of existing policy. Imagine you would have a choice to select your favorite health insurance provided! J
In 2010, four major public insurers which command over 60 per cent of total market had removed private hospitals from their preferred list citing overcharging by these hospitals under the cashless scheme. Now, all health insurers shall provide the cashless services at a hospital no longer covered under the preferred network list. “For the purpose of claim settlement, insurer shall make direct payments to the network provider and to the policyholders by integrating their banking system with the network provider or the insured, as the case may be,” the draft said.
Further, the claimant would have the right to make the optimum use of the multiple policies. Until now, claimants had to split between the two or more insurers in the ratio of sum assured. This would largely benefit the working population who are provided health insurance benefits by their employers and are forced to split in case a claim occurs. Also, there won’t be nasty surprises on hefty premiums as insurers would have to justify it on the basis of the preceding three years’ claims experience, projected claims experience.
The draft also spoke about providing coverage to non-allopathic treatments undergone in a government hospital or in any government recognized institute and/or accredited by suitable institutions. It also talked about a combi product, “Health plus life” which would be a combination of Pure Term Life Insurance cover offered by Life Insurance companies and Health Insurance cover offered by non-life insurance companies.
The draft rightly flowed in the direction desired in the larger interests of policy holders; now the onus lies how quickly it gets fixed. India would await a new and customer friendly health platform.
Be insured healthily!
