Issues with various Insurance Services in India: Inputs Sought

Below are some of the key issues listed by you in the past in regards to insurance in India. Kindly review and share any additional inputs you may have on the same. We look forward to your inputs and then escalating the same for policy and enforcement interventions!

Insurance in India - Key Issues

1.Cost of treatment when not hospitalized, not covered
2.Premium charges are very high
3.Claim processing is slow
4.No reason is given for the rejection of the claim
5.The duration in which a claim will be settled is not mentioned
6.Vehicle loss surveyors have thick closeness with fraudsters, their commission from fraud claim settlement is fixed
7.Application forms are lengthy and confusing
8.Terms and conditions are printed in small letters which usually go unnoticed
9.Sales executives do not give out the complete details while selling
10.Many frauds happen in the insurance sector
11.Mediclaim for senior citizens is very expensive
12.Grievance redressal channel is very bad
13.All companies don’t offer cashless insurance
14.All hospitals are not covered under the cashless program. more  

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Insurance services in India needs total revamping and restructuring. At present they simply collect premiums and dupe the clients when they approach for payments at the time of emergencies. with conditions that were not told to clients. The Insurance media print hundreds/thousands of conditions in miniscule print fonts that no human being could read and follow. They do not enumerate the salient features of conditions to clients at the time of entry. They object, when clients approach for claims, with various conditions that baffles the claimants. This should be ruled out and conditions must be simplified and clients must be explained and their signature must be obtained that the company has enumerated correctly about the conditions to the clients. more  
Fake & Fradulant Settlements of Claims - Mainly of Private Insurance Companied wherein BIG frauds are taking place.

The Best Example to quote that a flyover Bridge collesped neat CSMS (VT Railway Station) and Times Reporter who visited the Accident was named as Benificiery, when factually he as reported visited the place after accident. .

Where the Money Gone is NOT KNOWN, how the name exist and such other questions remained unanswered.

Same is the case of UNSETTLED Claims wherein some sily questions are raised for denial like Medcal Report analysis, denial of Original Document (Well submitted) etc.

Last BUT NOT THE LIST - In actions of the Authorities is a BIG & BIG PROBLEM to the effect to raise doubt about functioning.
It works just like postman wherein in a given case very complaint and supportings were forwarded to Insurance company and Response received is given to Insurer.
The Irony further is - The Covering letter states that the Matter is closed. more  
Wherever Freebies , Insurance exist , LOOTING TECHNIQUES paves Path HENCE CORRUPTION CONTROLS ARE THE MUST more  
There are many reforms needed in healthcare insurance
1. Insurance companies keep increasing the premium with age . Above 60 years premium for a couple becomes so high that it becomes unmanageable for most and many people discontinue their policies as their income has stopped or decreased .
A. Insurance companies should spread the premium to productive years and their shouldn’t be any premium after 60 year of age , if one has paid premium for 20 years.
B. Healthcare insurance products should be designed in this way that after 60 year of age , there is no need to pay premium.
C. Premium should remain static at entry levels like life Insurance policies and shouldn’t increase with age
2. Policies should be designed in such a way that they are all inclusive and risk should be spread over whole population of insured but all exclusions should go. No disease, illness or condition should be excluded from coverage, whether it is HIV , congenital condition , hereditary condition or mental disorders . Such products can easily be designed.
3. All hospitals and Nursing homes should be welcomed on network, if they are registered with appropriate state healthcare authorities or meet minimum standards. No restrictions should be created by imposing additional standards and criteria . Maximum providers mean easy accessibility of medical care and more choices for patients. More hospitals on provider networks, creates competition and avoids formation of cartels .
4. Responsibility of providing cashless should shift to insurance companies, instead of hospitals. Insurers should come out with a pre loaded credit cards for insured, which they should be able to use at any hospital during illness and hospitals should receive immediate payments. Insured should be able to submit documents in a very simple hassle free way and claims should be settled within 48 hours.
5. Insurance companies should come with transparent terms of policies and instead of imposing certain packages for procedures they should mention how much amount they assure to pay under particular policies and should avoid interfering with decisions of patients to chose type of care and providers. Anything above assured amount should be paid by patients. It will bring transparency in system
6. Any preauthorisation should be automated and human discretion should be removed . Claims should be settled between insured and insurance companies. Hospitals can provide assistance to insured for reasonable fees . more  
I too have a few suggestions/observations:
- Why should a mandatory Insurance for Motor Vehicle have a high rate of GST i.e 18%?.
- Most of the people are not aware of what to claim under insurance. This is true for all types of insurances.
- There are no insurance for some types of misfortunes such as job loss, old people care etc.
- Appliances Companies insist on taking AMC for each of the home appliance. Why not have an insurance to cover home, appliances, vehicles etc so that premia can be minimised and bring the household cost down?.
- Insurance is not provided for senior citizens, above 70 years, I think. But why not initiate a group family insurace package that can, at least, to some extend bring relief to a middle class family.
- Insurance agents are sometimes aggressive and do not touch upon some of the vital clauses within the policies and emphasize only on advantageous (but dubious) clauses. This should be avoided and their must be a mechanism to complain against such agents. The problem here is that agents are relatives or come through some referral and it is often not possible for the affected person to complain. It is better that Agents follow some code of ethics. more  
Exclusion less healthinsurence for senior citizens must be offered by all companies . more  
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