Health insurers fear misuse of portability

 The insurance regulator's fiat giving unhappy health insurance customers the option to switch insurers evoked mixed response from the companies. The Insurance Regulatory and Development Authority (IRDA) on Thursday allowed policy holders to change their existing insurer without any change in the premium outgo.

Some insurers believe that the guidelines may have some adverse impact on the sector. "Portability can be genesis to various frauds and misuses. We need to evaluate the pros and cons of the move but we are confident that in the long run, it would be the company with the better services and integrity that would stand to gain in the market dynamics," Antony Jacob, CEO of Apollo Munich Health Insurance, said. A CEO of a south-based health insurance company said that in the absence of standardisation of products in India, the switching of insurers can leading to misunderstanding.
As per the guidelines, in case of a switch, the old health insurance company will have to share the details of policy in seven days. However, industry people believe that there can be logistic issues there as all health insurance companies do not have a centralised data processing facility.  Some industry experts believe that new system will require strong underwriting and selection process by the companies as there may be some misuse by policyholders.

http://timesofindia.indiatimes.com/business/india-business/Health-insurers-fear-misuse-of-portability/articleshow/7478066.cms#ixzz1Djd0Oxpm

Health insurance policy portability from July 1

In a big relief to dissatisfied health insurance policyholders, Insurance Regulatory and Development Authority (IRDA) on Thursday allowed them portability — shifting policies from one insurer to another on same terms — from July 1.

“The authority has examined various issues involved in the portability of the health insurance plan and has issued the necessary orders for effecting portability which will be implemented from July 1,” IRDA says in a statement. The portability facility will allow policyholders to switch over to another insurance company with the same conditions.

“The accepting insurer shall provide cover, at least up to the sum assured in the previous insurance policy,” the regulator said. The new facility will help those policy holders who stick to one insurer throughout life for fear of losing the cover for Pre Existing Diseases (PED).

http://www.hindu.com/2011/02/11/stories/2011021160362000.htm

Lloyd’s to get a warm welcome

The government is planning a red carpet welcome for the world’s biggest insurer Lloyd’s to set shop in India. It is considering amending the Insurance Act to remove the legal hurdles that prevent the India foray of the London-based society of underwriters that handled gross premiums worth over £21.97 billion in 2009.

Currently, for an insurer to do business in India, it has either to be an Indian insurance company itself or a foreign company in joint venture with an Indian firm, subject to the 26% FDI cap in the sector. Lloyd’s could not use this route to enter India as it is not a company but a society of underwriters. Sources said the current provision in the Insurance Act which defines a “foreign company” as one that is not a “domestic company” would be changed to “a company or body established or incorporated under a law of any country outside India.” This would facilitate Lloyd’s entry.

Tata AIG, Max New York, Max Bupa, Bajaj Allianz are the insurance firms in India in which foreign players are involved.Sources added the government was also considering permitting overseas re-insurance companies to open branch offices in India with a minimum net worth of Rs 5,000 crore.

“Heath Insurance” would also be included in the Act and the minimum capital requirement for an exclusive health insurer would be pegged at Rs 50 crore. The proposals were discussed at a meeting between commerce and industry minister Anand Sharma and US commerce secretary Gary Locke on Monday. Locke wants the Indian government to take more steps to open its economy, particularly in dealing with trade barriers.

http://www.financialexpress.com/news/lloyds-to-get-a-warm-welcome/747770/0

Govt plans insurance cover for HIV-infected

India is set to have the first, government-run policy to provide health and life insurance covers for People Living with HIV (PLHIV).Sources in the National Aids Control Organisation (NACO) confirmed that a meeting had been finalised between key stakeholders, including insurance companies, economists and international and national healthcare experts, to work out a sustainable model for the policy.

The meeting, scheduled for February 3 and 4, will see delegates of various countries where successful insurance policies have been implemented for PLHIVs. The aim is for experts to study the models of these countries to arrive at a structure suitable for India.

According to a senior NACO official, though providing insurance cover to PLHIVs was outlined as an important agenda in the ongoing National AIDS Control Programme-3, cohesive action was being taken only now.

“Representatives from South Africa, the US, the Philippines and Namibia have confirmed their participation. The conference will also see a strong representation from the insurance sector. Officials from the Insurance Regulatory and Development Authority will also be present,” the official said.The government is seeking the help of NGO Population Services International (PSI),which has implemented a micro-level insurance programme for HIV-affected persons in high-risk states such as Karnataka, Andhra Pradesh and some districts of Maharashtra. According to Ravi Subbaiah, PSI project in-charge, “Our existing programme only provides for a cover up to Rs 30,000 for patients with CD 4 count up to 300 (CD4 cells or T-helper cells are a type of white blood cells that fight infection and their count indicates the stage of HIV or AIDS in a patient). We are now looking at a pan-Indian project for a much greater premium, with importance on accessibility of services to patients.”

He added that where the PSI programme only provides health insurance, brainstorming sessions with NACO had focused on a complete life insurance cover.

The PSI’s existing initiative ‘Connect’ is supported by the United States Agency for International Development (USAID), and provides patients cashless facilities at hospitals enlisted in the network.

For a premium of Rs 1,511, the patient has to pay Rs 750, and the rest is subsidised by the PSI. Patients can avail of Rs 15,000 on hospitalisation at the onset of AIDS, and the other half for treatment of co-infections associated with AIDS.

Source:

http://www.indianexpress.com

Govt plans health cover for all Indians

A health insurance scheme that will cover every Indian is on the cards.A committee of experts appointed by Prime Minister Manmohan Singh and headed by K Srinath Reddy, chief of the Public Health Foundation of India, is working on a publicfunded scheme, likely to be introduced in the 12th Five Year Plan, starting in 2012-13.

“We are looking at a scheme where people will pay premium depending on their income,” said Planning Commission member secretary Sudha Pillai. For instance, the government may pay the entire premium for those below the poverty line. For the better off, the government’s contribution will diminish the higher the individual's income.

This scheme is likely to cover not only hospitalisation expenses, but also treatment undergone at listed hospitals. Most private health insurance schemes cover only hospitalisation. It will also provide cover for conditions private schemes frequently do not — like heart ailments and pregnancy.

The scheme also intends the Centre to pay a higher premium for women — across all sections.There is already a health insurance scheme under the Rashtriya Swasth Bima Yojana for BPL families. Close to half of 6 crore BPL families are covered under this scheme. In the next step, all those enrolled in the Mahatma Gandhi National Rural Employment Guarantee Scheme will be covered, followed by women enrolled in over 10 lakh angwanwadi centers around the country.

According to the National Sample Survey Office, an Indian spends 80 % of his health expenses on buying medicine. The high cost of treatment makes health services unaffordable to many.

Presently, over 90 % Indians are not covered by any public or private health insurance.

http://www.hindustantimes.com/Government-plans-health-cover-for-all-Indians/Article1-651307.aspx

US health insurers vie for cashless service in India

American health insurance giants Aetna and United Healthcare are in the race to provide cashless service under health insurance in India. The two companies are among nine that have been shortlisted by government-owned general insurers which control close to 80% of the cashless mediclaim market.

The health giants are among the 24 that have responded to a request for joint venture proposals by the General Insurers Public Sector Association (GIPSA) that represents four of the largest health insurers —New India Assurance, National Insurance , Oriental Insurance and United India Insurance. These state-owned companies plan to float a captive third-party administrator (TPA) for managed healthcare services. GIPSA is seeking a partner that will provide technical support in networking and negotiating with healthcare providers.

The other companies shortlisted include Patni Computers and French Coris International , which provides claims management services . Cambridge Solutions and Lason , two BPO firms which are keen on diversifying into healthcare, are in the list. Among the existing TPAs, emeditek and Medi Assist have been shortlisted.

This stance affected thousands of policyholders as most of the tertiary care hospitals refused. Since then, things have changed. “In Delhi, most of the large hospitals have joined the network, including Batra, Gangaram , Saint Stephens. We are waiting for the corporate chains of Apollo, Max and Fortis,” said Pawan Bhalla, MD, Raksha TPA. In Mumbai of the five large tertiary care Hospitals Jaslok is agreed to have joined.

Existing TPAs have been up in arms against GIPSA’s decision to have a captive firm. Their main concern was that such a firm would put them out of business. The association of TPAs had filed a complaint with the Competition Commission of India (CCI) that such a captive firm would create a monopoly. A decision by the CCI is expected next week.

However, the initial antagonism appears to have worn off a bit considering that the health insurance market is growing at 35-40 % and most TPAs have their hands full managing the business. Also , there are indications that GIPSA may not hand over its entire health insurance business to the captive company to manage.

Star Health eyes Rs 1500-cr premium collection in FY 11

MUMBAI: Star Health and Allied Insurance Company is eyeing Rs 1500-crore premium collection by the end of this fiscal year (FY 11), a company official said.

Apart from retail customers, the company has collaborated with different state governments and public agencies to ensure medical coverage to their employees, farmers and others.

Last fiscal the company collected a total premium of Rs 979 crore. The company has launched two new products - Star Unique Health Insurance and Star Wedding Gift Insurance.

The Unique Health policy provides cover for hospitalisation benefits as well as pre-existing disease after awaiting period of 11 months. The policy is available under three sum insured options- Rs 1-lakh, Rs 2-lakh and Rs 3-lakh.

The second policy offers basic health cover for the couples on a floater basis. The policy also provides for child delivery expenses.

The qualifying age-bracket for availing the benefits of the policy is 18 to 40 years.