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Market Scenario of Health Insurance
 
(1) Where are We Heading?   (2) Future Changes Expected
(3) Market Share of Non Life Insurance   (4) Market Share of Health Insurance in India
(5) Rating Given by Consumer Voice      
1- Where are We Heading?
Public sector insurance companies suffer Rs. 21.67 cr. loss
Oriental Insurance Company and two other General Insurance Companies in the public sector suffered a total loss of Rs. 21.67 crore due to their serious lapses, according to the just-released report of the Comptroller and Auditor General (CAG) of India.
Oriental Insurance issued a group mediclaim policy to the staff of Life Insurance Corporation of India (LIC) allowing excess discount resulting in loss of premium of Rs. 8.57 crore, the CAG report said.
LIC was obtaining group mediclaim policy from New India Assurance Company Ltd. (NIA) until March 2001, but it switched to oriental when the NIA restricted the maximum group discount to 30 per cent citing its adverse claim ratio in the past.
A Mumbai-based divisional office of Oriental Insurance issued a group mediclaim policy to LIC covering 371722 employees for 2001-02, allowing 66 per cent group discount.
"This was in violation of the guidelines as the maximum group discount allowable for fresh client was only 30 per cent," the CAG observed.
Apart from this, the oriental should have checked the LIC's track record with NIC which would have made it clear the LIC was eligible only for 30 per cent discount, the report said.
"The compay (Oriental), therefore, by allowing 66 per cent discount in violation of the guidelines incurred a loss of premium of Rs. 8.57 crore (after adjusting demand of Rs. 5.94 crore raised against LIC in May 2002 towards short charging of premium".
The CAG rejected the explanation given by the company for allowing higher discount.
In another news item the problems of senior citizens were covered
Clout of Elders as Pressure Group Grows
The measure taken against Oriental Insurance Company by Insurance Regulatory and Development Authority (IRDA) attests to the growing clout of the elderly as a pressure group. Upset over the methodical purge of the middle-aged and elederly, they expressed anger at the July 23 meeting of National Council of Older Persons, the highest advisory body on ppolicies for senior citizens.
It was their persistent lobbying which forced the Union social justice ministry, the nodal wing to lodge a strong protest with the finance ministry.
While the campaign seems to hae paid off seeking a complete end to organised diserimination could still be a long drawn battle. Oriental is adamant on continuing with its new sales terms, saying that it has the prerogative to decide on the rate of commission which can range between zero and 15%.
In fact, Oriental has justified and stand, saying its sales offices and development officers were not entitled to any commission "it is not as if we have stopped seling to seniors. Our offices and DOs are still selling policies. For the agents, however, there interested in business from those above 45 to 50 years since they earned more commission", an executive said.
"We wanted to increase tariff since even the government is unwilling to take over the losses. But the regulator does not seem to agree with our proposal", added a source.
Oriental is also blaming IRDA for the present situation saying that it had proposed to raise its premium for those over 35 years but the regulator has not cleared the move despite the propsal being pending for nearly eight months.
The health insurance business is highly loss making with companies like Oriental coughting up Rs. 130 as calims for every Rs. 100 earned as premium for those above 55 years, the claims were to the tune of Rs. 300 on Rs. 100 earned through premium.
In a recent news itsm the issue between Insurance Company and treatment to be given by hospital has been covered.
'dictating' to doctors - how to treat ?
Should the patient have a normal delivery or a ceasarean? Should the patient in the surgical ward have a surgical therapy or be given just medicines ? Who decides ? The health insurance companies.
Hosptials say they are beginning to get instructions from insurance companies on the course of treatment, much the course of treatment, much to the frustration of doctors.
But the insurance industry alleges that hospitals push up treatment costs by around 20 to 25% when a patient walks in with a policy. Insurance companies say if they have taken on a regulatory role, it is because of increasing claims.
For long, they have complained about the misuse of insurance facility by hospitals. The issue seems to have got out of hand after the introduction of cashles medical insurance facility. Sarala Joseph an insured is just one of the many who is suffering on account of this battle. She has been waiting in a private hospital for an elective heart surgery for the last one week.
"Looks like the situation will become an emergency before the hospital gets a green signal from the insurance company. I thought i was doing myself a great favour by paying the premium. Now, I think I was wrong." she says.
The doctors attached to the insurance company have asked the hospital why they did not prefer a regular medical treatment. "We seem to be going the US way. If we have learnt our lessons, the insurance companies must advocate good medical practices instead of controlling the hospitals" say Vishal Bali, CEO Wockhardt Hospitals.
In fact, a host of leading hospitals, including Apollo Hospitals, Narayana Hrudayalaya, Leelavathi Hospitals and Escorts Hospitals, complain that they had scuffles with the insurance companies on the mode of treatment. But insurance companies disagree.
Expert committee set up to go into health insurance of senior citizens.
IRDA has set up a committee, which is going into various aspects / griveness or senior citizens. This committee will submit their report in end 2007.
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