Thursday, July 2, 2009
Third Party Administrator (TPA) Committee submits report to IRDA
The committee headed by S. B. Mathur, Secretary-General of the Life Insurance Council, has recommended the formation of a common body comprising members from the TPA’s, life and non-life insurance companies and hospitals and representatives from consumer groups.
This is a good suggestion as consumer representatives may get a say in claims settlement for Mediclaim policies .We are hopeful that IRDA will accept this recommendation made by the Third Party Administrator Committee.
The proposed body is expected to simplify and speed up cashless claims settlement of insurance policies. The body, it is proposed, would address claims-related complaints by hospitals and take the views of the nominated consumer representatives and other stakeholders in settling disputes. Its operation is expected to be independent of the insurance ombudsmen services. The Ministry of Health, through its Directorate-General, might also facilitate in the functioning of the new body, Mathur said. “We have suggested to the Insurance Regulatory and Development Authority to nominate one or two representatives to look after customer interest,” he said. The nominees, he pointed out, would not necessarily have to be members of consumer associations.
Currently, the policyholders have to rely solely on the TPA’s, which are intermediaries between insurance companies and hospitals for settlements of claims. There are 27 IRDA-approved TPA’s across the country. “The lack of coordination and the consequent blame game among the different stakeholders had thrown up a lot of problems,” Mathur said, adding that the objective of the proposed body would be to help standardize the settlement procedures and bring transparency to the system. Hospitals now are not under the IRDA and their representation in the proposed body therefore could at least make them more accountable, he added.
The panel has also recommended doubling the minimum capital requirement for TPA’s to Rs 2 crore. It has proposed extending licence to a TPA only if it is present in at least six locations. These regulations, however, are not particularly aimed at ranking of TPA’s, he added.
With 4 PSU’s having appointed KPMG to suggest format for their own TPA and ICICI/Star/Bajaj Allianz handling their own claims-we feel increase of equity requirement is unjustified. We foresee some TPA’s are going to return the licence to IRDA in future as the business prospects will be reduced with 4 PSU’s withdrawing the business from existing TPA’s.
With growth of Telecom sector through out the country and availablity of 1 800 free calling service is there a need to have 6 branches. We feel ther is no need provided 24x7 call centre is working efficiently .
Wednesday, July 1, 2009
HEALTH INSURERS PLAN DATABASE TO CHECK FRAUD CLAIMS
HEALTH INSURERS PLAN DATABASE TO CHECK FRAUD CLAIMS
It is intersting to read in The Economic Times about Insurers Data Base to be set up
According to this nes item health claim data of individuals/families will be compiled for being used by the Health Insurance companies.
My viewpoint is that Health Insurance has been a bleeding portfolio for not because of individuals but because of group policies, which are being picked up by the Insurance Companies at low premiums for achieving the targets .These targets are set up for managers and branches at unrealistic levels.We recently came across a case study where the premium quoted for a group by 3 different co's was Rs 6.50 lakh to Rs. 8.00 lakh.
Then suddenly someone from 4 th Insurance company appears and picks up the policy for Rs 4.00 lakhs.One does not realise how the underwriter of this company calculated that Rs. 4 lakhs is the reasonable and acceptable premium.
Let us come to the news item which appeared as follows;
Faced with mounting losses as claims exceed premium income, health insurers are looking at setting up a shared database of fraudulent claimants and those with pre-existing health conditions. Insurance companies feel that plugging leakages caused by unethical claims would help reduce losses.
Although data on fraudulent claims are absent, insurers say their experience points to several instances of inflated claims. They say such frauds are possible because of poor regulation of health-care service providers. "Industry- level discussions on the subject are already under way," said Anuj Gulati, director, services and business development, ICICI Lombard General Insurance.
Besides inflated claims, non-disclosure of pre-existing illnesses is a major concern for the industry, whose claims payout is estimated to be 130 percent of the premiums collected.
Once a database is in place, insurers can identify frauds if they move from one company to another. "The centralised database would help insurers plug the leakages and also offer inputs for taking more informed decisions while underwriting risks. The discussions are still on at the industry-level and there is a long way to go before it (database) takes definite shape," said Gulati.
Adds Antony Jacob, CEO, Apollo-DKV Insurance Company, "Formation of such a repository — whenever it takes shape — will certainly be welcome. Access to claims and exposure data pertaining to the Indian health market as a whole will be available to health insurers, helping them analyse the data in a meaningful way by using analytical tools while pricing new products and re-pricing existing ones."
In the long run, a central database will also be useful for policyholders, as it will facilitate portability of health insurance. "Some companies may be extremely cautious while acquiring other insurers' customers due to difficulty in underwriting without adequate data to compute the risks. Therefore, a repository giving health insurance companies selective access to proposers' claims history will help in appropriate pricing of the policy, benefiting the customers as well as health insurers," said Gulati
My comment on this news item is
"Let us compile the data of group policies first ,control the claims of group policies first and then move to the creation of the database of the individuals"
It is intersting to read in The Economic Times about Insurers Data Base to be set up
According to this nes item health claim data of individuals/families will be compiled for being used by the Health Insurance companies.
My viewpoint is that Health Insurance has been a bleeding portfolio for not because of individuals but because of group policies, which are being picked up by the Insurance Companies at low premiums for achieving the targets .These targets are set up for managers and branches at unrealistic levels.We recently came across a case study where the premium quoted for a group by 3 different co's was Rs 6.50 lakh to Rs. 8.00 lakh.
Then suddenly someone from 4 th Insurance company appears and picks up the policy for Rs 4.00 lakhs.One does not realise how the underwriter of this company calculated that Rs. 4 lakhs is the reasonable and acceptable premium.
Let us come to the news item which appeared as follows;
Faced with mounting losses as claims exceed premium income, health insurers are looking at setting up a shared database of fraudulent claimants and those with pre-existing health conditions. Insurance companies feel that plugging leakages caused by unethical claims would help reduce losses.
Although data on fraudulent claims are absent, insurers say their experience points to several instances of inflated claims. They say such frauds are possible because of poor regulation of health-care service providers. "Industry- level discussions on the subject are already under way," said Anuj Gulati, director, services and business development, ICICI Lombard General Insurance.
Besides inflated claims, non-disclosure of pre-existing illnesses is a major concern for the industry, whose claims payout is estimated to be 130 percent of the premiums collected.
Once a database is in place, insurers can identify frauds if they move from one company to another. "The centralised database would help insurers plug the leakages and also offer inputs for taking more informed decisions while underwriting risks. The discussions are still on at the industry-level and there is a long way to go before it (database) takes definite shape," said Gulati.
Adds Antony Jacob, CEO, Apollo-DKV Insurance Company, "Formation of such a repository — whenever it takes shape — will certainly be welcome. Access to claims and exposure data pertaining to the Indian health market as a whole will be available to health insurers, helping them analyse the data in a meaningful way by using analytical tools while pricing new products and re-pricing existing ones."
In the long run, a central database will also be useful for policyholders, as it will facilitate portability of health insurance. "Some companies may be extremely cautious while acquiring other insurers' customers due to difficulty in underwriting without adequate data to compute the risks. Therefore, a repository giving health insurance companies selective access to proposers' claims history will help in appropriate pricing of the policy, benefiting the customers as well as health insurers," said Gulati
My comment on this news item is
"Let us compile the data of group policies first ,control the claims of group policies first and then move to the creation of the database of the individuals"
RTI TO RESCUE OF MEDICLAIM POLICYHOLDERS AWAITING REFUND
The Times of India has carried an intersting news regarding RTI( Right To Information Act )being used by Anant M Nandu.
The news item covered is :
The Right To Information Act has come to the help of thousands of Mediclaim policy holders who have been struggling to get refunds for the excess premium they have paid.
The Central Information Commission (CIC), in a landmark order, has directed New India Assurance Company Ltd to make public the details of the total number of policy holders who are still to get a refund for the excess premium charged. The CIC has asked the firm to provide the information on the company’s website and send a copy of the information to the Insurance Regulatory & Development Authority.
The CIC’s order came after RTI applicant Anant M Nandu filed a query seeking details on the number of Mediclaim policyholders charged excess premium even after the quantum of premium was reduced.
Grant Road resident Nandu had filed an RTI query last year after he learnt that the company was charging an extra premium during the renewal of his policy. “I had earlier sent them a letter asking for a refund, but they never responded. That is when I filed the RTI query,’’ Nandu said
The question comes to my mind is CIC could take action because New India Assurance is a PSU.What options we as consumers are having with respect to Privately owned companies?
Can we expect from the Government that RTI Act is also made applicable to Private Banks & Insurance Companies.Consumers will be relieved from the difficulties ,they are facing
Comments are invited.
The news item covered is :
The Right To Information Act has come to the help of thousands of Mediclaim policy holders who have been struggling to get refunds for the excess premium they have paid.
The Central Information Commission (CIC), in a landmark order, has directed New India Assurance Company Ltd to make public the details of the total number of policy holders who are still to get a refund for the excess premium charged. The CIC has asked the firm to provide the information on the company’s website and send a copy of the information to the Insurance Regulatory & Development Authority.
The CIC’s order came after RTI applicant Anant M Nandu filed a query seeking details on the number of Mediclaim policyholders charged excess premium even after the quantum of premium was reduced.
Grant Road resident Nandu had filed an RTI query last year after he learnt that the company was charging an extra premium during the renewal of his policy. “I had earlier sent them a letter asking for a refund, but they never responded. That is when I filed the RTI query,’’ Nandu said
The question comes to my mind is CIC could take action because New India Assurance is a PSU.What options we as consumers are having with respect to Privately owned companies?
Can we expect from the Government that RTI Act is also made applicable to Private Banks & Insurance Companies.Consumers will be relieved from the difficulties ,they are facing
Comments are invited.
Thursday, June 25, 2009
Why should I buy health insurance from you rather than buying from elsewhere?
Very common question which we have from those who access our website is
''Why I should buy health insurance from you?"
Our reply is given and I thought let me put it down for benefit of many of you.
We handle products of all Insurance companies As a leading health insurance source, we are able to offer our customers:
1- Broad Selection. Because we are an Insurance Brokerage Company and not a health insurance company/an insurance company, therefore we can offer products from multiple insurance companies. We offer a broad or we can say 100% selection/range of products from all insurance companies and as a result, it allows you to find the Insurance Product that best fits your needs. In fact, we are the leading source in India of health insurance for individuals, families and corporate clients.
2- Best Prices. Health insurance premiums are filed by the insurance companies to the regulator and are approved by them (Insurance Regulatory & Development Authority). Whether you buy from us, your local agent, or directly from the insurance company/health insurance company, you'll pay the same yearly premium for the same product. Good thing about us is that we tell you about all the products and also the service level of various companies.We have the feedback from large number of our clients.
3- Fast Processing. We offer the fastest way to get health insurancepolicy issued because we focus on health insurance and are handling so many proposals on everyday basis . This reduces average processing time significantly for you.We can be reached by phone /email as per your convenience.
4- Excellent Customer Care. We believe that you should enjoy the best customer experience available for getting the health insurance policy issued from us . The highly trained staff of our company handles your query in the professional way and with care, which it needs as you are important to us .They help you make the most of your money with professional, unbiased advice, which we only can give you because we are an Insurance Brokerage Firm and we handle all the products and that too of all the companies.
''Why I should buy health insurance from you?"
Our reply is given and I thought let me put it down for benefit of many of you.
We handle products of all Insurance companies As a leading health insurance source, we are able to offer our customers:
1- Broad Selection. Because we are an Insurance Brokerage Company and not a health insurance company/an insurance company, therefore we can offer products from multiple insurance companies. We offer a broad or we can say 100% selection/range of products from all insurance companies and as a result, it allows you to find the Insurance Product that best fits your needs. In fact, we are the leading source in India of health insurance for individuals, families and corporate clients.
2- Best Prices. Health insurance premiums are filed by the insurance companies to the regulator and are approved by them (Insurance Regulatory & Development Authority). Whether you buy from us, your local agent, or directly from the insurance company/health insurance company, you'll pay the same yearly premium for the same product. Good thing about us is that we tell you about all the products and also the service level of various companies.We have the feedback from large number of our clients.
3- Fast Processing. We offer the fastest way to get health insurancepolicy issued because we focus on health insurance and are handling so many proposals on everyday basis . This reduces average processing time significantly for you.We can be reached by phone /email as per your convenience.
4- Excellent Customer Care. We believe that you should enjoy the best customer experience available for getting the health insurance policy issued from us . The highly trained staff of our company handles your query in the professional way and with care, which it needs as you are important to us .They help you make the most of your money with professional, unbiased advice, which we only can give you because we are an Insurance Brokerage Firm and we handle all the products and that too of all the companies.
Thursday, June 4, 2009
ICICI Lombard will not be aggressive in selling Health Insurance
On the one hand we notice aggressive advertising campaign of ICICI Lombard and at the same time we find the following statement has been issued by Sanjay Datta, head of health insurance, ICICI Lombard General Insurance, at an interactive session in Kolkata.
The statement is " Like most general insurance companies, ICICI Lombard would not be aggressive selling group health insurance policy due to high claim ratio"
We feel Health Insurance is a specialized product and co's like BUPA,Munich Re(DKV),Swiss Re will ultimately become active players in the Indian Market and traditional co's( General Insuarnce ) will start losing market share.
Incidentally ICICI Lombard has been having highest premium rates among health Insurance co's of the country.Root cause is that ICICI has been picking up marginal group policies in the past.It is good that they are realizing the realiites of business.
The statement is " Like most general insurance companies, ICICI Lombard would not be aggressive selling group health insurance policy due to high claim ratio"
We feel Health Insurance is a specialized product and co's like BUPA,Munich Re(DKV),Swiss Re will ultimately become active players in the Indian Market and traditional co's( General Insuarnce ) will start losing market share.
Incidentally ICICI Lombard has been having highest premium rates among health Insurance co's of the country.Root cause is that ICICI has been picking up marginal group policies in the past.It is good that they are realizing the realiites of business.
Joint Venture Partners in Health Insurance Companies of India
Very soon we will have Max BUPA and Religare Swiss Re entering the health insurance sector in India. With their joining we will have 4 co's in this sector and the details are;
Foreign Partners in Health Insurance Co's of India - June 2009
Name Foreign Partner Status
Star Health ETA Ascon, Oman Operational,
Revenue Rs.511.93 crores
(2008-09)
Apollo DKV DKV (Munich Re.C.) Operational,
Germany Revenue Rs.48.95 crores
(2008-09)
Max BUPA BUPA, UK Moving towards becoming
Operational
Religare Swiss Re, Switzerland Agreement reached
Foreign Partners in Health Insurance Co's of India - June 2009
Name Foreign Partner Status
Star Health ETA Ascon, Oman Operational,
Revenue Rs.511.93 crores
(2008-09)
Apollo DKV DKV (Munich Re.C.) Operational,
Germany Revenue Rs.48.95 crores
(2008-09)
Max BUPA BUPA, UK Moving towards becoming
Operational
Religare Swiss Re, Switzerland Agreement reached
Friday, May 8, 2009
Reliance General Insurance Company Limited Increases Minimum Sum Assured Limit
Reliance General Insurance Company Limited has increased minimum sum assured limit for Health Wise Silver Plan to Rs.3 lakhs. Even though in leaflets/ brochures Reliance Health Wise minimum sum assured limit for Silver Plan is Rs.1 lakh. But in May 2009 Reliance has stopped accepting proposals for less than Rs.3 lakhs. It means minimum sum assured under Reliance Health-Wise Silver Plan is now Rs.3 lakhs. We feel that this is a step in the right direction as insurance companies are under pressure to control costs. Cost of issuing a policy is estimated at Rs.350 to 450. For a policy where premium is Rs.800 only the insurance company is definitely losing good amount ofmoney.
We are also informed that Reliance has issued guidelines under which at the time of renewal sum assured cannot be increased for Health Wise Silver or Gold. This will motivate customers to buy higher sum in the beginning itself.
For more information visit http://www.healthinsuranceindia.org
We are also informed that Reliance has issued guidelines under which at the time of renewal sum assured cannot be increased for Health Wise Silver or Gold. This will motivate customers to buy higher sum in the beginning itself.
For more information visit http://www.healthinsuranceindia.org
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