Saturday, December 29, 2012

Mount Elizabeth Hospital Singapore

Mount Elizabeth Hospital Singapore
This great hospital has got lot of publicity in India in last 3 days (Dec. 27, 2012 to Dec. 29, 2012).

We had high hopes for recovery / treatment of first private citizen of India, who was sent for treatment on Government of India expense.

The Interesting phenomenon I came across in 3 days is that more than 60 crores persons living in India have become aware of this hospital that it is a super specialty hospital of world repute for organ transplant.

We receive many phone calls .You will find interesting case studies, which we came across in last 2 days:

Case Study 1:

Phone call received by us from a prospective client who wishes to buy Overseas Travel Insurance policy for 7days so that he can go and get treated in Mount Elizabeth under this policy.

He was rather disappointed to know that Overseas Travel Insurance policy issued by insurance companies does not cover treatment for disease which is pre-existing.
Case Study 2:
Phone call received by us from a prospective client who wishes to buy Health Insurance Policy for Rs. 2 Lakhs and wishes to go to Singapore for being treated in Mount Elizabeth.

He was surprised to know that

a)      Rs. 2 Lakhs is too small an amount for being treated in this world class hospital, where room rent for lowest single room is Rs. 30,000 or so.  We are not aware of costs for treatment. Our assumption is that it should be very high.
b)      The policies issued by all but 1 insurance company cover treatment within India. The only exception is Religare Health Insurance product where you can get treatment in an overseas hospital (Mount Elizabeth Hospital also) provided you have sum assured of either Rs. 50 Lakhs or Rs. 60 Lakhs.

We come to conclusion that:

  • Those who can afford.
  • Those who wish to be treated in reputed hospitals like Mount Elizabeth should go in for Religare Health Insurance policy for sum assured of Rs. 50 Lakhs / Rs. 60 Lakhs.

Otherwise let us be satisfied with our world class hospitals- Medanta, Apollo, Fortis etc. can be reached for details / support in this regard.

Friday, December 28, 2012

Intoxicated accidental victims have better recovery in hospitals

According to recent study of University of Illinois at Chicago School of Public Health – Injured patients were less likely to die in the hospital if they had alcohol in their blood and the more alcohol; the more likely they were to survive.
Dr. Lee Friedman epidemiologist who was the project head said “However, after an injury, if you are intoxicated there seems to be a pretty substantial protective effect,” “The more alcohol you have in your system, the more the protective effect.” Dr. Lee Friedman is Assistant Professor of Environmental and Occupational Health Sciences at UIC in Chicago.

The project team headed by learned professor analyzed Illinois Trauma Registry data for 190,612 patients treated at trauma centers between 1995 and 2009 who were tested for blood alcohol content, which ranged from zero to 0.5 percent at the time they were admitted to the trauma unit. It is surprising that only 6,733 died in the hospital.

The study examined the relationship of alcohol dosage to in-hospital mortality following traumatic injuries such as fractures, internal injuries and open wounds. Alcohol benefited patients across the range of injuries, with burns as the only exception.

The benefit extended from the lowest blood alcohol concentration (below 0.1 percent) through the highest levels (up to 0.5 percent).

“At the higher levels of blood alcohol concentration, there was a reduction of almost 50 percent in hospital mortality rates,” Friedman said. “This protective benefit persists even after taking into account injury severity and other factors known to be strongly associated with mortality following an injury.”

The findings of this study point:

  1. It’s important for clinicians to recognize intoxicated patients but also to understand how alcohol might affect the course of treatment.
  1. This study is not encouraging people to drink, the good thing which we find in this study is that interesting projects are undertaken in USA.
I wonder whether any such study has been undertaken in India.
The implication of such study as for  insurance industry in India is concerned is that if a person was intoxicated and is involved in accident his hospitalization claim, claim far car damage everything may be denied.

Let us welcome Liberty Videocon General Insurance Company Limited

Let us welcome

Liberty Videocon General Insurance Company Limited

This company is starting operations from Jan 1, 2013.

This company is 25th insurance company fromGeneral / Non Life / Health Insurance Segment.

Health Insurance products from this company should become available in first quarter of 2013.

Wednesday, September 26, 2012

Artificial Heart is available – Does your Health Insurance policy cover its cost

The Times of India has covered interesting news on availability of artificial heart.

According to this

“A tiny mechanized device weighing 400 grams may give hope to more than 4 million people in the country who die of heart failure every year. A Mumbai hospital has brought in the technology to implant an artificial heart that takes over all functions of the original heart and promises to double the patient’s life expectancy.”

Globally, over 10,000 people are believed to be living with this device so we can say it is a proven commercial alternative.

Rates announced by some hospitals in the country are:
Asian Heart Institute Mumbai                 Rs. 1 crore,
Narayana Hrudayalaya, Bangalore          Rs. 50 Lakhs

It is good to know that some of the Insurance Companies are new offering health insurance product under which you can insure yourself for Rs 50 lakhs /Rs 60 lakhs.

Some of these companies are:-

  1. Religare Health Insurance Company Limited
  2. L & T General Insurance Company Limited
  3. ICICI Lombard General Insurance Company Limited
  4. Max Bupa Health Insurance Company Limited
We hope that in near future some insurance companies will come up with Top up/ Super Top products so that families can have insurance Cover of Rs. 100 Lakhs.

Monday, September 24, 2012

Non availability of Health Insurance can make life miserable for any one

Non availability of Health Insurance can make life miserable for any one
Hindustan Times Sep. 24, 2012 has covered a news item on inflation and has covered the case study which is as follows:

“Samuel Baig, Still Stout at 70, has taken a painful decision that could simply mean not being able to walk straight again.

His Broken leg fused incorrectly after a fall seven months ago. Hobbled by healthcare expenses, Baig told his doctors last month he had no cash to continue treatment or even a surgery. He’d rather limp.”

It is sad to read this case study.

  • A senior citizen because of limping defect will avoid going out as frequently as he should. He can not go for morning walk or to the community centre to spend his time, attend functions or meet his friends.
He could have avoided this sad situation by going in for Health Insurance.

You may ask how much it would have costed him.

  • If he had taken the policy when he was in his fifties then at the age of 70 coverage of Rs. 1 Lakh would have cost him Rs. 7820 per year.
  • If he decides to take the policy (now when he is 70 years) then coverage of Rs. 1 Lakh from National Insurance will cost him Rs.5838   per year with condition that insured will pay 10 % as co payment as and when claim is lodged. In the present scenario Samuel Baig‘s Limping disease /ailment will be considered as pre existing ailment and will not be covered. For 4 years.
This premium amount at Rs 20 a day is not much? It could have avoided him the situation as on today – Limping while walking or being bed ridden.

Moral of this blog is you muust have health insurance. Sum of large, very large or small but you must have it.

Tuesday, August 14, 2012

Insurance companies should pay for Cataract check up/ surgery with a view to reduce Orthopedic Fracture Claims being submitted by senior citizens

Insurance companies should pay for Cataract check up/ surgery with a view to reduce Orthopedic FractureClaims being submitted by senior citizens

Everyone knows that older people undergo eye surgery to remove cataract and consequently they improve their vision. A large sample study undertaken in USA has revealed that there is correlation between poor eye sight and hip fractures among senior citizens. It is noticed that for senior citizens, there is significant reduction of their risk of breaking a hip in a fall in case they have undergone cataract surgery. This study also revealed that those in their early 80s experienced nearly 30% fewer Hip Fractures in comparison to those who had not underwent cataract surgery. 

According to Dr. Anne L Coleman, the study’s lead author and a professor of Ophthalmology at the Jules Stein Eye Institute at the University of California “it is desirable that senior citizens should go in for Cataract Surgery as and when required as:
  • It is safe and low cost surgery in comparison to complex orthopedic hip fracture surgery.
  • It reduces Orthopedic Fracture rate among senior citizens significantly and reduces monetary expenses as well as painful surgery/ physiotherapy exercises which the senior citizen has to undergo.
  • An orthopedic Fracture rate is 30% lower in case of those who have gone Cataract surgery.
We know that orthopedic fracture surgery costs Rs 1.20lakh to Rs 2.00lakhs against Cataract surgery which costs Rs. 20000 to Rs 30000.

This leads us to the thinking that Insurance Companies in India should encourage senior citizens to go in for eye check up at 60 years + at interval of 2 years and also encourage them to go in for Cataract Surgery, if required. This will save large amount of claims which are filed/going to be filed in future (population of senior citizens is going to increase in the country in the coming years) under the head of Orthopedic Fracture Claims.

I am 32 years old and was suffering from cholesterol a few months back but now it is normal. I have decided to take a health policy. If I mention about the high cholesterol, what are the chances for the policy getting rejected. What all should I check when taking a policy.

I am 32 years old and was suffering from cholesterol a few months back but now it is normal. I have decided to take a health policy. If I mention about the high cholesterol, what are the chances for the policy getting rejected. What all should I check when taking a policy.

The fact is that if you are having high cholesterol and you are taking medicine then cholesterol level should be coming normal whenever blood test is conducted.
The proposal form of insurance companies is having question.

For example in Oriental Insurance proposal form it is:-
  1. Have you suffered from any of these following?

    • High blood pressure
    • Palpitation
    • Heart Diseases including ischemic heart disease. Yes No
In Apollo Munich Health Insurance proposal form it is:-

    • Hypertension
    • Chest pain
    • Ischemic heart disease  
    • or any other cardiac disorder. Yes No      

You have to mention Yes or No against every question. Assuming you have replied yes then it will be for Insurance company to decide whether they should ask for medical examination to decide whether to 
    • Issue the policy
    • Refuse the policy
    • Issue the policy with loading
Assuming you have replied No, then there is near to 100% chance that policy will be issued without medical examination. In the event of lodging of claim of high amount the Insurance Company may call for investigation and if it is proved that at the time of filling up of proposal form you were taking the medicine to bring down cholesterol level then they may say that heart ailment was preexisting disease and refuse to pay the claim.

It is up to you to decide which option you want to take.

Saturday, July 14, 2012

Let us welcome Religare Health Insurance

Let us welcome Religare Health Insurance                                                                          
It is always good to have entry of a new Insurance company. There is a challenge for the new company to come out with new/innovative /attractive product.

Religare Health Insurance has become operational and has started doing business in July, 2012

Salient points of their policy are:
  • Maximum sum Assured – Rs 60 Lakhs (highest in India)
  • Yearly check up on free of cost basis.
  • Overseas treatment permitted for those who have sum assured of Rs 50 Lakhs/ Rs 60 Lakhs.
  • No age limit for entry
  • Life long renewals
  • In house claim settlement
  • Restoration of sum assured after lodging/settlement  of claim

You will be interested to know the premium to be paid by someone for sum assured of Rs 50 Lakhs:

Family Floater for 2 adults of age group 61-65 years it is Rs 2, 58,360.

The good point is that insured is permitted to undergo treatment in foreign countries for critical/serious ailments/surgeries. This is to make clear that till now all health insurance policies were having the condition that insured can have treatment within India only.
Religare has taken a welcome step by permitting overseas treatment (for sum assured Rs 50 lakhs & Rs.60 lakhs).

You being a well informed person are aware of that Overseas Travel Policy does not permit you to travel abroad and get hospitalized for treatment of existing diseases.

For the same family -Family Floater for 2 adults of age group 61-65 years for sum assured of Rs 25 Lakhs the premium is Rs 47,958. But it permits treatment within India only.

The premium for Rs 50 Lakhs is not 2 times of the premium for Rs 25 Lakhs but it is 5.39 times or 439% higher.

Any Comment?

Saturday, July 7, 2012

Is Rs 92 Lakhs compensation for 2 lives high or low?

Is Rs 92 Lakhs compensation for 2 lives high or low?

On November 20, 2009, Prathap Kumar (28) who was working in Canada and had come to Chennai on a 10- day holiday. He met with an accident with truck when he and his family were going on the bike. The daughter was thrown off the bike on impact of the crash and was saved. Prathap and his wife died.

This case went to Motor Vehicle Tribunal in Chennai and after the trial Judgement has come in June 2012 .According to it;

·         Total compensation to be paid is Rs. 92 Lakhs.
·         Rs 50 Lakh will be kept in the name of the daughter in a nationalized bank until she’s 18.
·          Her grandparents will get Rs 20.9 Lakhs each so that they can use it for living /education of grand daughter.

Question before us is – Is it that Rs 92 Lakhs high or low?

We feel it is very less – A software engineer who was working in Canada and who is aged 28 years  could have worked /earned till  the age of 65 years – which means 37 years.

Monday, June 18, 2012

Insurance Industry who is coming? Who is going?

Insurance Industry who is coming? Who is going?

Every year we see developments in which:
·         New Insurance companies enter the Indian Market.
·         Some of the existing partners in an insurance company decide to exit as a result of which new investor or shareholder comes in and consequently there can be change in name of the company.

Let us look at the names of new entrants/ names:
·         Edelweiss Tokio Life Insurance Co. Ltd. has entered.
·         Magma HDI General Insurance Company Limited has entered
·         Liberty Videocon General Insurance Company Limited has entered
 ·         Religare Health Insurance Company Limited has entered
Change in partners have happened in the recent months 
Who is gone/going
Who has come/ is coming
Max New York
New York Life USA
Mitsui Japan
J & K Bank
Punjab National Bank
Reliance General
Entry of a foreign partner
Intact Insurance Co./ HDI-Gerling International Holding AG.
Future Generali
Kishore Biyani Group
Indian partner is planning to exit
Tata AIG General
AIG has gone
AIA has come
Tata AIG Life
AIG has gone
AIA has come

 Let us wait and watch.

Friday, June 8, 2012

Health Insurance Portfolio – An Analysis

Few years back we were very enthusiastic about the growth of Health Insurance portfolio. This was especially true during 2007-08, when this portfolio grew from Rs 3210 Cr to Rs 5110 Cr. i.e by 59.20%. Let us look at the growth figures from 2006 to 2012:

% Growth of Health Insurance over the Years
We have drawn graph showing the % growth YOY and, it shows that figure is fluctuating and is becoming less and less attractive as years have passed by.

Graph Showing % Growth Year  Over Year
Let us try to make projections for next 6 years.
We have done this with growth rate of 12%, 20%, 30% & 60%.

Projections for Health Insurance Portfolio
If we achieve figure of 30% then the portfolio will be Rs 64414 Cr. in 2017-2018.

If some one asks me- What should be the growth with which you will be happy?- I will say it should not be 30% gross but it should be 30% net (as we have to discount for inflation of 10% per annum in normal costs and 20% per annum in health care costs). Let us not be satisfied with meager growth of 16%- let us aim for 60%.
It means we should have growth of 60% year over year and then the figure will reach Rs 223892 crores.

Tuesday, June 5, 2012

Is compulsory Co Payment of 20% in Group Health Insurance Policy a solution?

We understand that for controlling the losses of Health Insurance portfolio a circular has been issued by Ministry Of Finance to 4 PSU’s namely
  • New
  • National
  • Oriental
  • United
This circular has many guidelines out of which few guidelines are such, which are to be strictly followed:-

(i)     Co-payment (20%) shall be made compulsory in every Group Health Policy.

Let us see the implication

Employer- Should it pay this Co payment as and when any member of Group Health Insurance Policy undergoes hospitalization and lodges claims to the insurance company.
Employee- Should it be borne by him/her.

Employer is ready to pay higher premium (but without Co Payment clause) in the beginning so that it does not have uncertainly with respect to

  • Payment under Co Payment clause.
  • Funds planning.
  • Avoid unnecessary paper work in accounts/ administration department of the company in dealing with copies of bills etc. In case employer pays this- taxation aspect also is to be taken care of as payment beyond Rs 15000 may have implication of TDS.
Is it that with this move an effort is being made to?

-          decelerate the growth of health insurance portfolio
-          Move business to Private sector companies?

What will be the repercussions of this?

Only Time will tell- let us wait.

Our suggestion is that insurance companies should be asked /instructed to give 2 quotations:-

Option 1- Premium with Co-payment 0% (as at present). We know it will be higher.
Option 2- Premium with Co-payment 20%. Let customers choose this option if budget is the constraint at their end.
Let the Market and the customer decide whether they need Option 1 or Option 2?

Monday, June 4, 2012

Comments are invited by IRDA on draft Health Insurance Regulations 2012

Health Insurance emerged as an important segment of Indian Insurance Industry as a result of that various initiatives were taken by the following:

IRDA Regulations Health Companies with a view to consolidate various guidelines circulars/ instructions the reputation has released.

IRDA’s exposure draft on Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012

This is a serious attempt to put various points in one document. Selected Points are:

• The IRDA (Policyholder Protection of Interest) Regulations, 2002 (hereinafter referred as “2002 Regulations” shall be applicable mutatis mutandis to all health insurance policies, wherever relevant.

• Entry and Exit Age:

All health insurance policies shall provide for entry age at least up to 65 years, except for those referred in regulation. In health insurance policies, where the covers offered are specific to a particular age groups like maternity covers, children covered under a family floater policies, cover offered to students etc, insurers shall offer an option to migrate to a suitable health insurance policy, at the renewal of the policy or at the end of the specified exit age, by providing suitable credits for all the previous policy years, provided the policy has been maintained without break.

All health insurance policies shall not have an exit age for renewal of the policies, once the proposal is accepted, provided policy is continuously renewed without break.

Settlement of Claim: On receipt of complete documents, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recording in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of complete documents.

• Timeline for Submission of claims documents:

I. Insurer may stipulate a time limit latest by which the claims documents should be furnished by the policyholder/ insured to make a claim.

II. In case of non submission of timely submission of claims documents, insurers shall not repudiate such claims unless and until the reasons of delay are categorically enquired about, reasons recorded and the insurers sufficiently satisfy that the delayed claims could have otherwise been rejected if reported in time.

III. All insurers shall develop a sound mechanism of their own to handle such claims with utmost care and caution. The insurers shall incorporate additional wordings in the policy documents, suitably providing insurer’s decision to condone delay on merit for claims which are not submitted in time, but if substantiated by the insured that the delay is beyond his/her control and due to exceptional/ unavoidable circumstances.

You as a customer are the most important link- It is suggested that you should go into details of this 44 pages document and make suggestions to IRDA by June 30, 2012. Feel free to send comments to us.