Preeti Kulkarni has written a good article in The Economic Times of January 6, 2010 on “Take extra cover for sake of your health”
The Heading carries the line “In many cases, claims can be made under both the policies” is very interesting .

The same article under the sub heading “Making a claim under two policies.” mentions

“Many policy holders tend to assume that they can file a claim under any of the policies they have signed up for, which may not always be the case; whether the individual can make a choice to claim depends on the provisions made in the policies taken.

Also, whether the individual can make a choice to claim depends on the provisions made in the policies taken. Typically, there is a declaration sought from the customer on the policies under which s/he is covered, and the total liability is shared by the insurers, informs.

The contribution clause in the policies states that claims can be made under both the polices, in the same ratio as the sum insured. For instance, if you are covered under a corporate policy with a sum insured of Rs. 2 lakh, in addition to a personal cover of Rs. 1 lakh and makes a claim for Rs. 1 lakh, the insurer servicing the former will contribute around Rs. 66,000 while the balance will come from the other insurer.
However, according to Pawan Bhalla, CEO of Rakish TPA, in India, policyholders are not legally bound to disclose the details of any existing policy or make a claim under any of the two policies they are covered under.”

Pawan has mentioned that it is not necessary to make the declaration to both the Insurance Companies.

Reality is that if the claim is of small sum then everything is fine. But if the claim is large and let us say the facts are
Policy 1 Coverage under corporate group policy = Rs. 5 Lakh
Policy 1 Coverage under own policy = Rs. 5 Lakh

Policy 1 was issued in 2003, and is continuing. A claim was lodged in June 2009, for Rs. 2 lakh and was paid.

Policy 2 was issued in November 2008 and is continuing. Insurance company 2 was not informed about existence of policy 1.

Let us say in January 2010 claim is to be lodged for Rs. 7 lakh.
This is the point at which problem like claim settlement arises when the claim is to be lodge with both companies.

As only one set of original documents (Invoice bill / Receipt / Test Reports / Discharge Summary) can be issued by Hospital therefore if will become necessary for the client to reveal to both the companies about details of polices.

If any document is required from Insurance Company (Policy 1) they will point out when you took this policy and why we were not informed about policy 2 on earlier occasion as they would have asked Insurance Company 2 to pay half of the claim amount of Rs. 2 Lakh. In most probability Insurance company 1 while paying the claim of Rs. 7 lakhs in ratio of 1;1 which means Rs. 3.50 lakh will deduct Rs. 1 lakh for June 2009 claim.

In the absence of letter from Insurance Company 1 he can not go to Insurance Company 2. Alternatively if lodges original documents with Insurance Company 2 then he may find slightly easier but problem for claim settlement is bound to emerge.

Any effort to get 2 sets of original form Hospital is not suggested as Insurance Co’s / TPA’s are cautious and are trying to control frauds as many cases of multiple claims being lodged with more than 1 Insurance Company have been noticed / reported.

In the end I will like to say you are buying Insurance for having peace of mind then it is better to reveal to both the Insurance Companies about the policy.

Maternity insurance is a health insurance which includes the costs related to pregnancy from delivery to care in hospitals, the hospitalization expenses, surgery, and pre and post hospitalization for 60 days. Some maternity insurance also covers the prenatal visits.

The exclusions of maternity insurance are it does not cover the unfortunate events of termination of pregnancy in the first 12 weeks. The insurance company which covers the maternity insurance is ICICI, United India insurance, Apollo DKV, health insurance, and many more.

The maternity insurance depend upon many factors like – on the profile of the company being insured, the industry in which it is operating and the risks factors associated with it. It can also depend upon the number of employees working there, the age profile of the employees and the previous health insurance claim ratios pertinent to the company. The advantages of maternity insurance include the save of money up to 60% on doctor’s visits, lab work, hospital stay, sonograms, and much more.

The maternity insurance does not offer the insurance for a lady who is already pregnant but some states offer mediclaimed health insurance or plans to low income families. You can have this insurance for a pregnant lady, have recently given birth, are adopting a child or are caring for a newborn. Having maternity insurance is the best option if you are planning to become pregnant. It offers maternity services as insurance coverage.

Insurance Regulatory Development Authority (IRDA) chairman J Hari Narayan has expressed concern over the “very low” level of health insurance penetration in the country. The situation, though, offers a great opportunity for health insurers to grow in a substantial way, he said. Hari Narayan was delivering the key note address at a two-day seminar on Health insurance and care’ that got underway at the National Insurance Academy (NIA). NIA director Prathap Oburai presided over the function.

According to Hari Narayan, of the total health expenditure worth Rs 3 lakh crore, the spending on hospitalisation accounts for Rs 1 lakh crore in the country. Against this, the existing level of health insurance premium was worth only Rs 6,000 crore, which means that a majority section of the Indian populace does not have an insurance cover. “This a matter of great concern,” he said.

Referring to standardisation of policy wordings, Hari Narayan said that the policy wordings can be improved upon by resorting to methods of rewriting or rephrasing, which, he felt, will clear the ambiguity currently prevalent in the policy wordings. Often ambiguities in policy writing is at the root of most disputes arising out of health insurance deals.

The IRDA chief also cautioned the health insurance industry to be prepared for the potential challenge in the form of a fresh tax liability that was recently levied on the third party assurers (TPAs), which play facilitators between health insurers and policy holders.

In his speech, NIA chief Oburai said, “The surging claim cost is a matter of great worry for the insurance industry and needs to be reversed or contained considering that the health insurance sector finds itself delicately poised.”

J Meenakumari, joint director (health) at IRDA, presented a paper on current and proposed regulatory developments in health insurance industry in India. She spoke at length on the recent health insurance initiatives that have been taken by the regulator. She also dwelt upon implication of recent regulatory changes on product designing and pricing.

Malati Jaiswal, CEO, Meditek, and Lalit Baveja, senior health care consultant with Milliman India, spoke about the strategies to manage claim costs. Jaiswal said, “Product design, policy terms and conditions, insured profile age, lifestyle, domicile, culture and health status are the main drivers of claim cost.” She cited solutions for strengthening the claim process, by designing and implementing hospital package rates.

Georgina Howes, vice-president, Life and Health Products of Swiss Reinsurers, spoke about underwriting methods and how simplified products were shaping initial stage underwriting and how underwriters were adapting to the environment. “In the prevailing market conditions, underwriters are expected to have many strings to their insurance bow, to wear many different hats and to be prepared for any eventuality,” she said.

Sanjay Datta, head, customer service at ICICI Lombard General Insurance Company; Ankur Njhawan, associate vice-president, Marsh Brokers Group; Neeraj Basur, director finance at Max BUPA Health Insurance Company; and Robert Prochnow, chief actuary, Swiss Re Health Care, were other prominent speakers.

Ashok Kulthe, chair professor, NIA, made the welcome remarks while NIA faculty member Abhijeet K. Chattoraj conducted the proceedings. Around 160 delegates representing various insurance companies and other service providers are attending the two-day event.

In today’s busy world people love to use the internet to shop for almost everything. We buy groceries to cars using the internet to find the best prices and research the products. Many people today use the internet to purchase health insurance. There are a few things to know about health insurance prices, they are regulated and they same policy from the internet and from an Insurance broker will be the same price. This is good news for the consumer this makes is easy to compare plans and premium costs via the internet. This can be a great way to go if you are healthy and you know what you want, but it can be a large problem for someone who has some medical issues to find the best plan and company for their particular situation.

The Insurance Agent/Broker can offer you the personalized advice and guidance you need to navigate through obtaining health insurance. To get this personalized service there is no effect in the premium cost, so why would you shop on the internet alone for insurance. The personalized service you will get will save you a lot of time when you need to ask a question or need help. They will know who you are when you call. You will have a person who you know to call if you have a question. If you call an 800 number of one of those internet services to buy insurance, you will be talking to a different agent every time you call. You may even need to call the insurance company and have no one on your side to help you work an issue.

The great advantage of working with an Insurance Broker/Agent is growing a relationship together. They know you and you know them so it will save you time if you need help. The insurance agent has support people in the particular insurance company to help them if your issue has not been resolved through the normal channels.

The Insurance Agent/Broker has something you do not have when you are applying for insurance online is access to the underwriter guide and to underwriters to do a pre-screen before you apply to see if the insurance company can accept you and what your rate up may be. The insurance company has the final word on your premiums, but you will be able to get an estimate with the help of an Agent. Using an insurance agent can save you some frustration and guidance that can help lead you to an approach to saving you on your premiums.

I would suggest you build a relationship with your insurance agent to help you through any personal insurance needs. They will be a good contact for you in the event of any issues and can help you through finding the best solution for your needs. Do not go it alone, find an agent you trust to help you. The best complement for any insurance agent is a referral, so ask around to find one of your friends if they know if an agent.

Help your neighbor not a big company; use an insurance broker/agent.

Financial Planning in your twenties-Some more points

2. Understand your money:

Your parents maybe trying to help you prepare your taxes, balancing your checkbook or managing your investments, but they may not be around forever to help you out. While there’s no denying that 20s is the time for experimentation, the fact is, you’re not a kid any more. Once you start earning, your finances are your responsibility and there may or may not probably be a wealthy Prince or Princess waiting to sweep you off your feet. Why take a chance? Focus on learning the true value of money and how to be responsible for your self. You need to succeed financially on your own.

3. Build an Emergency fund and seek Insurance:

It pays to be prepared for the “what ifs” in life. For any age group maintaining an emergency fund is a must. During the start of your career, investing in Health insurance is a necessity to protect you from the downside of a possibility of an accident, illness or disease which can lay a considerable hole in your pocket. House owners’ insurance and auto insurance also require equal mention. Plus, if you have children, life insurance is an absolute MUST.

credit-card-trap4. Stay away from debt:

Debt is one of the biggest financial problems facing young adults. Live within your means. Can’t afford something? Don’t buy it. Learn to keep spending in check while you’re young and you’ll save lakhs of rupees over the years — and save yourself a lot of stress, too. A monthly budget helps keep your spending in check and in the process, frees up money in your budget you never knew you had. Borrow only to build your wealth. Pay off your credit card bills in full every month. Keep tidy financial records. Not only would you need a down payment to buy a house, you would also need an established credit history and a record of on-time payments. Building a good credit history in your twenties will ensure it’s ready when you need to use it. Read in between the lines before entering into a contract and ensure you uphold it financially.

5. Think Retirement:

When you are in your 20s, it is easier to focus on immediate and short term needs. However, it’s not so easy for young adults to start planning for their retirement seriously from their first job itself. After all, retirement is a long way off. Yet it is the most essential piece to one’s long term financial security. Unlike in the US, in India the government does not provide social security on retirement. An individual has to depend on his own investments for his retirement nest. When you’re young, time is on your side. The sooner you start investing toward your retirement, the bigger the amount you accumulate.

6. Increase your social network:

Join or create an online community. Increase your social network and learn from each other. Even if you are a non-finance executive, you can still improve your financial literacy by reading books, searching the web, joining a community or a club or talking to experienced people.

7. Get yourself a financial plan

Financial planning serves very important purpose of bringing discipline and clarity to your investment habits.

An ideal plan gives you a complete picture of your current investments and liabilities, your net worth, cash flow, goals and a specific plan to achieve those goals. When you are young you tend to live for the moment and do things as they come but it’s very important to secure your financial future. At the same time it does not have to be at the cost of a good lifestyle.

The decisions you make today about your career, education, debt and retirement will stick with you and shape your future. So, invest in yourself. Start early. Start small. And ignore the typecast.

India is a young country. Approximately 60% of the Indian population is below 30 years of age. Asian Development Bank estimates India’s working age group to top most others globally in the next 2 decades. This would comprise those between 15 to 64 years of age.

The large ‘young and urban’ population (the working population with purchasing power) adds to our country’s economic growth enormously. It is the major driver of consumption as this young population has the ability (disposable income) and willingness to spend due to rising income levels (increasing instances of double incomes in most families). The increase in the number of nuclear families, easy financing options, increase in the population of working women continue to contribute to the increase in the domestic consumption propelling growth.

Meanwhile this ‘young’ segment continues to buy homes and select insurance, loans and retirement plans with little attention and relevant a dvice. For example, very few individuals start retirement planning when they are young.

We agree that planning for your future can be tough for anyone especially in this age of unlimited spending and investment choices.

So we at InvestmentYogi have taken the overwhelming task of financial planning and broken it down for you in few simple steps. With these pieces in place, you’ll be well on your way to financial security.

goal_1 1. What are your aspirations?

Work out what your goals are. It may not always be career or marriage or children centric. A goal can also be something you have been longing to do since a while. Is it trekking the Mount Everest? Is it going on a complete world tour? Or is it attending art lessons in Europe? Whatever your goals are, try measuring them in money terms so that you know before hand their precise financial requirements to help you plan better and achieve them too! Saving for a car or a holiday is a great way to fast-track a sense of achievement – and it sets up an invaluable habit – Saving. Save up ahead of time and you’ll be in key position to make the most of your thirties.

Medical care has become an expensive affair today. Instant catering to huge hospital bills may not be probable for all. With big diseases like cancer, cardiac problems, severe joint problems, etc. becoming common, it has become difficult for the common masses to bear the expenses at ease.

As per a survey, less than 10% of the population of India has the ability to pay Rs. 5 lakh or less in case of a surgical emergency. Mediclaim is the best answer in such a situation. With a mediclaim, an individual or a family can lead a stress-free and worry-free life and any inconveniences related to health will be taken care of by the insurer.

A Mediclaim policy essentially provides a health cover equal to the insured sum. The amount of the insured sum depends on the premium you pay and the benefits covered vary from plan to plan and from company to company. Do check the diseases covered while buying a mediclaim health insurance policy and also check whether it is cashless or not. A cashless policy ensures hassle-free transactions.

The premium amount also varies as per age; the higher your age, the higher the amount you need to pay. Though most insurance providers do not require you to undergo medical tests, a senior citizen applicant or mostly those above fifty years of age, need to undergo a medical test to be able to buy a mediclaim health insurance.

There are numerous companies that offer mediclaim policies and buyers get a variety of choice. Buy the one that best suits your needs or the needs of your family. There is a vast difference between individual mediclaim health insurance and family mediclaim health insurance.

While an individual policy entitles the insured to avail benefits for self, the family plan covers the entire family; most companies cover husband, wife, two kids below 12 years and dependent parents. The premium to be paid will no doubt be more than an individual plan. Do keep the insured sum a bit higher and look into the terms and conditions of the mediclaim policy, diseases covered, etc.

You avail several advantages with a mediclaim policy. In addition to providing yourself and your family financial shelter against health risks if any, you also save on your tax amount. Many a corporate executive today who fall under the tax slab does buy a mediclaim policy to save tax.

Financial shelter is desired by all and when you pay a meager one-time amount for one term and get your health risks covered, the hassles and worry of spurring medical expenses become far fetched realities.

Most health insurance providers in India offer short term health insurance with a validity of a year at the maximum with options for renewal and a minimum discount if the insured sum is not utilized. With the rising pollution, change in lifestyle, change in eating trends, and a lot more factors, diseases have attacked mankind today like never before.

The intensity is such that as per a survey, one out of every three persons will develop cancer, one out of every four will develop a heart disease by middle age, and the list goes on. Treatment of such diseases is possible in big hospitals that are equipped with good facilities and excellent doctors. And the hospital bills can take a toll on one’s life. This is where health care policy comes into play.

A Health Insurance covers all medical risks involved as stated in the terms and conditions of the particular policy. The insured need not pay the hospital bills if the insured amount doesn’t exceed the bills.

Why health insurance is a must

For example, if the insured amount is Rs. 5 lakh and the hospital expense totals to Rs. 6 lakh, the patient will have to pay the extra Rs. 1 lakh from his pocket; Rs. 5 lakh will be borne by the health insurance provider.

In India, only a select few can afford to pay the complete amount instantly even if they are not insured with any health care policy. They may also ultimately face a financial crunch. Middle class families and lower middle class families are all the more struck financially when they encounter sudden hospitalization and unforeseen medical expenses. Hence for all sections of the society health insurance is a must.

There are a number of Health Insurance Providers that offer health insurance for individuals and families in different variants. Choosing a health insurance provider is again a tough job for the insurance seeker as he/she may not be able to distinguish the benefits covered under various plans offered by the health insurance providers.

A health care policy may not cover all diseases; so, the seeker should study in detail what is covered and what benefits he/she would derive. An online comparison of rates, policies and benefits is the best option to buy a health insurance from the best health insurance provider.

First of all, it is not only possible to buy health insurance when you’re self-employed, it’s absolutely critical … afterall, your health is one of your most important business assets.

Here are a couple of things to keep in mind as you shop for your best health insurance plan. And remember, when it comes to health insurance, there is no one-size-fits-all policy. You’ll need to consider your individual circumstances as you compare options.

1. If you’re relatively healthy, consider a high-premium policy that covers only catastrophic events, such as surgeries and major injuries. The premiums are much lower than traditional health insurance policies, but that means you’ll be paying out of pocket for check-ups and minor medical care.

2. Take advantage of Section 80D: You get an advantage of an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants. For senior citizens, this deduction is Rs. 20,000.

3. If you want more coverage than the catastrophic policy offers, consider a comprehensive policy and then choose the highest possible deductible that you can afford, even if that deductible would be a financial stretch. The dollars you save on the premiums will likely exceed the deductible in the long run.

4. If you choose to go with a comprehensive policy, make sure it doesn’t include coverage you don’t need like: pregnancy, mental health, chiropractic or unnecessary prescription drug coverage. On the other hand, if any of those coverages are important to you, ask your insurer to include them in your policy.

5. Consider a supplemental insurance policy to help cover your deductibles and out-of-pocket medical expenses that aren’t covered by your primary insurance policy. This type of policy can even pay a cash benefit is you are unable to work because of illness or injury, an important feature for the self-employed.

By deciding up-front what type of insurance is best for your situation, you’ll feel more confident as you shop for the best policy.

If you would like to learn more about health insurance for the self-employed, please visit the website recommended below.

The country’s largest private non-life company, ICICI Lombard General Insurance, expects health insurance to contribute a third of its total business in a couple of years. The company, which is one of seven non-life insurers selected to implement the Rashtriya Swasthya Bima Yojna, a universal health programme introduced in 2008-09 budget, has covered 4.5million families under the scheme.

Given the large volumes in health insurance, the company has set up an in-house division I-Healthcare. In future, the management of all health insurance claims will be outsourced to this division. I-healthcare would take over the functions that are presently being outsourced to third-party administrators (TPAs) – entities that network with insurance companies, their customers and healthcare providers to ensure that customers can avail of cashless treatment in hospitals.

ICICI Lombard is the second-largest health insurer in the country after New India Insurance. Figures released by Insurance Regulatory and Development Authority show that ICICI Lombard had a market share of around 17% in health insurance at the end of FY09 (Apr-Mar). The company has booked total premium of Rs 1,031crore in FY09 from health insurance.

According to Bhargav Dasgupta, managing director, ICICI Lombard, there are two challenges in health insurance. First, the group health business which brings in close to half the total premium is overall unprofitable. “On the individual side the challenge is of distribution,” said Mr Dasgupta.

ICICI Lombard is among the seven insurance companies that have won tenders to cover a large section of the population under the RSBY. The scheme facilitates members to get hospitalisation coverage up to Rs 30,000 with the entire premium of Rs 750 per family being borne by the government.

ICICI Lombard has won tenders to implement the project in Maharashtra, Haryana, UP and Rajasthan. It has issued 1.5million biometric smart cards, that contain biometric information of the insured family and facilitate cashless treatment at hospitals.

To bring down the cost the company is working very hard on various channels. “We are way ahead of other in sales through our e channel, but as a proportion of our overall sales it is still small”.

Mr Dasguta said that in the short-run health might see a bit of slowdown in growth as the company attempts to make its group health business profitable. This could result in a reduction in the group business in the short run.

Health is surely one’s wealth indeed. But it is true that one does not think of getting their insurance done against the illnesses until the time comes when they have to face some serious health related problems. Health insurance has become a necessity in the present scenario.

The price of medicinal heed and management has ascended to new tallness in topical years and is predictable to go up still more in the coming years.
What exactly is health insurance:-

Health insurance is actually a protection against medicinal expenses. Non-life insurance corporations propose health insurance. Nevertheless, it could be bought as an extra advantage condition with your life cover plan with few limitations. You have to make your payments in installments or as in the form of lump sum amount.

Health insurance frequently offers either straight expense or compensation for operating cost linked with illnesses and damages. The price and variety of defense given by your health insurance would depend on the insurance supplier and the exacting policy which you may purchase.

Need of a health insurance:-

Suppose for a minute if you face any health problem by tomorrow that might cost a lot of money, then you will get the importance of health insurance in your lives. People who do not get their insurance done live a risky life every day. A good health insurance can guard you against that risk.

Even after having a sound good health you cannot predict what the future holds for you. And therefore the need for health insurance arises. The greater expenses related to medicinal treatments are far above the reach of a common man.

Growing charge of healthcare and rising life duration would force the present age band of functioning class to consider a sensible mix of investment and risk wraps to face future tests. In any of the therapeutic emergency, charge of hospital room, the doctor’s bill, tablets and connected health services would come out to be a massive sum. In similar cases health insurance offers you the financial assistance.

Need to know about Health insurance:-

You should recognize the plan, and become recognizable with frequent health insurance necessities, inclusive of different kind of limitations and conditions. Therefore it is necessary to have knowledge about the coverage that policy offers and to understand how much you have to pay for getting it. Many corporations provide “Mediclaim” for complete health insurance coverage of an individual.

Religare Enterprises plans to roll out its health insurance business by April 2010 even as it continues to scout for a foreign partner for the venture. The company is confident of completing all formalities in the current financial year, said Amit Varma, president for healthcare at Religare Enterprises. We will approach the Insurance Regulatory and Development Authority (Irda) in a couple of months for a licence to start operations, he added.

Religare Enterprises has started hiring for the proposed health insurance business and expects to appoint a CEO shortly. The company is in the process of setting up operations and is likely to appoint a new head by November, Mr Varma said.

The news of a fresh venture comes close on the heels of Religare Enterprises’ aborted joint venture with Swiss Reinsurance for health insurance. The company is now in talks with global health insurers such as Discovery Health, Cigna and Aetna for a possible tie up, learns ET. “We hope to induct a foreign partner in the health insurance venture after our proposed joint venture with the world’s second-largest reinsurer Swiss Re fell through last month,” Mr Varma said.

Religare Enterprises, which has a life insurance joint venture with Aegon of the Netherlands, had signed a non-binding term sheet with Switzerland-based Swiss Reinsurance Co to develop a health insurance joint venture earlier this year.

However, talks between the companies fell through as Swiss Re was already present in the Indian market through a 26% stake in TTK Healthcare Services, a third-party administrator in health insurance, and Religare believed that the new deal could clash with the existing Indian venture.

With a reach of just about 2% of the country’s 1.1-billion population, India offers a huge potential in health insurance market. There are over 30 health insurance products in the category offered by both life and non-life insurers. While ICICI Lombard, Bajaj Allianz and Reliance General are some of the prominent general insurers in the health insurance space, Apollo DKV, Max Bupa and Star Health & Allied Insurance are the standalone players.

Religare is a Delhi-based financial services holding company, led by the former promoters of Ranbaxy, brothers Malvinder and Shivinder Singh. The company is present across retail, institutional and wealth spectrums through its subsidiaries and joint ventures.
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Introduction

Having health insurance is important because coverage helps people get timely medical care and improves their lives and health. Some may believe that people always have access to medical care because they can always go to an emergency room.

But even areas with well supported safety-net care do not remove barriers to access to the same extent as does having health insurance. “Coverage matters,” concluded the Institute of Medicine (IOM) during a recent multiyear appraisal. Indeed, the prestigious IOM estimated that lack of coverage was associated with about 18,000 extra deaths per year among uninsured adults. Several points deserve emphasis.

1. Uninsured people receive less medical care and less timely care.

Overall, uninsured people get about half as much care as the privately insured, as measured in dollars spent on their care—even taking into account free care received from providers. This discrepancy holds true even when spending is adjusted for age, income, health status, and other factors. (This finding and most information presented here do not come directly from District sources, for which data are often lacking. But most patterns are believed to be generally true of all locations.)

Uninsured adults get fewer preventive and screening services and on a less timely basis. Shortfalls are documented for many types of illness or condition, including screening for cervical and breast cancer as well as testing for high blood pressure or cholesterol. Cancers, for example, are more likely to be diagnosed at a later stage of illness, when treatment is less successful.

Uninsured pregnant women use fewer prenatal services, and uninsured children and adults are less likely than their uninsured counterparts to report having a regular source of care, to see medical providers, or to receive all recommended treatment. Shortfalls are particularly notable for chronic conditions. For instance, uninsured adults with heart conditions are less likely to stay on drug therapy for high blood pressure.

Some uninsured people may decide not to obtain insurance precisely because they expect not to need medical care, so simple comparisons of the insured and uninsured can be misleading. However, many studies adjust for factors like age and health status that affect need for care.

One recent study examined people who experienced an unintentional injury or a new chronic condition—times when care is more clearly needed. Uninsured individuals were less likely to obtain any medical care, and if they did receive some initial care, they were more likely to get none of the recommended follow-up care.

Agent

An agent is appointed by the insurer to conduct business on behalf of the insurance company. An agent must hold a license issued by the IRDA.

Claim

The process of applying to the insurer for reimbursement of the expenses incurred for treatment is called “filing a claim”. Usually, this process is handled by a service provider to the health insurance company. This service provider is called a “Third Party Administrator” (See below).

Cashless Claim

As the term suggests, the insured can make a claim without paying any cash upfront.
The insurer or its Third Party Administrator have tie-ups with network of hospitals and nursing homes called a “network hospital”(see below) across the country. The insured can get themselves admitted in these specified network hospitals and take treatment for the disease contracted without any cash payment to the hospital at the time of discharge.
However cashless mediclaim settlement is subject to the limits and sub limits which is subject to the sum insured of the policy.

Coverage Amount

Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the health insurance policy is dependent on the coverage amount chosen by you.

Critical Illness Policy

A Critical Illness is a serious possibly terminal disease, which is strictly defined by the insurer. Conditions such as cancer, multiple sclerosis, major organ transplants are deemed as “Critical Illness”. Most critical illness policies provide for the payment of a lump sum benefit if the policyholder is diagnosed as suffering from one of a number of specified terminal conditions.

Cumulative Bonus

Each claim free year ensures that you get a benefit known as “cumulative”bonus – it is similar to “no claim discount”(see below) in concept. The only difference being that instead of giving an upfront discount, the health insurance company adds more benefits for the same premium paid. However, the overall amount of these benefits will not exceed a certain percentage as specified in the policy.

Related Links
Healthcare Insurance-Common Terms and Definitions

Tamil Nadu’s Karunanidhi government has reached out to people with a unique offer: a Rs 517-crore state health insurance scheme for 1 crore poor families. In a grand gesture, the CM also said that his house will be turned into a free hospital. CNBC-TV18’s Meenakshi Madhavan reports.

After free colour TVs and rice at Re 1 per kg, DMK chief K Karunanidhi has another gift for Tamil Nadu’s poor. He’s now giving them health cover! Union Health Minister Ghulam Nabi Azad was in the state to inaugurate the Kalaignar Insurance Scheme for life-saving treatments. The scheme will benefit 1 crore poor families who can now avail of medical services up to Rs 1 lakh. The premium of Rs 500 per year will be paid for by the government.

“If the Kalaignar Insurance Scheme for life-saving treatments reduces the out-of-pocket expenditure of poor households and ensures quality health services for them, it would have alleviated the pauperization of poor households as health expenses are one of the leading causes for families remaining poor,” Health Minister Azad said.

Star insurance, a private insurance provider, will implement the scheme. It has already identified six hospitals in each district and 15 hospitals in each major city where the scheme will be made available.

“The DMK believes in starting schemes that will help the needy,” Karunanidhi has said.

It’s yet another populist measure from a party known for its sops. The CM has said that after he and his wife dies, he wants a free hospital to be built on the land he owns in his native village. He also wants his Chennai house to be converted into a free hospital. This one is sure to take Karunanidhi closer to the masses.

What is the best health insurance available for the age group of 72-80 and for 44-50 ?

Key factors: lowest possible premium and maximum premium

Unfortunately, there is no fresh health insurance policy available for the age group of 72-80. For age group of 44-50, I advise you to go for Star Health and Allied Insurance Company’s Medi Classic Individual Plan or Family Health Optima Plan, as the case may be.

A term insurance plan is the cheap and best bet!

A term plan is pure protection. It is the cheapest type of life insurance policy. But what you see might not be what you get, most insurers have a range of health parameters for standard rates.

If any of your health parameters — weight, blood pressure for instance fall outside this range, you will pay more. For some companies, the standard range is very narrow.

Certain life insurers offer concession on premium rates for those who make efforts to maintain good health (like not smoking) — in other words, those who are likely to survive the policy term.

The Birla Sun Life insurance offer insurance policies in three categories — preferred non-smoker, non-smoker and smoker. For a preferred non-smoker, the premiums rates will be relatively lower, as his/her state of health (height, weight, family history and so on) will be evaluated before issuing the policy .

Besides, most insurance companies offer different rates for women. For instance, a woman aged 33 could be paying the same premium that is applicable to a man aged 30.

If you want only protection for the lowest premium, then term plans are the best bet.

You can get back what you paid under a return of premium policy. The additional payments that you make towards return of premium are tax deductible as well under Section 80D.

Q. Is a medical checkup necessary before buying a health insurance policy?

A. A medical checkup is necessary for a new affordable health insurance policy for customers above the age of 40 or 45 years depending on the health insurer’s norms. Medical checkups are usually not needed for renewal of policies.

Q. What are the minimum and maximum policy durations?

A. Health insurance policies are general insurance policies usually issued for a period of 1 year only. However, some companies also issue a two year policy. At the end of your insurance period you must renew your policy.

Q. What is coverage amount?

A. Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the policy is dependent on the coverage amount chosen by you.

Q. My wife and children are residing at Chennai while I am here in Mumbai . Can I cover all of us in one policy?

A. Yes, you can cover the entire family under one policy. Your health insurance policy is in force across India. You must check whether there is any network hospital near to your as well as your family’s place of residence.

You must check if your insurer has a network hospital close to you or where the rest of your family resides. Network Hospitals are the hospitals that have tied up with the TPA(Third Party Administrator) for cashless settlement for expenses incurred there.

If there are no network hospitals at the place of your residence, you could opt for reimbursement mode of settlement.

Q. Are naturopathy and homeopathy treatments covered under a health policy?

A. Naturopathy and Homeopathy treatments are not covered under a standard health policy. The coverage is available only for allopathic treatments in recognized hospitals and nursing homes.

Q. Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?

A. Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc as long they are associated with the patients stay in the hospital for at least one night. Any diagnostic tests which have been prescribed in the OPD are generally not covered.

Q. -I am young and healthy. Do I need health insurance?

A -Yes. You will need insurance. Even if you’re young, healthy and haven’t had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency.

While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren’t too costly like routine doctor’s visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury.

No one knows when a medical emergency might strike. It is best to buy health insurance, to save money when an emergency strikes.

Q. Is Health Insurance the same as Life Insurance?

A-No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death/or if something happens to you.

The payout is made only post the death of the person insured or at the maturity of the policy.

Health Insurance protects you against ill health/diseases by covering the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury.

There is no payout made at maturity. Health insurance also needs to be renewed annually.

Q-My employer provides me with health insurance coverage. Is it advisable to take another policy on my own?

A_It is strongly advised to have health insurance on your own as well because of reasons of continuity. Firstly, if you change your job, you might not necessarily get health insurance from your new employer. In any case you will be exposed to health costs in the transition period between jobs.

Secondly, the track record that you have built in health insurance at your old employer will not transfer to the new company policy. Covering pre existing diseases might be a problem. In most policies pre-existing diseases are covered only from the 5th year onwards.

Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group health insurance policy.

Q. Is there any tax benefit that one can avail of while purchasing Health Insurance?

A-Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants.

For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show the proof for payment of premium. (Section 80D benefit is different from the Rs 1, 00,000 exemptions under Section 80 C)

Speaking to media persons on the occasion of launching a new 360 degree health plan – Maxima, the CEO said that Indian health insurance market grew from Rs 500 crore 11 years ago to the current Rs 10,000 crore.

The CEO further claimed that Maxima is India’s first 360 degree health plan which is set to redefine health insurance in the country.

Initially, it will be available in the four metros and Bangalore and Hyderabad. It has special features like life long renewal benefit, annual comprehensive health check up, Rs 3 lakh cover for IP treatment with pre and post hospitalization benefits, Income tax benefit and cumulative bonus and carry forward of OPD benefits.

In the last three years, the health insurance market has been growing at a CAGR of over 45 per cent and it is expected to clock 50 per cent growth per annum in the next five to seven years.

The venture, which has rolled out first generation products, sees tremendous scope to become a significant player in the segment.

The products are valid in all the hospitals across the country on a reimbursement basis. Its policy holders can avail cashless hospitalization service in around 4000 designated hospitals, including 42 Apollo group hospitals.

It will leverage on the backing by India’s largest integrated healthcare group in partnership with Europe’s No I pure health insurance company.

Mr Jacob said the venture will go in for bank assurance model for forging tie ups with banks for selling the products once the existing rules (which restricted the tie up to one life insurer and one non-life insurer) are relaxed.

Besides the agency force, it is using exclusive tie ups with NBFC s, database marketing, internet etc, for distributing the products.

He said that the company has started developing co-insurance products and the first one was launched in August this year in tie up with HDFC alliance. Under such initiatives Apollo DKV would design the product while the marketing would be done by the partner.

It will also look at partnering with state governments to cover a large number of weaker sections. It has signed a MoU with Meghalaya government for an insurance scheme (RSY) and is expected to be rolled out next month.

At present, the Central government employees are covered under the CHGS scheme, being operated by the health ministry.

The government has formulated a novel health insurance scheme that will allow its employees to choose between a health insurance plan provided by an insurer or that from state-run Central Government Health Scheme (CGHS).

“The scheme is already formulated…It will open the choice for government servants,” G C Chaturvedi, Additional Secretary in the Finance Ministry told news agency.

The new scheme explained

The new scheme, which will be placed before the Union Cabinet for approval soon, will immediately benefit at least three lakh Central government employees, he said.

The new scheme, Chaturvedi said, will be more beneficial to the employees who are posted at places where there are no CGHS dispensaries or they are far away from the place of posting.

CGHS dispensaries and hospitals are located only in 26 places in the country.

“Those who are residing outside CGHS dispensaries areas will immediately opt for it… There are over three lakh employees who will immediately opt for it, others will take some time,” Chaturvedi said.

The government had earlier appointed an inter-ministerial committee to work out a health insurance scheme to supplement the CGHS scheme to provide better coverage to its employees.

The fairer sex is not getting a fair deal despite conclusive evidence of higher life expectancy for women.

Life expectancy of males in India is 63.87 years whereas females score 66.91 years, according to data available with the ministry of health and family welfare.

“A majority of women are non-smokers, which contributes to their longer life,” says SK Sethi, vice president and director of the Insurance Brokers Association of India. But while absence of distinction between men and women on premiums is the norm, some exceptions are emerging.

Aviva Life says it offers women lower rates in case of its pure-protection product, Aviva Life Shield Plus, and charges less for certain unit-linked plans too.

LIC has an exclusive insurance product aimed at women — Jeevan Bharathi — and premiums charged are lower in this case than regular policies, says ED Rajesh Kandwal. However, such examples are few and some in the industry say it is also because of poor financial literacy standards.

One insurance broker, who asked not be named, said companies charged both men and women equal premium because most women are unaware that once they reach the middle age, they carry lower risk and, hence, should be charged less.

Health Insurance Covers hospitalization when a patient is in hospital for more than 24 hours due to:

1)  Surgery requirement
2)  Illness
3)  Accident
4)  Symptoms, when diagnosis is been done

According to the Document of Cholamandalam MS General Insurance the costs covered are :

1. Room, Boarding Expenses in Hospital/Nursing Home
2. Nursing Expenses, intensive care unit expenses,
3. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees
4. Anesthesia
* Blood Oxygen,
* Operation Theater Charges,
* Surgical Appliances, Medicines,
* Drugs,
* Diagnostic Materials,
* X-ray,
* Dialysis,
* Chemotherapy,
* Radiotherapy,
* Pacemaker cost,
* Artificial Limbs,
* Cost of Organs.
5. Pre-Hospitalization Expenses
6. Post-Hospitalization Expenses
7. General Health and Eye Examination (Optional with extra premium)
8. Local Ambulance Services (Optional with extra premium)
9. Hospital Daily Allowance (Optional with extra premium)

Admissible Limits:

• Minimum 24 hrs. Hospitalization except Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy, D&C, Tonsillectomy (insured discharged on same day)
• Pre-Hospitalization Expense: Laboratory, X-ray or any other medically necessary diagnostic procedures ordered by a physician (60 days prior to Hospitalization in case of all type of covers)
• Post-Hospitalization Expenses: The medically necessary treatment ordered by a physician and readered (within a time period of the Insured person’s discharge from Hospital or Day Treatment) (90 days after hospitalization in case of all type of covers).
• General Health and Eye Examination: Radiology, Blood Diabetes, Liver, Renal/Kidney, Cardiac Lipid, Phospholids, Lung, Abdomen, Cancer, Optometry, Slit Lamp Examination, Direct Fungus Examination, Indirect Fungus Examination, Color Vision Testing, Prescription of Glasses if necessary.
• Local Ambulance Services; Emergency ambulance road transportation by a licensed ambulance service to the nearest Hospital.
• Hospital Daily Allowance: The Hospital Daily Allowance benefit is payable per day of Hospitalization in India for a limited period per person and policy period.
• Day care Surgeries: Microsurgical operations on the middle ear, other operations on the middle and internal ear, nose and the nasal sinuses, the eyes, the skin and subcutaneous tissues, the mouth and the face, Traumatological surgery and orthopedics, the breast, the digestive tract, the female sexual organs, the male sexual organs, the urinary system. For Applicants aged 45 and above a medical test is mandatory.

Weigh the cost and benefits.

When selecting an affordable and cheap health insurance plan, think about the benefits you may need, and what level of protection you feel comfortable with in case the unexpected happens, and be sure the plan you choose includes them.

Health plans have various benefit structures-some of the typical benefits excluded or limited in cheaper plans include:

1.Doctor’s consultation fee
2.Prescription drug coverage
3.Maternity benefits
4.Chiropractic care

Conversely, some health plans provide limited benefits that may only cover some preventive care or doctor’s office visits, and very limited hospital care.

Look at the premium.

The premium is the monthly fee you must pay in order to keep your health insurance plan. This is the first step in determining if you can afford a health care plan. Make sure you can pay this fee each month; if you fail to make a payment, you may be dropped from your plan.

If benefits are important to you, look past the cost of the premium.

Usually, paying a higher premium will result in more benefits. If certain benefits are important to you, you may want to pay the higher premium to get them. As with many things, you can pay more to get more.

Buying the best individual health insurance requires some knowledge about health insurance companies and their plans. Most people have never been educated in Insurance.  No company will pay benefits not covered in a policy, and the commissioner of insurance will uphold the company’s decision to decline benefits that are not specifically covered.

Law suits against insurance companies are seldom won as companies are experts in making sure every detail of coverage is spelled out. Yet, the average client has never actually read an insurance policy from cover to cover.

The policy arrives in the mail and is shoved into a drawer or a file box and never actually read. Bear in mind that neglecting to read the policy does not make a company liable for things you didn’t understand.

That being said, you will avoid confusion and have greater peace of mind if you work with an agent who is willing to take the time to help you understand your policy. Don’t just assume your agent will do this.

Many will simply send the policy in the mail and leave you to figure it out. A truly good agent from a reputable company is worth working with even if the premium is a few dollars more. When you do select an agent, you should be sure to ask the following questions.

• How long do pre-existing conditions apply?

When you go from one group coverage plan to another, the pre-existing condition clause is waived. This is not true when going from group coverage to private coverage. Your new company may refuse to pay for a pre-existing condition for as long as two years. They may also look back over your entire life for that pre-existing condition. Thus, if you had cancer 15 years ago but are still taking some sort of preventive medication, you will have a waiting period even though you have been cancer free for 14 years.

• What are the exclusions? There will always be some as no company pays for everything. You need to know what they are.

• What are the anticipated rate increases?

Your agent may tell you that he doesn’t know as rates are approved by the commissioner on an annual basis. That much is true, but the company has charts showing what your premium would be today for any given age. They also know the average company increase rates over time. Don’t buy if they won’t provide you with that information.

• What is the lifetime maximum benefit?

• Can you reduce the premium by taking a higher deductible?

• How are co-payments determined?

• How do you get permission to go to the hospital?
  

• Are prescription drugs included? Is there a separate deductible? What is the copay?
• How are customer service issues handled? Can you get help from the agent?

Health insurance is not very expensive when compared to the cover it gives you.

Healthcare is increasingly expensive, with technological advances, new procedures and more effective medicines that have also driven up the costs of healthcare.

While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

The costs payable for a health insurance policy generally depends on various factors like the number of persons insured, their age group, the sum insured opted for, the cost sharing mechanisms like co-payments and deductibles in the policy, health status of the proposed insured persons, and the kind of coverage sought.

The costs thus start from a subsidized premium of Rs 100 under a Universal Health Insurance Scheme policy for a person below the poverty line, and could reach up to tens of thousands for high amounts of comprehensive coverage.

For illustration purposes, the data of the insurance regulator for 2007-08 indicates that the average premium per person was in the range of Rs 1143 per person during the year, which comprised of a mix of group individual policies with varying cover.

It is important to be an informed customer and do proper research on insurance companies and the health insurance products as there is so much variety and choice available.

Despite the variety available, there is no single policy which could fit all the needs of all individuals.

It is important to assess one’s needs from a health insurance cover and choose a cover, or covers, appropriately.

It is possible to combine different products for coverage appropriate to one’s needs.

Thus, for example, a hospitalization indemnity policy could be complemented with other insurance covers like a

• Critical illness benefit policy or
• A hospital daily cash benefit policy, which could be used to cover incidental costs not covered by hospitalization indemnity products, like excess room charges or the loss of income due to hospitalization, and
• Various other ‘non-medical’ expenses not reimbursed in health insurance plans.

Similarly, adding a personal accident cover helps maintain life style and also accommodate for additional cost of disability caused by accidental injuries.

For those already covered under a group insurance scheme by their employers, a high-deductible health insurance policy is a useful add-on which enhances coverage and provides continuity as an individual product.

When comparing policies, do not compare them just on the premium structure, but also on the details of the scope of coverage, waiting periods, exclusions, cost sharing provisions and other policy terms and conditions.

Cost sharing provisions

Health insurance policies also use cost-sharing provisions though the extent and amount of such cost sharing requirements varies between products and insurers.

The cost sharing provisions include sub-limits, which cap the maximum amount payable by the insurer for a particular procedure or cost component, as also co-payments, which are a cost-sharing requirement that provide that the insured will bear a specified percentage of the admissible costs.

Another cost sharing mechanism, a deductible provides that the insurer will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable by the insurer

Always buy a health insurance policy when you are young

Buy a policy at a young age to avail richer benefits and do cover your entire family- all of them are exposed to the risk of medical costs. Make sure that you pay the premium regularly & renew your policy in time, as failure to do so may lead to loss of continuity benefits.

Fill the proposal form correctly and completely

It is important to fill the proposal form correctly and completely, including the questions on health status. Otherwise, any non-disclosure or incorrect disclosure may lead to the policy being rendered invalid or the claims on the policy being denied.

Insurers may also require a medical examination and lab tests before buying a policy, especially when the proposal form for a new health insurance policy indicates the need for the same and also where insurance is sought for the first time by a person above a certain age, say 45 or 50 years, though this varies from insurer to insurer.

It may also be required when the sum insured is sought to be raised at renewal time.

There are multiple channels available to purchase Health insurance.

• You can buy health insurance products either directly from the various channels offered by the insurance company, including online sales and telephone or
• Through IRDA licensed intermediaries like agents and brokers.

It is important to purchase health insurance only from authorized channels.

Swine Flu -Is it covered or not?

Insurance companies have come out with some clarifications and these are;

1. Cost of Tami flu is not covered as this is being given by the Government on free of cost basis.
2. Private hospitals can charge the patient for facilities like tests, beds and doctors fees. And this will be covered.
3. If admitted in a hospital and the tests are negative then nothing is payable. If positive then it is payable.
4. If it is a new policy then 30 days clause is applicable. Summary of all points is do not wait ,get health insurance policy ,otherwise be prepared to be treated in one of the government owned hospital. Wish you best of luck so that you don’t get affected with this disease.

TPA’s to deduct TDS when releasing payment to Hospitals

Recent news item indicates that this decision is being implemented. We are not going into details but we feel that the impact of this will be increase in rates by hospitals as they will find it a necessity to increase the rates with a view to handle the increased need for working capital.

The normal inflation of health acre in India is 15% per year-should we expect 18% this year. Let us wait and watch.

Medical Mafia Aug 28, 2009 issue of Fortune

It is always a pleasure to read independent articles in publications like Fortune, where unbiased article can be eye opener for all of us.

This article is worth reading – where a group comprising of doctors and lawyers handles the cases and fights with Health Insurance co’s so that the genuine or inflated claims are passed.

They manage the best of doctors assisted by lawyers to appear in the court so that the client gets paid. Ofcourse the agreed % out of this payment goes into their (lawyer/doctors) pocket. Question before us is does it happen because Health Insurance co’s are hesitant in passing of claims?

We do hope that Indian Non Life Insurance co’s as well as Health Insurance co’s will take corrective steps and we can avoid excessive role for lawyers to get the claims passed.

The Chairman of the Insurance Regulatory and Development Authority (IRDA) on Tuesday said that low consumer awareness and insufficient healthcare infrastructure are the major hindrances to widen the reach of healthcare insurance in India.

“Even if there is a marginal increase in the type of healthcare insurance services, we will find our physical capacities insufficient. Therefore, there is an urgent need to build alternative systems to take care of the deficit in healthcare infrastructure,” stressed J. Hari Narayan, Chairman, and IRDA, at the Health Insurance Summit 2008 organized by the Confederation of Indian Industry (CII) here.

Mr. Narayan emphasized on building up investment in infrastructure and adequate training along with focus on improving the traditional systems of government and public hospitals.

“In order to cover larger proportion of the Indian population, it is requisite that we encourage the public private partnership mode,” advocated the IRDA Chairman. Mr. Narayan also stressed the importance of developing new and simple insurance products, where majority of the policy could be on the Internet and further recommended that insurance policies be also explained in vernacular languages to reach the masses.

“Requiring the third-party administrators (TPAs) to build their IT systems and infrastructure for speedier claim processes, encouraging insurers to make their systems robust and embarking on wide consumer awareness programmes are the various measures undertaken by IRDA towards the growth of the health insurance in India,” said Mr. Narayan.

“It is time to take major steps in bringing good health to all people,” said Prathap C. Reddy Chairman, CII National Healthcare Council & Chairman Apollo Hospitals Group, through video conferencing at the CII Summit. While commending the model followed by the Andhra Pradesh Government in making healthcare reach the masses, he said measures should be taken to make such a model sustainable with appropriate contribution by consumers, providers and insurers.

Regarding consumer awareness as a major challenge for the healthcare insurance in India, Dr. Reddy stressed on the importance of making health insurance a way of life by spreading consumer awareness rather than through the use of compulsive methods.
The CII-KPMG report on ‘Health Insurance Inc. — the road ahead’ was released at the summit. The report gives an outlook of the healthcare insurance industry with emphasis on the challenges and growth enablers.

The US health insurance companies are tying up with Indian corporate hospitals for flying down patients to the country for treatment in order to cut costs. Wellpoint, the largest health insurance company in the US, and Bluecross Blueshield have joined hands with Apollo Hospitals to treat the US citizens.

Wellpoint and Apollo Hospitals are set to start a pilot project next month to treat the US insurer’s members in Apollo’s hospitals in Delhi and Bangalore, which was approved by the Joint Commission International (JCI), the US-based hospital certifying agency.

Apollo Hospitals president (corporate development) Anil Mani said: “The pilot project will run for 6-12 months.” The Wellpoint’s website says it has around 35 million members. In other words, one in every nine Americans is affiliated with the company.

Apollo, the country’s largest hospital chain, was in discussions with Wellpoint for around two years. Mr Mani said that it has also tied up with another health insurance firm, Companion Healthcare, the South Carolina subsidiary of another leading US insurance company BlueCross Blueshield.

Similarly, Wockhardt Hospital, which tied up with Companion Healthcare last month, hopes to ink similar deals with the other US health insures to treat the insured citizens. Wockhardt Hospitals CEO Vishal Bali said, “Wellpoint has already completed assessment of Wockhardt Hospitals. We are also in talks with few other health insurance companies and exploring the possibility of expanding our tie-up with Bluecross Blueshield to other US states.”