Health Insurance - Key Issues

Today, we would like to seek your inputs on key issues faced by citizens with Health Insurance in Delhi.

This will give us a better understanding and work with you to develop solutions that can improve the workings of Health Insurance companies-hospitals together so citizens have a better experience.

Dept of Health & Family Welfare more  

Friends, I feel we are all being taken for a ride. The various insurance policies that some members have mentioned are issued by Companies which are regulated by a central body called IRDA. So DoH, Delhi Govt has practically no control or role to play. It has become a practice with many deptts especially of Delhi Govt to use the localcircles forum to raise issues which are not in their jurisdiction, which ends up giving a false impression to citizens as if the deptt will do something to ameliorate their difficulties. But in reality the deptt is taking us for a ride as they won't be able to solve our problems, and are simply indulging in time pass and wasting members' time & efforts spent in giving their suggestions & observations. more  
1. There are few types of health insurance and the general public is not fully aware of them. Some of them are
a. Mediclaim policy, the most popular one.
b. Accidental insurance with 5 components.
c. Critical illness policy
d. b. & c can also be riders in life insurance policy.
e. Top up policy on mediclaim policy.

Companies have made their plans in ordinary (by different names), silver, gold, platinum etc with few more benefits and riders as well. If a person try to understand and make comparisons of facilitates, limitation, premiums, he/she will be more than confused. The companies, their officers, advisers do not explain the limitations or negative part of them, which the customers learns/forced to learn at the time of claim.
Few difficulties in the present systems are
a. Very high room rents leading to deductions in the claims
b. Other medical charges are dependent on room rent, a bad practice, to be removed.
c. Once the patient had a health policy, it is a highly profitable venture for the hospitals and doctors at the cost of the patients, with connivance of insurance and doctors and hospitals.
d. If it it not free treatment in registered hospitals with insurance card, getting reimbursement means a loss of sizable money besides the delay, even after the treatment is done in AIIMS, New Delhi at 1/4th of the cost in private hospitals.
e. Unnecessary tests are prescribed for the commission of doctors and hospitals.
f. Costly and sometimes unnecessary medicines are prescribed to be taken from hospital medical stores fr better profitability of hospitals and doctors.
g. Private hospital try to prolong the stay in hospital so that theiur revenue earning are more.
h. Specialists are invited from other hospitals. Their and indoor doctors visit fees are very high.
i. Generic drugs are not prescribed to reduce the cost of medication. However in the present system, there is no differentiation in generic and ethical drugs and MRPs on generic drugs are equal or more than ethical drugs.
f. The premiums for senior citizen goes in exponential forms, as if they are more than 4-5 times risk than middle men, which is not true. These premiums further go high if there are any claims by senior citizens or they may be denied extension of the policy.

The GOI has introduced a wonderful scheme of accidental cover of Rs 2 Lac on premium of Rs 12. Out of 5 parts of accidental cover (1. Death, 2.Total disability, 3. Partial disability 4. Mediclaim, 5. Compensation on non-earning days), first and second are fully covered, the third part of partial disability is covered up to Rs 1 Lac. However the premium f Rs 12 only is unthinkable (Extremely low). I recommend that every citizen should enroll under this policy at the earliest possible. It is one of the best scheme of the govt. for common masses. more  
Health insurances, not only in Delhi but in entire India, have many issues so unless specified topic is selected for sharing it is difficult to contribute.

However, there is a communication gap at the time of sale of insurance (mediclaim) policy due to lack of detail knowledge of marketing force of insurance companies, bad morale of some policy holders, greed and wrong practice of hospitals for inflating bills to take benefits out of insurance, high claim loss of insurance companies, wrong or negative interpretations of policy conditions by insurance officials, involving investigators doubting on all at the cost of credit of noble customers and the delay and deduction in settlement of the claims are some of the issues.

Due to these issues insurance company, hospitals and public suffer difficulties but ultimate sufferer, financially and mentally, are genuine customers .

I request to invite contribution on a specific issue so that combined efforts could enable you to recommend a suitable solution of the the issue for the benefit of citizens of Delhi and all in our country.
Dr. J. H. Rusat
Ex Chief Manager of The New India Assurance Co. Ltd. more  
I could find the comments and question of Shri R. Tayal quite appropriate, as while looking towards the importance of key issues, we spend our productive time in writing our comments/ suggestions, but finding no outcome for the suggested options for any betterment feel disappointed. So, please do act on the earlier comments/ suggestions and come back. more  
Dear DoH, several of the major issues are already well known. We a citizens will feel really motivated to give our inputs & suggestions to you if you first tell us what actions have you taken during the last few months to address some of those issues. Else please stop using this forum for time pass. more  
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