There is good news for medical tourists! Most insurers retreat when it comes to covering medical procedures performed overseas, but times are changing as some insurers are exploring the option.

Twenty years ago, an American needing knee surgery probably wouldn’t think of jetting off to India for the operation. But times keep changing, health insurance costs keep rising, and Kumar Jagadeesan can cite a statistic that has led many patients to jump aboard a plane.

“A knee surgery operation in the U.S. can cost $45,000 to $50,000,” says Jagadeesan, the vice-president and CEO of Star Hospitals.net, a medical travel company. “In India, the cost would be $10,000, plus the price of a plane ticket,” which could be as little as $1,330 for a round-trip.

Star Hospitals.net is one of several medical travel companies advertising inexpensive services where patients fly to India, Thailand, the Philippines, and other countries to have surgery. With a few notable exceptions, however, insurance companies aren’t eager to cover these trips, even while they acknowledge the cost savings may be great. So for now, most patients must put up their own cash or put down a credit card.

Worries About Credentials

Why are insurers reluctant to send policyholders overseas? “One of the biggest issues is credentialing claims,” says Scott Edelstein, a lawyer with the global law firm Squire, Sanders & Dempsey. “They have to take reasonable measures that the providers overseas have the credentials to provide adequate care.”

Most medical travel companies, including Star Hospitals, currently rely on the Joint Commission International (JCI), an American nonprofit that accredits hospitals in the U.S., to help find suitable medical centers overseas. Lately the number of international hospitals getting the thumbs-up from the JCI has been growing. “There is great potential for growth, which is being driven by the build out of high quality hospitals on the global scene,” says Josef Woodman, the author of Patients Without Borders. Kenneth A. Powers, the JCI’s media relation’s manager, said that in 2005, there were just 76 JCI-accredited hospitals. Now there are more than 220.

JCI accreditation will probably help insurers overcome fears of getting sued by injured patients. But there are other issues to worry about. The insurers “have to make sure there will be smooth claims processing,” says Woodman. And, he says, there are concerns about continuity of care. “What happens when the patient comes back? Even if there are no complications with a procedure, how much is the insurance company willing to cover for physical therapy back in the U.S.?”

Few Legal Options

Despite these lingering issues, a few insurers have been bold enough to dip their toes into medical tourism in the past year. In March 2008, Blue Cross & Blue Shield of South Carolina signed alliances with seven overseas hospitals (BusinessWeek, 03/13/08). And more insurers are in talks with medical tourism companies, attests Rudy Rupak, founder of the medical travel agency Planet Hospital. “Right now we’re having active discussions with insurance companies about adding us to their plan design,” he says.

Getting more insurers involved might help ease patients’ reluctance to fly to another country for a procedure. But lack of coverage is not the only deal-breaker. “What happens if there’s an adverse effect?” asks Edelstein. “Will they have any recourse? That’s a very hot area in the legal arena. For the most part, those patients are not going to have much recourse in the U.S.”

Nor will patients have many legal options in the country where they had the operation. “Access to the court system in countries like India is not as good as in the U.S.,” Edelstein adds. “And even if you do get a trial, the judgments tend to be much lower than they would be in the U.S.”"

Nevertheless, Woodman and others are optimistic about the changing world of medical tourism and the role of health insurers. “When you think of medical tourism 20 years ago, you picture the Beverly Hills crowd of upper-crust men and women going to Brazil for a procedure and coming back home to brag about it,” says Woodman. “The profile has changed. It’s becoming a middle-class and working-class phenomenon, where folks are being driven to seek cost-effective alternatives.”

The innovative scheme of Rashtriya Swasthya Bima Yojna (RSBY) announced by Prime Minister Manmohan Singh on Independence Day last year that was formally launched on October 1, 2007 and activated on April 1 2008 is all set for a global stage.

After getting accolades in the Wall Street Journal that carried a detailed article on RSBY titled “India’s poor get health card to fund medical treatment”, the World Bank has now invited the Indian officials to make a presentation of the scheme before other countries at the World Bank headquarters in Washington.

The presentation is scheduled for November during the annual meeting of the World Bank on “most innovative ideas”. At the meeting, countries selected for their innovative ideas, share their plans with other nations.

The cashless and paperless health insurance (RSBY) is made available for BPL (below poverty line) families across the nation.

Under the RSBY, a smart card is given to a BPL family that contains complete personal data and thumb impressions of the entire family members. Over five lakh cards have so far been issued in 16 states and 1,200 patients have already used their cards in Haryana, Delhi and Punjab.

“The biometrics help check any misuse of card,” said Anil Swaroop, Director General Labour Welfare.

To obtain the smart card, each BPL family has to pay Rs 30 that entitles the entire family — head of the family/spouse and three children — to receive over 700 medical treatments/surgeries costing up to Rs 30,000 for one year. Once the whole money is debited from the beneficiary’s account he can get a recharge of the same amount by again paying Rs 30.

The salient feature of the scheme is that it actually empowers the economically backward family to choose the service provided by various government or private hospitals.

Swaroop said that several experiments on health insurance schemes have failed so far and the world is looking for a foolproof scheme.

“It is considered a technically innovative scheme as this card is cashless and paperless involving transactions that are done electronically,” said Swaroop, who will be heading to Washington in November to make the presentation. “In two months time, details of each card distributed and in use will be available on the Internet,” added Swaroop. While the Centre finances 75 per cent of the cost of the scheme, the state governments have to pay 25 per cent.

For the distribution of cards, an electronic list of… eligible BPL households is also provided to the insurance company according to a pre-specified format. The list is also posted in each village prior to the enrollment, the date and location for which it is publicised in advance.

The mobile stations are set up at local centers and are equipped with hardware required to collect biometric information of family members. They also print smart cards and distribute information pamphlet describing the scheme.

APOLLO DKV, HEALTH INSURANCE COMES WITH A HEALTH ASSURANCE

Special features of Apollo DKV health insurance: Products and services would be valid on a “Cashless Basis” in over 4000 of best hospitals (including the 42 Apollo hospitals) across India and on a reimbursement basis in all hospitals in the country.

(FAQ’s) Frequently Asked Questions

Q: What is a Family Floater plan?

A Family Floater is a single policy that takes care of the hospitalization expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.

Q: Why should I take a Family Floater Health Plan if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Family Floater Health Insurance policy will come to your rescue.

Family Floater Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.

Q: How do I go about getting in touch with someone for a health insurance plan with Apollo DKV?

Simply Contact us at 9884843378 or 044-26263372

Q: Is the premium exempted from Income Tax?

The premium is exempt under Section 80D of the IT, Premium up to Rs.15,000/- qualifies for tax benefit under Section 80D of Income Tax Act

EASY HEALTH STANDARD PLAN @ A MINIMUM OF Rs 3/day

Standard Plan

A plan that is tailor-made especially to fit every one’s pocket. Starting at just Rs. 3/day. Health insurance was never so accessible before.

The mission of Apollo DKV is to constantly introduce innovative health insurance and wellness solutions that meet customer needs. Our product philosophy emphasises the incorporation of wellness and prevention components into health insurance with the goal of moving the current market, which is largely addressing “curative” needs, to a “preventive” focus.

Apollo DKV will approach the market with products that will have differentiated features / benefits / service offerings and reflect our philosophy of wellness and prevention.

To avail a Apollo DKV plan call us at 044-26263372,9884843378

Apollo DKV Easy Health Insurance Plans are designed in a way to suit your need and fit your pocket. They will not only guard you against the spiraling medical costs but will also guide you on the path of wellness, providing you a double protection of prevention and cover.

The Easy Health Insurance Plans are available for Individuals (Easy Health Individual Health Insurance Plan) and Families (Easy Health Family Health Insurance Plan). These Plans manage you and your families health-related needs right from consultation, hospitalisation to the post-hospitalisation.

These policies are available on a cashless basis in over 4000 hospitals thus managing your expenses and providing hassle-free transactions. To let you decide on what policy suits your needs they come in three variants, which gives you a choice to decide your premium.

The Easy Health Insurance policies are power-packed with unique features like cash credited on daily basis on choosing shared accommodation, daily cash for accompanying an insured child, maternity expenses*, health check-up, spectacles, contact lenses, etc. and out-patient dental treatment**.

Wide options:

Choose from the wide choices of the sum insured starting from Rs 1 lac to 10 lacs.

Portability:

A customer-friendly policy that ensures that you avail most of the accrued benefits when you opt for Apollo DKV’s health insurance plans.

Pre-Hospitalisation and Post-Hospitalisation cover:

Takes care of medical expenses incurred before and after the hospitalization.

Cumulative bonus:

Get special incentives on every renewal after a claim-free year.

Tax benefits:

Get tax benefits for the premium amount under Section 80D of the Income Tax Act.

The best family health insurance policy would be one that is tailor-made to suit your requirements as well as your budget. Considering that its function is to shield against any medical contingency, it would be wise to opt for the best health insurance cover after due comparison with other family health insurance plans with a good financial advisor who would give you an unbiased view of the plans and services of the company. Check out for a good financial advisor with your friends.

Should you need any further information that you, as a consumer, would require on the plans and specified family health insurance covers offered by a particular health care company, ask your freinds who have availed of health insurance plans from that particular company and ensure that the company is quick and prompt in settling claims. Also enquire about good agents who would render prompt services.

12 key points to ascertain before cutting the cheque

• Is the monthly/yearly/semi annual premium affordable?
• Upto what percentage of the medical costs would I be reimbursed?
• Would I be reimbursed if I use the services of a medical professional not included in the insurance firm’s network? If so, how much?
• Will the plan cover any pre-existent medical problem?
• Does the plan cover terminal illness like cancer or AIDS or chronic conditions like asthma or diabetes? If yes, how would they be treated?
• What are the procedures for obtaining medical care and reimbursement, in an emergency?
• Does the plan cover reimbursement of alternative medicine procedures?
• Does the plan cover the costs involved in delivering a baby?
• What are my doctor’s/friend’s opinion about their experience with this Plan?
• What is the percentage of members who “disenrolled” from the Plan?
• How many complaints filed by patients against the Plan were upheld by the Insurance regulatory development authority(IRDA)?
• Most important, what sort of accreditation/rating has the Plan received from independent government and non-government Commissions like CNBC TV- 18, Outlook Magazine and other established financial magazines.

Bank Of India with National Insurance Co. has started from this year a new attractive family floater Health Insurance Policy exclusively for Bank of India account holders,BOI Card holders and its employees with Lower premium.

Special features are:–

1. Bank Of India account holder will be the Policy holder(For this you have to open an SB a/c with a near by Bank Of India Branch)
2. Hospitalisation expenses of policy holders & their family members,totalling 4 persons will be covered under one policy.(self,spouse and 2 children below 21 years)
3. Available to persons in the age group of 3 months to 65 years.
4. Floater Policy(any one or all family members can avail Hospitalisation benefits during the policy period up to the sum insured opted) .
5. Sum insured fromRs.50,000/- to Rs.5 lacs.
6. Ambulance charges payable up to Rs.1000/-per policy period.
7. Out of pocket expenses payable for hospitalisation of children below 12 years -a lumpsum amount of RS.1000/-per policy period.
8. Cost of Health Checkup after 3 continues claim free years.
9. Pre-existing diseases covered from 4th year onwards. .
10. No medical examinations is required before acceptance. .
11. Premium exempted under Sec 80D of IT Act. .
12. ashless access through 3rd party admin.in network hospitals all over India. .
13. Reimbursement of claims by TPA where treatment is taken in non-net work hospitals. .
14. Pre & Post Hospitalisation expenses for first 30days and 60 days resp.
15. Maternity benefit and Baby care expenses are also reimbursed up to 5% of the sum insured.

I am giving below few sum insured and premium payable(including Tax)

Rs.50,000/-………..Premium Rs.931/-
Rs.1 lac……………………… …….Rs.1748/-
Rs.1.5 lacs ……………………….Rs .2638/-
Rs.2 lacs…………………….. ……Rs.3394/- ( like this goes up to Rs.5 lacs)

To obtain the policy,first you have to open an a/c and become a BOI family member.

The best way is to contact different insurance agents, as there are lots of companies these days and take the opinion of all of them and decide which one is best for you. To start with read through these articles which help you decide on the company that has the policy to suit your needs.

New India Insurance may be the best for you.

Read through the mediclaim policy 2007 of “The New India Insurance Company” published in Medindia.net.

New Delhi-based public sector general insurer Oriental Insurance has introduced a new set of mediclaim policies that is targeted at the youth.

Oriental has reworked its policies with an aim to reduce losses from this segment. The mediclaim portfolio, in absolute terms, was about Rs 450 crore in ‘04-05. The policies will be priced differently which the younger population will be motivated to buy, while individuals, above 40 years, will be required to pay higher premium vis-à-vis the present tariff structure.

At present, Oriental has two mediclaim polices in its portfolio – one for individuals and the other for groups. The policy papers will also have more clarity in terms of coverage and definitions of different aspects of the policies. The new products will do away with any ambiguity in literature that the existing policies have.

Although not propelled by any Insurance Regulatory Development Authority (IRDA) directives, the move is in line with the regulator’s move of increasing readability of insurance policy papers for the layman.

The company is expecting a total premium collection of Rs 3,500 crore in ‘05-06 against Rs 3,038 crore in the previous year. The company has already collected about Rs 2,800 crore till December 2007.

What is the group medi claim policy and what are the major benefits?

Medi claim Insurance is a cover which takes care of medical expenses following Hospitalization/Domiciliary Hospitalization of the Insured in respect of the following situations: (A) In case of a sudden illness (B) In case of an accident (C) In case of any surgery which is required in respect of any disease which has arisen during the policy period.

A Group Medi claim policy is a policy in which the insured gets a Group discount; hence the premium per person is lower and this is the major benefit for taking the group medi claim policy.

Who can avail Group Mediclaim Policy?

Group medi claim policy is available to any homogeneous group/association/ institution/corporate body provided it has a central administration and subject to minimum of 100 persons to be covered.

What is the benefit of group mediclaim policy?

Group discount on premium is allowed depending upon the total number of insured persons.

Covered Risks:

This cover is a hospitalization cover and reimburses the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in-patient. The cover also extends to pre- hospitalsation and post- hospitalization for periods of 30 days and 60 days respectively.

Major Exclusions:

Any pre-existing disease, any expense incurred during first 30 days of cover except injury due to accident, all expenses incurred in respect of any treatment relating to pregnancy and child birth. Treatment for Cataracts, Benign prostatic hypertrophy,Hysterectomy, Menorrhagia or Fibromyoma, Hernia,Fitula of anus,Piles, Sinusitis, Asthma,Bronchitis, All Psychiatric or Psychosomatic disorders are excluded from the scope of the cover.

Competition in medical insurance or health insurance business is increasing day-by-day forcing companies to offer better products than before. Free medical insurance counseling can be availed through existing medical insurance or health insurance agents.

In picking the best mediclaim policy or mediclaim insurance one has to have a look at the features of the policy carefully and decide based on the requirements. It is always best to go for a low cost medical insurance or mediclaim policy that offers cashless facility and a higher bonus for every ‘no claim year’.

If your company offers group medical insurance, then be sure to sign up for it. Group mediclaim policy will cover diseases like diabetes and costs like maternity, that individual polices do not.

As group premium rates are much lower than individual rates , be sure to sign up for a group mediclaim even if your company may deduct the premium from your salary,  and even if this is not a perk.

Ask for premium rates from the different companies you consider and then choose one that gives you the maximum features for the lowest premium. See what suits the age profile of you and your family. This is the strong determining factor in policy purchase.

Mediclaim policy is useless if the medical insurance claims  involves a cumbersome  process or takes too long. Find out from friends, family and colleagues about their experiences with different companies before you cut the cheque.

Also speak to some doctor friends to find out which companies create the most problems. Obviously, choose the one most people are satisfied with.

Finally the mediclaim policy, earns the agent a commission each year. Be sure to get an agent who gives you good service. He should remind you before the policy is due and also help with claims. Find out a good agent with the help of your friends.

1) Is there an age limit for Mediclaim Policy?

The mediclaim policy is available to persons between age of 5 and 80 years. Children between the age of 3 months and 5 years can be covered provided one or both parents are covered concurrently.

2) What is the amount of tax benefit?

For Premiums up to Rs.10000/- tax benefit under Section 80 D of Income Tax Act can be availed.

Mediclaim policy is available only for allopathy, ayurvedic and unanipathy systems of medicine.

4) If the spouse or any other family members are covered by another Mediclaim Policy, can they avail of both the company policies?

If the spouse or any other member of the family is already covered under another Mediclaim Policy, coverage will be allowed for them only under one company.

5) Does the Mediclaim policy cover benefit if one suffers illness/disease or contract injury through accident either in India or outside India?

Yes, Mediclaim protection is available for illness/disease contracted anywhere in the World provided the treatment is availed in India.

The mediclaim insurance policy protects the insured party against unprecedented medical expenses incurred for hospitalization for diseases/ illness/ accidents/ as well as domiciliary hospitalization.

The mediclaim policy includes operation theatre and hospital room charges; expenses incurred due to diagnostic tests, blood transfusions, medicines, oxygen cylinders as well as cost of appliances like artificial limbs pacemakers etc.

This mediclaim policy is ideally suited for

Individuals aged between 5 and 75 years of age.

Children have to be insured with their parents (age group: 3 months –5 years).

• Government employees and employees of private companies
• Bona-fide members of Clubs or associations.

The three key features of the mediclaim policy are

1. Risks covered
2. Compensation Offered
3. Exclusions

Risks covered

This mediclaim policy protects the insured from the risks of hospitalization due to illness or disease, or injury due to accidents.

Compensation offered

The mediclaim policy will provide compensation for

Hospitalization expenses based on actual and subject to the sum insured.

Domiciliary hospitalization charges based on actual and subject to the sum insured.

Exclusions

This insurance policy will not pay any claims arising from

• Disease or injury incurred within 30 days of commencement of policy will not be covered.
• Injury due to accidents within 30 days of commencement of policy will be covered.
• Disease already in existence at the time of treatment, Pre or post hospitalization treatment of asthma, hypertension,chronic nephritis, diabetes, gastroenteritis, epilepsy, cough or cold, influenza, pyrexia, tonsillitis, psychiatric orpsychosomatic disorders, arthritis, rheumatism or any treatment relating to any illness will also not be covered.
• Naturopathy treatment.
• AIDS.
• Costs of spectacles or contact lenses or hearing aids.
• Vitamins or tonics not forming part of the treatment.
• Hospital/ nursing charges inconsistent or non-incidental to the diagnosis or treatment.
• Convalescence, general debility, sterility, venereal diseases, intentional self-injury or use of intoxicants.
• Vaccination, inoculation, circumcision, changes of life, cosmetic or aesthetic treatment, plastic surgery unless thetreatment necessitating hospitalization is necessary.
• Any treatment related to pregnancy, childbirth or voluntary termination of pregnancy during the first 12 months afterpregnancy.
• Cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia on fibromyoma, hernia, hydrocele, congenitalinternal disease, fistula in anus, sinusitis and related disorders in the first year of cover under the contract.
• Nuclear or war perils.

The mediclaim policy is offered by:

• The New India Assurance Company Ltd. (NIAC)
• United India Insurance Company Ltd. (UIIC)
• The Oriental Insurance Company Ltd. (OIC)
• National Insurance Company Ltd. (NIC)

What is the Family Floater Plan?

The Family Floater Health Plan introduced for the first time in India is that single policy that takes care of the hospitalization expenses of your entire family.

For eg: If Stephens’ Family is covered under a traditional health insurance plan say Mr. Stephen is covered for a sum assured of Rs. 3 lac, and his wife for Rs. 2 lac, their son and daughter Rs.50, 000 each and they have paid premium for all these 4 policies, in an unforeseen situation, wherein surgery and post hospitalization bill of their son amounts to Rs. 2 lacs the existing policy will cover only Rs. 50,000, while Mr. Stephen will have to bear the balance Rs. 1,50,000 from his pocket.

With the Family Health Floater Insurance plan, each member of Stephens’ family is covered up to Rs. 6 lac. Thus, Family Floater would have covered entire Rs. 2 lacs medical expenses of Mr. Stephen’s son.

Why should I take Family Floater health plan if I already have health insurance from my employer?

Your employer will cover your medical expenses as long as you are in his services. Tomorrow, when you change your job, retire, or even start something on your own your family should not be stranded when a medical emergency arises and you have not arranged for an alternative health insurance policy.

“The Family Floater Health Insurance policy will come to your rescue” at this point of time.

In case the cost of medical treatment is higher than your existing cover level the Family Floater Health Insurance policy can also act as a supplement to your existing medical cover.

Only 4 companies offer Family Floater Policies – they are Star Health Insurance, Reliance, ICICI and Apollo DKV.

The first thing that you need to do is to flash the cashless card at a network hospital.

In the case of a non-network hospital you will be reimbursed for your hospitalization costs.

Go through the ‘Claims’ procedure meticulously sent along with the product bought by you.

Q Can the proposer (policy holder or one who buys the policy) and his/her parents be insured in the same policy if the proposer is not a dependent to them?

A Under a family floater, parents and children not dependant on parents, cannot be covered. You need to take separate policies for your parents and one for you.

Q How will I get my Health policy/cards?

A When you order a policy online you will get a receipt online for the payment and acknowledgment of the transaction. The Customer Care will send you the relevant form and other details, which you will need to send us by scan/email Once done, you will get your policy and cards within 15 days.

Q Can I take a policy for my parents and claim tax benefits?

A Once you are the proposer for the policy you can claim tax benefits also.

Contact us for more details.

Medindia health network (p) ltd
A-113, Anna nagar, Chennai-6000102, Tamilnadu , India
Ph: 91-44-26263378, Fax: 91-44-26263477
Email: info@medindia.net

The Government announced that under the Rajiv Gandhi Shilpi Swasthya Bima Yojna about 40 lakh artisans would be provided health insurance coverage over a period of five years.

Launched during the eleventh plan period the “Rajiv Gandhi Shilpi Swasthya Bima Yojna (RGSSBY) has covered about nine lakh artisans so far for health insurance.

The Textile Minister Shankersinh Vaghela said that he hopes to cover about 40 lakh artisans by the end of the 11th plan.

The aim of RGSSBY is to financially enable the artisans’ community to access to the best of healthcare facilities in the country. The scheme covers four members of the artisan’s family, including dependent parents, self, spouse and children.

The scheme also provides reimbursement of medical expenses to the beneficiaries, subject to an annual limit of Rs 15,000 per family.

Under the scheme, a sum of Rs one lakh for personal disability or death due to an accident is provided.

The beneficiaries’ contribution is Rs 150 per year for general category and Rs 75 per year for Schedule Caste and Schedule Tribes and below poverty line categories, while the balance of Rs 650 and Rs 725, respectively, would be borne by the Central government out of the annual premium of Rs 800.

The minister also released a book by name- ‘Crafts of India- Handmade in India’ which is a compilation of diverse range of crafts from every nook and corner of the country.

Whether your employer gives you a choice of plans or you need to purchase your own coverage, it is crucial that you understand your health insurance

choices and pick the insurance that is best for you and your family.

Here are some questions you should ask yourself when choosing a health insurance plan:

How affordable is the cost of care?

What is the monthly premium I will have to pay?

Should I try to insure most of my medical expenses or just the large ones?

What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?

After I have met my deductible, what percentage of my medical expenses are reimbursed?

How much less am I reimbursed if I use doctors outside the insurance company’s network?

Does the insurance plan cover the services I am likely to use?

Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company’s network?

If I want to use a doctor outside the network, will the plan permit it?

How easily can I change primary-care physicians if I want to?

Do I need to get permission before I see a medical specialist?

What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?

If I have a preexisting medical condition, will the plan cover it?

If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?

Are the prescription medicines that I use covered by the plan?

Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?

Does the plan cover the costs of delivering a baby?

First we, remixed old hindi film numbers, then fashion styles (Sushmita Sen teamed a saree with a spagetti in Main Hoon Na?). Food too, chinese bhel and paneer pizzas.

We also remixed financial products. Unit linked insurance is a classic example. Now, there’s one more — unit linked health insurance. That’s unit linked investments plus medical insurance for you.

What is a unit linked health insurance plan?

Simply put, it means that you can now pay one annual premium, part of which will get invested to give you returns, and the rest will be used to buy you a health insurance, more populary called mediclaim.

Mani , 41,* who lives in Delhi wants to know whether he should opt for this scheme.

Mani’s wife is 37 and they have two children, aged, 7 and 9 respectively. All these years he has been buying a medical insurance policy for his family. He would pay an annual premium of Rs 9,137 and get a cover of Rs 7 lakh for his family. This would care of all their medical needs. And since he had not made a claim yet on his policy, he had accumulated a no-claim bonus of Rs 2.31 lakh, thus increasing his total cover to Rs 9.31 lakh.

Now, he says, “I have read many articles in the newspapers recently regarding mediclaim policies and I am really confused. I have decided to discontinue my existing mediclaim policy and to go for the new unit linked health insurance policies being offered by leading life insurance companies. Here, by paying a sum of Rs 28,500 as yearly premium I can get my family insured for Rs 14 lakh (Rs 5 lakh for my wife and Rs 3 lakh each for myself and my kids). I can also make investments.”

He asks two questions:

i. Should he switch form a mediclaim policy to a unit linked health insurance plan? No

The client is advised not to go for a unit linked health insurance plan as cash less hospitalization facilities are not available.

In a volatile market situation like the prevalent market condition it is not advisable to go for a unit linked health insurance plan as mediclaim policy offers cashless hospitalization and you need not be worried about the market condition as health is very important and timely health care is absolutely essential.

ii. How will the premiums be treated, with respect to tax benefits? Will get Tax benefits

At present, the main covers they buy are for loss of ad revenue due to rainfall. They also take cover against breakdown of satellites. If there is no live feed on television, the advertisers simply do not play, the sources said. Indian insurance companies have made big payouts in 2007 for matches that were disrupted. The India-Sri Lanka match in Kolkata at the start of the year, which was washed out, and the India-Australia match in Bangalore that was cancelled after 50 overs are the two examples when the insurers had to cough up huge payouts.

Industry sources said nearly Rs 12 crore was paid out to the broadcaster — Neo Sports in India — for the two matches. Similarly, BCCI was paid nearly Rs 15 crore when the India-Pakistan match in Ireland was disrupted, they said and added that last year the claim ratio has been against the insurers.

Smaller players in the chain, like the in-stadium advertisers and local cricket associations, have also begun to purchase insurance policies. The Indian team’s sponsor — the Sahara group — has bought polices for each match, sources said.

Though cricket insurance has existed for several years, what has changed now is the innovative clauses and policies, industry observers said. Earlier, a policy would become inoperative after the first is bowled, but today’s policies are alive till last ball is bowled, although liability comes down as the overs go up, they pointed out.

Cricket may be a game of glorious uncertainties, but the rise in the number of off-the-field incidents has opened up new business opportunities for insurance companies.

The Indian cricket board’s (BCCI) stand-off with the International Cricket Council (the governing body of the game) over the three-Test ban on Harbhajan Singh has brought to fore the financial cost of such wrangles and possible protection.

Even as BCCI’s tough stance against the ban on the Indian spinner cast a cloud over the ongoing India-Australia series, insurance companies have used this as an opportunity to sell cricket bodies ‘libel and defamation policies’ that would cover future match disruptions due to such off-field incidents that have the potential to stall a match or a series.

Initially, event insurance companies were flummoxed when there was uncertainty in the air due to sledging and some controversial umpiring decisions, but they quickly spotted the big business.

Industry sources said some insurers have already approached cricket bodies with ‘libel and defamation policies’ that would cover this new variable. Big broadcasters like Neo Sports, Star Sports and Nimbus are seen as the bulk buyers of such policies as the risk is passed on from the cricket boards to these companies the moment the team arrives on the ground.

The other potential big buyers are the national cricket boards, like the Board of Control for Cricket in India, that have lot at stake if matches go haywire. Since bulk of the money from the gate collections goes to them, they have lot at stake in such events.

For broadcasters, the potential loss from match disruptions is huge, too, particularly the one-day and Twenty-20 versions for which the telecast rights have been won at astronomical prices. Sources point out that their entire revenue model through sale of airtime and cable rights will be grossly affected due to match disruptions.

Health insurance industry is expected to grow at about 50 per cent per annum, Insurance Regulatory and Development Authority Chairman C S Rao said here on Friday.

On the sidelines of the First Health Insurance Summit organised by CII, Rao told reporters that the premium collected under health insurance was only about Rs 600 crore when he took over as Chairman of the regulatory body in 2003.

Whereas, during 2006-07 the premium collection was about Rs 3,200 crore, having grown 35 per cent over the previous year.

The figures for 2007-08 have so far not been released but are expected to be well over Rs 4,000 crore.

“The health insurance business is likely to grow by about 50 per cent per annum,” he said.

Rao, who is close to completing his tenure as Chairman of IRDA said: “The health insurance segment has been growing much more than the overall general insurance industry and collection of premium of health insurance now accounts for about 16-17 per cent of the total collection of the general insurance industry”.

He, however, pointed out that the overall penetration made by the industry segment is still low. At present, there are quite a few players offering health insurance and the IRDA Chairman indicated that a few more are planning to enter the sector.

Referring to the high claim ratio witnessed by health insurance companies, he said the ratio could come down if the volume of business goes up. Besides, he felt if the health policies are sold to different age groups, particularly young, the claim ratio could go down.

This is going to be an interesting year for health insurance. While mediclaim will continue to enjoy a reasonable chunk of the market share, we will also see more product innovations particularly related to ‘health income’ type of products which provide fixed payment due to medical situations,” he says. Chak feels that this type of ‘health income’ product, which covers not only the medical expenses but also any related expenses such as transportation cost as well as post operative medical costs can be used as a supplement of mediclaim policies.

Analysts believe that in the realm of life insurance, these additions of benefits will come in the form of health rider contracts. This essentially means options to select additional health protection on top of the traditional life protection under the same policy. “ However, the customers should buy a cover for their health needs after understanding their perceived medical insurance need and not just look into the advantages churned out of higher return on their investment,” cautions C Chandreshekhar, CMO, Apollo DKV.

Another important aspect of health insurance, which many consumers choose to ignore or fail to realise is the importance of a secondary cover. Experts stress that as a long-term plan, it is strongly advisable that you should have an individual health insurance policy as well as for the family. This also becomes important as the health insurance cover, extended by the employer to its employees ,caters to the medical insurance needs of the individual and his/her family till the time he is employed with the employer.

Once he moves to a new employer, the accrued benefits and the terms and conditions change as per the insurance policy at the new employer. “Having an individual policy not only gives you the leverage of a long standing relation but also supports the waiting term requirements for various critical illness and pre-existing diseases,” says Chandreshekhar. Also, to claim the tax benefit u/s 80D up to Rs 15,000 it is important that you should take a separate policy on an above the employers provided health policy.

It is also expected that with detariffing of other portfolios, chances are high for the market forces to take care of the premium rates at which various differential services to be offered. “The consumer will have more choices, but it is always advisable that you should first have a pure health policy and then look out for a mix health insurance with unit linked features,” says Manoj Aggarwal.

So, if you’re looking for a health cover it’s pertinent that you furnish your medical details in full so as to avoid any discrepancy in the claim settlement process. After all health is wealth!

Nandakumar Rajeshirke was suspicious of health insurance when he first heard about the idea three years ago. He had trouble understanding why it made sense to gamble on an unforeseen illness or accident when there was no guarantee he would ever see any money in return.

But his insurance provider, a network of nongovernmental organizations called UpLift India Association, had already earned his trust by supplying him with reliable microcredit to fund his stone carving business in the city of Pune. Mr. Rajeshirke decided to buy coverage for his whole family at 50 rupees ($1.10) per person annually and renewed the plan for several years in a row.

In 2005, his gamble paid off. Rajeshirke’s wife needed a hysterectomy, a procedure that would normally cost 20,000 rupees ($446), one-third of his yearly salary.

“Without insurance,” he says, “I would have had to sell some things from my house or get a loan from someone at high rates.” Instead of facing financial ruin, he paid 6,000 rupees ($134) total and had help navigating the long process through diagnosis, surgery, and medication.

Such plans, known as micro health insurance, are gathering momentum in regions of Asia and Africa that lack public health strategies. These nonprofit programs aim to provide quality healthcare at low premiums on a community-level scale. The idea is that, with creative planning, the poor can benefit from the same protections against risk as the rich.

India is a world leader in this emerging field, with 5 to 10 million people enrolled in micro health insurance nationwide. Fewer than 10 percent of India’s 1.1 billion people have any sort of health insurance, much of which covers only government employees. Poor people usually work in informal jobs or are self-employed, so they are extremely unlikely to be included in employment-related plans.

The Indian healthcare industry has grown manifold during the last few years. Although there is a yawning divide between healthcare facilities available in rural and urban India and in the demand and supply of healthcare services across the country, overall the Indian healthcare infrastructure is fast improving with initiatives by the government and the private sector. The entry of private players has further spurred the development of the healthcare sector.

The striking feature of the sector is that it has the potential to grow at a much faster rate in the foreseeable future and will present new ‘ sectors of opportunity’ within healthcare, which will emerge as growth drivers. The Indian healthcare industry overview indicates it has the same exponential growth potential as software and pharmaceutical industries in the country. Till now only 12% of the opportunities in the Indian healthcare sector have been employed.

With abundant opportunities for businessmen, equipment makers and service providers to invest in curative and preventive services and possibilities of investing in medical infrastructure and medical tourism, it becomes imperative for providers to get a feel of what’ s happening in the industry to make informed decisions on investment options.

The India Healthcare Trends 2008 aims to be an informed view of trends and drivers for the Indian Healthcare industry by delving into how providers like hospitals and physicians conduct their business and the issues they face in doing so, as well as dissect it in terms of what healthcare means to the end consumer.

Currently, STAR Health and Allied Insurance Co. Ltd, is among the very few to offer independent health insurance products. Do you think you have been able to tap the first-mover advantage?

Most definitely. We have made our mark in the health insurance space and our products and services are very well received in the market.

It has been claimed that the Indian health insurance market is estimated to be INR 3,000 crore, but has a potential to grow to INR 15,000 crore in the near-term. How have you planned to maximise your reach and benefits from this enormous potential?

To tap this vast potential we have introduced many innovative products at very competitive premium that cater to all the segments of the society such as:

a)Policy for HIV+ persons b) Senior Citizens Policy c) A long term cash back Policy d)Policy benefiting dependents of NRIs e) Policy for diabetics etc. We also have a large network of over 110 offices supported by a large agency force.

So far there has been no retail focused health insurance player. What is your strategy as regards this market trend?

Our focus is on the retail segment via the agency distribution model. Also unlike many other insurance companies, we have our own claims servicing mechanism, and do not depend on a third party for this crucial activity.

We have a proprietary network of over 3200 hospitals across India to provide cashless facility to our customers. A 24 X 7 toll free call centre is also at the disposal of our customers.

All our claims are handled in-house and we ensure to visit each and every policyholder in the hospital, whenever a claim is reported.

What are your views on the possibility of India developing a National Health Information Exchange? How would it impact the insurance industry?

It would be a welcome move and definitely help health insurance companies in product development and pricing.

How do you foresee the future of health insurance in India? What policy shifts and innovations would you like to see? And what role do you see STAR Health play in it?

It is common knowledge that health insurance is indeed going to be the key revenue driver for insurance companies in the near future. We realized this potential early and are geared to lead from the front in this space.

Special Correspondent The All India Anna Dravida Munnetra Kazhagam has charged that the State Government is trying to impose a new health insurance scheme on its employees from June this year.

The scheme, to be implemented in coordination with Star Health and Allied Insurance Company, will also cover the employees of public sector undertakings, statutory corporations, local bodies and universities.

In a statement here on Monday, party general secretary Jayalalithaa said under the scheme Rs 25 would be deducted every month from the employees’ salary to cover their medical expenses up to Rs 2 lakh in a block of four years.

The Government decided to remit an annual premium of Rs 75 crore to the insurance company immediately. The Director of Treasuries would be in charge of implementing the scheme. A government order had been issued.

Ms.Jayalalithaa questioned why the Government preferred a private health insurance company when nationalised insurance companies were offering such services. Again where was the need for paying the premium urgently to the company even before it released the list of hospitals where employees could avail themselves of the medical facilities. Moreover, the company did not have branches in 12 districts in the State.

The AIADMK leader also said as per the GO several conditions had been laid down which would create problems for the staff in availing the benefits of the scheme. The GO had provided ways for the company to have its representatives in committees being set up for enquiring complaints preferred by employees but the same facility had not been provided to the employees.

The Government should consult employees unions and modify the scheme so that the procedures were simplified, the statement added.

In a country where the demand for health insurance is growing by 25% every year, and where health insurance penetration is less than 0.02% of the GDP, there is no specific expertise for health insurance in the insurance industry, according to a report commissioned by USAID.

The report, which was released on Monday, to study the impact of private life insurance on health coverage in Focus on claims control hurts health insurance

India has said that the focus in India is on controlling claims pay-out by following strategies designed to minimise insured person’s ability to collect claims. “There is excessive emphasis on disqualification because of pre-existing conditions and post-claim underwriting,” it said. No wonder then, that it is one of the largest litigation areas for insurers. The report has suggested a slew of measures to improve the regulatory framework for health insurance.

For IRDA, the report has a separate prescription for health insurance. Separate reserving rules should be considered for the different categories of health insurance, taking into account the short-term versus long-term nature of contracts, whether polices provide indemnity or assured benefits and the loss experience of varying health insurance products.

It has also asked IRDA to promulgate specific regulations for the sector. These include a minimum regulatory definition of pre-existing illness or condition to provide clarity in interpretation —spelling out maximum ‘look-back’ and ‘look-forward’ periods. Further regulation is needed to prohibit post-claims underwriting, making it mandatory for insurers to offer both group and individual policies among others.

Taking into account medical inflation, the report called for higher public health care spending. Effective primary care and prevention, safe maternity care and chronic disease management should be a part of public and private insurance, it said. “The burden of disease as measured by disability adjusted life-years could be reduced significantly if both health insurance coverage and publicly provided care included these services,” it said.

The country has a dismal record of even hospitalisation coverage — the basis for health insurance, it said. Quoting a recent census, it said only 1.7% of admissions were reimbursed and the average reimbursement was only Rs 258 (or 3.6% of the average hospitalisation cost of Rs 6,225).

Private insurers’ administrative costs are 40% of total premiums, double the target benchmark of 20%. Policy holders pay higher charges for healthcare services than those without insurance, because the mediclaim product has been modified in ways that make it less a program to control the cost of care and more a reimbursement target for providers.

The report forsees a more dynamic third party administrator market going forward, where TPAs could partner with insurer organisations. To encourage competition, it is recommended that mutual insurance companies and non-profit companies should be allowed to enter the market. Although IRDA can retain licensing TPAs, parts of regulation of TPAs should gradually come under the contractual relationships that insurers have with TPAs.

Pointing to central government-sponsored insurance schemes in attracting the uninsured, the report said that poor marketing, low enrolment and adverse selection have all contributed to the relative failure of these schemes. It has been suggested that microinsurance products and services should be tax-free in all respects, including investment taxes of reserves, service taxes and income taxes.

Financial incentives

While the desire to protect savings by itself is a strong motivator, India may well consider proposing enhanced tax treatment of insurance costs for individuals (some of which exists.) Another path not currently present in India is structuring financing alternatives such as medical savings accounts, which combine higher-deductible insurance coverage with money set aside in tax-favored accounts for future health costs.

Competitively priced products with choice

To make prudent purchases, consumers should be able to choose among hospitals and other healthcare providers, along with coverage scope and insurers. Not every family situation is the same, nor does every person need or want the same coverage. Likewise, providing for non-inpatient services encourages smarter buying: Fairly priced, affordable products will ensure accessibility to the greatest number of people.

Understandable information

Educating consumers about health insurance, in general, will be extremely important. Beyond awareness of insurance coverage, information on disease, cost of treatments, alternative treatment options, and the quality of the treatments provided must be available to consumers to make informed choices.

Employer-sponsored programs

Financing of health insurance through employer-sponsored programs is likely to improve access to insurance for some. Employers would have to be motivated to provide such coverage; again, more favorable tax treatment might be a motivating force.

While it is important that health insurance provide sufficient protection to make it attractive to the buying public, care must be taken to design coverages that sufficiently involve the consumer in the cost of care, so that individuals are encouraged to behave in a cost-conscious way. A health insurance policy that provides 100% coverage for all services removes the patient entirely from the economic consequences of his course or place of treatment. The patient, then, has no incentive to pursue cost-effective treatment options.

Historically (and internationally) this almost always leads to the over-utilization of services and very high costs, which in turn leads to high premium rate increases and, ultimately, to an unstable health insurance market. Relevant here is the big lesson from the U.S.: Individuals must remain responsible for their health and care treatment. Notions of paternalism and entitlement do not work well in a private, voluntary health insurance market.

This feeling of responsibility could easily be overlooked in a rush to create broad coverage for today’s Indian health insurance policies.

Tie-ups with general insurers help families that lack access to formal credit or costly health care.

Micro finance institutions (MFIs) such as SKS Micro finance, Basix-both Hyderabad-based and the Kath-ir Foundation of Tamil Nadu are gearing up to provide health insurance products to the rural and urban poor.

These MFIs are entering into partnerships with private sector insurers to offer micro health insurance to families, which do not have access to formal credit and cannot afford expensive treatment at private hospitals.

Take the case of women such as Sharanamma, who goes by one name and lives in Sultanpur, a village in the Gulbarga district of Karnataka. When her son Sidilinga, a rickshaw driver, was detected with a hernia and had to be operated, the family’s only option would have been to go to a moneylender for the Rs7,000 it would take.

Reluctant to get trapped in high interest rates, Sharanamma kept postponing the operation, jeopardizing her son’s health.

But, during a routine field visit, the loan officer of SKS spoke to Sharanamma and her peers about Swayam Shakti a health insurance programme for the MFI’s clients through which they could insure an entire family for an annual premium of Rs525. Sharanamma signed up and Sidilanga was operated at a private hospital in Gulbarga. The entire hospital expense of Rs6,570 was covered by the SKS health insurance scheme.

SKS tied up with ICICI Lombard General Insurance Co. Ltd to offer the insurance and other MFIs, such as Awareness and Biswa, both based in Orissa, are also providing health insurance products in association with ICICI Lombard. For an annual premium ranging from Rs200 to Rs500, private insurers are providing a medical cover of Rs20,000-50,000.

They are also willing to take alternative proofs from customers, such as declaration of age by community members or self-help groups. Policy conditions have been simplified in micro health insurance to enable policyholders to get admitted and treated at any registered hospital in a rural area. According to the regulator, normal health insurance policies recognize only those hospitals that have at least 10 beds.

A survey conducted among 248 urban and rural below poverty line families by SKS before it began offering health insurance showed that 67% of the respondents had used private medical facilities. On average, they spent Rs2,340 per family per annum on consultation, diagnosis, treatment and transportation. Some 45% of the families surveyed borrowed money to meet health emergencies. Nearly 94% of the families had borrowed less than Rs5,000 and only 3% had a health insurance cover.

For private insurers trying to get a foothold in rural areas, this kind of arrangement works out well, especially in rural areas.

Pranav Prashad, head-rural and agriculture business at ICICI Lombard, said working with MFIs also gives insurance companies “a wealth of data” (as) there is very little data about the bulk of the families living in poverty. We do have to tailor-make products for every different MFIs or NGO that we work with and we use these experiences and replicate them in other geographies across the country,” he said.

S.K. Alaghusundaramani, a senior manager at the Kathir Foundation, that has been offering health insurance in partnership with Reliance General Insurance Co. Ltd for the past six months, says his loan officers go on field visits and speak to pregnant women to convince them to enroll for their health insurance scheme.

Under the plan, a woman could get herself and her entire family a Rs20,000 insurance cover for an annual premium of Rs325. She would get an extra cover of Rs10,000 for normal childbirth and Rs15,000 for a Cesarean section operation. Out of the 10 claims that the foundation has received so far, three have been maternity claims, Mani said.

As per a new index brought out by the Asian Development Bank, India is ranked above China and Malaysia in providing social security like health care, education and child welfare to its people.

In a list of 31 Asia-Pacific countries, India ranked at 10th place, above China and Malaysia, but below Uzbekistan, Mongolia, South Korea and Japan, which topped the ADB’s Social Protection Index (SPI).

Apart from China and Malaysia, the countries, which are ranked below India, include Philippines, Nepal, Indonesia and Bangladesh. Pakistan was ranked at the bottom, next only to Papua New Guinea.

The ADB, in the new Index, has established that providing social protection is not subject to the wealth of a nation. Even poor countries like India can afford to provide social cover in the form of health insurance, labour market, child protection, education among other things, if there is government will.

On a scale between zero and 1, India has scored 0.46 points, with Japan topping the chart with 0.96 points. However, the ranking of India shows that although people are getting some level of social protection, the impact of social protection programs on the incomes of the poor is low.

Social protection is basically a term coined for showing the extent to which Asia-Pacific countries provide for welfare, labour market, social security, health insurance, micro-credit, child protection, education, and health support programmes to their citizens, mainly to those living below the poverty line.

The ranking is expected to have some effect on international donors who work for supporting social protection activities.

With health insurance expected to grow 50% annually, several specialized health insurance companies are waiting to launch business in India. The Insurance Regulatory and Development Authority (IRDA) has said that there are several specialized companies looking to set shop in India.

Already two specialized companies — Apollo DKV Health Insurance and Star Allied Health Insurance have received permission from the IRDA to do business in India. Another French insurer BUPA is understood to be in advanced talks.

Speaking on the sidelines of the First Health Insurance Summit organized by CII, Rao told reporters that health insurance was expected to continue growing at 50% making it the fastest growing business.

This growth is despite the fact that most insurance companies have been complaining of the lack of profits in this line of activity. At the same time the number of consumer complaints is the highest in health insurance.

According to Mr Rao, the premium collected under health insurance was only about Rs 600 crore when he took over as chairman of the regulatory body in 2003. Whereas, during 2006-07 the premium collection was about Rs 3,200 crore, having grown 35% over the previous year. The figures for 2007-08 have so far not been released but are expected to be well over Rs 4,000 crore.

“The health insurance business is likely to grow by about 50% per an-num,” he said. Rao, who is close to completing his tenure as chairman of IRDA said: “The health insurance segment has been growing much more than the overall general insurance industry and collection of premium of health insurance now accounts for about 16-17% of the total collection of the general insurance industry.”

He, however, pointed out that the overall penetration made by the industry segment is still low. At present, there are quite a few players offering health insurance and the IRDA chairman indicated that a few more are planning to enter the sector.

Referring to the high claim ratio witnessed by health insurance companies, he said the ratio could come down if the volume of business goes up. Besides, he felt if the health policies are sold to different age groups, particularly young, the claim ratio could go down.