Health Insurance - Key Issues
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
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
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