We are spoiling the image of Health Insurance Industry

Decision of TPA's to go for legal action/Competition Commission /IRDA against 4 PSU's tender for TPA JV is resulting in spoiling the image of Health Insurance Industry.

The newspapers /electronic media are covering it as it is their business to do news coverage.

We are not realising that this is leading to customers losing confidence in the industry.

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Cigna USA is ready to come

It is a welcome news that Cigna Health Insurance is ready to enter the Indian market and is having discussions with many banks.
PNB is one of the banks.Can we say that health portfolio will become profitable in near future ?

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Health Care providers bargaining with Insurance companies -Is it affecting the image of Indian Insurance companies

The news papers and TV channels are covering the news of neogotiations going on between healthcare providers/TPA/Insurance Companies (4 PSU's).Waht apperas in the morning newspaper is contradicted during the day on TV.

Is it not bringing down the reputation of healthcare providers/TPA/Insurance Companies?

They are not realizing what the customers are talking about them.Their reputation has come down by 50% since July 1 ,when the controversy started.

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Should PSU's have a common TPA or they should create a subsidiary

Should PSU’s create a common TPA or they should create a stand alone health insurance company?

Creation of a common TPA is not looking at the future. The right thing for the PSU’s will be to set up a JV company (ownership being shared by 4PSU companies, may be 25 % each) and then have in house claim settlement department. If Bajaj Allianz, Star and others are having success in house claim settlement department then this company (let us say for discussion sake GIPSA Health Insurance Company Ltd) can also have in house claim settlement department, strong Business Development Department to negotiate with Health Care Providers, Medical Devices Manufacturers, even Pharma suppliers so that they can have economies of procurement, use of technology to best possible extent. With the first year target of Rs 10,000 crores this company will be strong enough to negotiate and emerge the trend setter for growth of health insurance industry in our country. What NTPC did for power generation and BHEL did for Power Generation Equipment can be expected from this strong health insurance company.

We feel JV TPA with any one who is selected will not work as TPA Company (26%) will be the driving force or 4 companies who will jointly own74% .This option is not going to work.

The only successful model will be a stand alone GIPSA Health insurance Company. This strong company manned by those who specialize in health insurance, who are dedicated to make career in health insurance, who have passion for health insurance will be the solution. In 5 yrs this company can reach level of Rs 25,000 crores, may be Rs 40,000 crores.

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Premium Health Insurance Product will have the same features which you were getting prior to July 1,2010

Those desirous of availing healthcare facilities of reputed super speciality hospitals may have to buy new products in near future .It is natural that premium rates for these products will be higher.PSU's will be introducing new product in near future.

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Private Business houses owning own Insurance companies bought group health insurance policies from PSU’s

It is interesting to note from Government auditor CAG that public sector insurance companies have incurred huge losses on group mediclaim policies because of

Their lackluster attitude in adopting a standard rate for medical services.

According to the report during the three years (2006-09), the four PSUs suffered a loss of Rest 417 core from individual portfolio and Rest 622.49 core from group policies.

The CAG said that the premium earned by the four insurance companies nearly tripled to Rest 3,696 core in 2008-09, from Rest 1,321 core in 2004-05. It also said that some of the big corporate houses, despite having their own group company in this sector took policies with PSU insurers.

The report said that against Rest 11.74 core premium collected from IT firm TCS; claims paid only for domiciliary hospitalization were Rs 71.64 crore. "Despite its own group company being in the health insurance business, TCS, Tata Motors and Tata Power went for group policies with PSU insurers," it said.

The insures should have increased the premium of the policies when they come up for renewal every year, but "the four insurance companies did not do this in respect of group policies resulting in a loss of premium of Rs 329.68 crore for three years ended March 31, 2009," it said.

The report said the group policy holders were given additional benefits such as maternity, baby day one care, preexisting diseases among others, without charging additional premium. The CAG also pulled up the insurance companies for failing to monitor the quality of services offered by the TPAs to the insured, which in turn impacted customer satisfaction.

Let us see what will be the impact of this report.
Will it result in hardening of premium rates? Yes definitely this is going to happen.

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HOW TO ENSURE A SMOOTH CLAIM SETTLEMENT IN CASE OF EMERGENCY HOSPITALISATION

This article is a welcome news for the timebeing .Emergency /accidental cases will be treated in hospitals.We suggest you use this article as a reference.You may point out last stanza of this news to PSU or the TPA.

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Most of the problems of insurance companies and healthcare providers will be solved by August 10,2010

Every one is talking about the controversy which started on July 1,2010. Yes it started with names of about 800 hospitals being deleted from the list of empanelled
hospitals.

Meetings are going on between insurance companies and health care providers and you can expect solution of the problem by August 10,2010
Let us hope for the best.

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