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.
Thursday, 12 August 2010
Saturday, 7 August 2010
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.
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.
Monday, 2 August 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.
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.
Thursday, 29 July 2010
It is nice to know that Insurance companies will now be buying devices like stunt/pace maker at whole sale or say negotiated rates from manufacturers with a view to save on their claim costs.
It is also laernt that hospitals have been buying medicines at whole sale rates and were billing to the insurance companies at retail rates.This practice will also stop.
Any steps taken by the insurance industry to reduce the claim cost is welcomed.Let all of us support this initiative.
It is also laernt that hospitals have been buying medicines at whole sale rates and were billing to the insurance companies at retail rates.This practice will also stop.
Any steps taken by the insurance industry to reduce the claim cost is welcomed.Let all of us support this initiative.
Wednesday, 28 July 2010
Where to lodge your grievances?
Various options available with any consumer in India are to lodge complain
1. Grievance cell of Insurance Company (after pre empting your phone calls/ visits to their branch, which issued you the policy )
2. Insurance Ombudsman
3. Consumer Forum (at District level, State level and National level)
4. IRDA, which is the new addition.
We welcome the service started by IRDA(insurance regulatory and development authority. But the question before us is why we should have too many authorities for grievance resolutions.
Is it not the responsibility of the Insurance Company to provide service as a part of the product? Why they do not show the name of Grievance Officer, phone no/email on their website. Why they do not have online grievance lodging facility?
The consumers will like to have the data- how many cases lodged against the company in Consumer Forums? How many have been decided? How many have gone in favour of the insurance company and how many have gone against them?
Should there be a fee for lodging a complaint so that incomplete complaints are neither lodged nor received.
Various options available with any consumer in India are to lodge complain
1. Grievance cell of Insurance Company (after pre empting your phone calls/ visits to their branch, which issued you the policy )
2. Insurance Ombudsman
3. Consumer Forum (at District level, State level and National level)
4. IRDA, which is the new addition.
We welcome the service started by IRDA(insurance regulatory and development authority. But the question before us is why we should have too many authorities for grievance resolutions.
Is it not the responsibility of the Insurance Company to provide service as a part of the product? Why they do not show the name of Grievance Officer, phone no/email on their website. Why they do not have online grievance lodging facility?
The consumers will like to have the data- how many cases lodged against the company in Consumer Forums? How many have been decided? How many have gone in favour of the insurance company and how many have gone against them?
Should there be a fee for lodging a complaint so that incomplete complaints are neither lodged nor received.
Friday, 23 July 2010
Yes there may be time lag of 10 years in coming of the judgment but it is heartening to note that Maharashtra State Consumer disputes Redressal Commission has agreed that it is the doctor ,who has to decide whether it is emergency or not. It is good that this will not be for TPA’s to decide whether it is emergency or not.
It is interesting to note the observations
“An insurance company’s officials are not experts who can decide whether a particular case is of medical emergency or not, the Maharashtra State Consumer disputes Redressal Commission observed while ordering an insurance company to pay Mediclaim to a Versova resident. It is for the expert doctor in the field to give an opinion if this is case of medical emergency or not, the commission stated in its order. The case dated back to 2000. Shamim Khan was working as a schoolteacher in Jeddah, Saudi Arabia. It was during a visit to India in July 2000 that she suffered unbearable stomach pain that led to severe bleeding.
She also experienced breathing problems and her haemoglobin levels began to drop considerably. Khan was admitted to Bombay Hospital immediately where an emergency surgery was conducted. She was discharged after eight days of stay in the hospital and, after incurring a total expenditure of Rs 41,158, Khan lodged a claim for insurance with the New India Assurance Company Limited from whom she had taken a policy. The policy was in force from April 2000 to March 2001.
Kahn’s claim was, however, rejected on the ground that there was no emergency need to undergo the operation” Aggrieved by the repudiation letter she filed a complaint in a district consumer forum, where the insurance company argued that “she (Khan) knew of the illness even before she came to India and had purchased the policy by suppressing material facts of her illness”, son it had the right to repudiated the in surer pleaded.
Khan had, however, procured a doctor’s certificate to the effect that there was an emergency situation and the doctor was required to operate on her to save her life.
Based on this document, the district forum on July 7, 2007, directed the insurance company to pay the medical claim and also Rs 5000 for causing mental harassment to Khan.
The insurance company then filed an appeal against the order in the state commission. But the state commission agreed with the district forum’s view, saying “doctor’s certificate proved beyond doubt that this was clearly a case of medical emergency”.
The commission, while up holding the order of the district forum, added that the insurance company had wrongly repudiated Khan’s claim.
The order- coming at a time when insurance firms are desperately trying to whittle down expenses on claims –will spread cheer among the insured, feel consumers; organizations.
The name of the insurance company was not mentioned in the news which appeared in a leading newspaper .If you know the name of the insurance company then do let us know.
While we respect and appreciate the judgment –it will be better if the fine imposed on such co is higher, because Rs 5000 is a negligible amount for large insurance companies.
It is interesting to note the observations
“An insurance company’s officials are not experts who can decide whether a particular case is of medical emergency or not, the Maharashtra State Consumer disputes Redressal Commission observed while ordering an insurance company to pay Mediclaim to a Versova resident. It is for the expert doctor in the field to give an opinion if this is case of medical emergency or not, the commission stated in its order. The case dated back to 2000. Shamim Khan was working as a schoolteacher in Jeddah, Saudi Arabia. It was during a visit to India in July 2000 that she suffered unbearable stomach pain that led to severe bleeding.
She also experienced breathing problems and her haemoglobin levels began to drop considerably. Khan was admitted to Bombay Hospital immediately where an emergency surgery was conducted. She was discharged after eight days of stay in the hospital and, after incurring a total expenditure of Rs 41,158, Khan lodged a claim for insurance with the New India Assurance Company Limited from whom she had taken a policy. The policy was in force from April 2000 to March 2001.
Kahn’s claim was, however, rejected on the ground that there was no emergency need to undergo the operation” Aggrieved by the repudiation letter she filed a complaint in a district consumer forum, where the insurance company argued that “she (Khan) knew of the illness even before she came to India and had purchased the policy by suppressing material facts of her illness”, son it had the right to repudiated the in surer pleaded.
Khan had, however, procured a doctor’s certificate to the effect that there was an emergency situation and the doctor was required to operate on her to save her life.
Based on this document, the district forum on July 7, 2007, directed the insurance company to pay the medical claim and also Rs 5000 for causing mental harassment to Khan.
The insurance company then filed an appeal against the order in the state commission. But the state commission agreed with the district forum’s view, saying “doctor’s certificate proved beyond doubt that this was clearly a case of medical emergency”.
The commission, while up holding the order of the district forum, added that the insurance company had wrongly repudiated Khan’s claim.
The order- coming at a time when insurance firms are desperately trying to whittle down expenses on claims –will spread cheer among the insured, feel consumers; organizations.
The name of the insurance company was not mentioned in the news which appeared in a leading newspaper .If you know the name of the insurance company then do let us know.
While we respect and appreciate the judgment –it will be better if the fine imposed on such co is higher, because Rs 5000 is a negligible amount for large insurance companies.
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