Wednesday, 27 February 2013

Get Insured

With the changing face of health insurance in India, are we now seeking quality and systematic insurers

A little over two years ago, 47-year-old Vikram Talwar was diagnosed with gall bladder stones which required removal without surgery. “At times, the pain was excruciating. It hindered my life in a big way. I underwent a laparoscopic removal at Jaslok Hospital. I am glad I had health insurance since it made the process simpler. The cashless insurance scheme worked wonders during this hour of need,” says Talwar.
Talwar’s various medical costs, tests, hospitalization and even post-treatment medication requirements were metbecause he hadsufficiently covered himself and his family against any financial constraints arising from such emergencies.

Talwar is just one among the miniscule percentage of our country’s booming population that has invested in themselves. India, as a country, traditionally did not grow up with the concept of insurance. Here, insurance does not play as integral a role in life’s whereabouts as it does in the West. But, over the last three years, with growing awareness, things are changing for the better. And it’s medical insurance that’s changing the game.

“Health insurance has been fastest growing segment in the non-life industry in India. Commercial health insurance constituted only 0.7 per cent of this expenditure in 2001-02 and barely covered 1 per cent of India’s population. But, in just seven years, by 2008-09, it has grown almost ten-fold,” states Varun Jani, an Vadodara- based financial planner.That single life insurance policy that every villager and city boy inherits, is today transforming to varied policies and schemes as per requirements and capabilities.While insurance as investment, for retirement benefits and education purposes is around, it’s medical insurance that is taking the lead in changing the face of the industry.

According to latest statistics released by the I.R.D.A., total health insurance premiums, by non-life insurance companies and stand-alone health insurance companies, grew by 24.4 percent in the first quarter of the financial year of 2011-12. "The approximate consolidated health insurance premium collected in India is almost Rs15,000 crore," says a development officer with a reputed insurance company.
Today, health insurance forms the second largest segment of the non-life insurer products in India. It contributes 23.35 per cent of the total premium portfolio.With various international healthcare facilities zoning in on India, we are gently migrating towards a nation that focuses on health insurance and the benefits that could be derived through it.

“In 2007, the number of non-elderly people insured increased by more than six million persons to 43.3 million,” says Jani. From then on, there has been no looking back. Then, came the boom in 2009. The year saw urban India reporting a considerable increase in health insurance policies, also known as Mediclaim. There are a number of reasons why the health insurance segment grew dramatically. In the last five decades, life expectancy rose from 50 years to over 64years. Plus, a higher standard of life in the metros and higher disposable incomes meant that people were able to spare cash for insurance premiums on a regular basis. This reflected on the insurance sector and the healthcare radius that boosted efforts at marketing and creating awareness. With the country simultaneously seeing the proliferation of international healthcare facilities, costs of hospitalization rose sharply. All the three factors came together to create a new chapter in the health insurance industry in India.
And history is still in the making.

While the face of health insurance is definitely changing, there are still some basic challenges that are India specific.

The rural India challenge
Almost 70 per cent of India still lives in the villages. The word healthcare here still deals with local, ill-equipped hospitals and basic sanitation and hygiene challenges. A large section of rural India is below the poverty line. Therefore, private insurance premiums are out of the question.
They are entirely dependent on the availability of government medical benefits. But, here too things are changing for the better. The Universal Health Insurance policy has become one of the policies designed for people coming from low-income groups and those below the poverty line. Here the total expenses incurred for any one illness are limited to Rs 15,000. The insurance company’s liability in respect of all claims admitted during the period of insurance also do not exceed the sum insured of Rs 30,000 per person or per family. Also, the network of Rashtriya Swasthya BimaYojana (RSBY), the government health scheme, provides smart-card based cashless health cover to those below poverty line. With the RSBY continuing to expand its policies to cover domestic help and seven other informal vocations, there is good news.
Plus, very few insurers in India, including the public and private sector, are providing health insurance information in regional languages. “The inclusion of literature on insurance in regional languages will provide better insight to a large section of the population,” says the assistant manager of a reputed insurance company. So much is rural India under-insured that experts predict a whopping “15 to 20 per cent increase in the sale of the health insurance products by the next fiscal year”.

The clarity challenge
The sum insured offered in the Indian market begins from Rs 50,000 uptoRs 10 lakh, depending upon the age and health of the customer.
The diseases suffered by people may be almost common depending upon sex, age and health of an individual but each policy’s terms and conditions are different.India has four public sector insurers (United India Insurance Limited, National Insurance Company Limited, The Oriental Insurance Company Limited, The New India Company Assurance Limited), three stand-alone health insurers and 12 private insurers, each offering different terms and conditions to their customers. Obviously, there is very little clarity for the customer.

What is required are some laws or guidelines to be followed to ensure that people have transparency in what they are opting for. “Considering how disparate India is, it would be a good idea to frame common terms and conditions for all Mediclaim policies to be followed for different income groups such as the lower, middle and upper socio-economic sectors. This would be an efficient way to prepare individuals for healthcare,” advises an assistant manager with a public sector insurance company.

The healthcare business challenge
Systematic clarity on health insurance will also bring about clarity on hospital bills for both patients as well as hospitals. Concerns within the sector speak about how hospitalization bill amounts vary for the same treatment at the same hospital, depending upon the Mediclaim policy coverage.
For example, for a single eye cataract surgery, the minimum expenditure incurred by the customer should be approximately Rs 24,000 in a private hospital. Unfortunately, the class-rated hospitals in the metros charge a bill amount ranging between Rs 50,000 to Rs 2 lakh. “The basic purpose of the Mediclaim policy is to provide help and support to the customer. But, various tests incurred on the patient accelerate medical bills. If the hospital takes undue advantages of the policy, how will the insurer control the same?” demands a manager with a private insurance firm.
“The professional fee of any doctor always varies. It is in proportion to the package offered to the customer. It ranges anywhere between 20 per cent to 30 per cent of the hospital bill. Patients who seek healthcare in class-rated hospitals have to understand that it has many components, among them the doctor’s professional fees and hospital charges,” argues a Mumbai-based gynecologist.

What the average customer is really looking at from his Mediclaim is quite a bouquet of facilities that are currently unavailable. These are facilities that all health insurance takes into account in developed countries. But, they have yet to make their way into India.
A policy that covers all medicine bills for the entire year. At present, no insurer in India provides coverage for medicine bills suggested by the general practitioner.
There is no special package health cover provided by any insurance company for major illnesses, such as heart and other related disorders, knee replacements, cancer and related disorders. At present, in India, the insurance companies are settling claims for major illnesses by deducting a certain percentage of the admissible claim amount as an excess or deductible. For example, the United India Insurance Company Limited offers 70 per cent of the sum insured or actual expenses, whichever is less.
Insurance companies need to have a legitimate tie-up with major hospitals in the metros where the crucial surgeries take place. This would make things simpler for the insurer as well as the insured.

Third party administrators (TPA)
No hospital can refuse to admit a patient into their facility. It is only if a patient or his relatives fail to pay the bill for the treatment, that the hospital has the authority to discontinue treatment or forcefully discharge a patient.In such cases, it is the TPA who plays a very significant role between the insurance company and the customer.
A TPA is an organization which processes claims or provides cashless facilities as a separate entity. They provide services to health insurance policyholders across the country.

Cashless insurance: The road ahead
The cashless facility is one of the key features of the TPA services. Unlike traditional insurance policies where the patient pays up-front and claims are reimbursed later, in a cashless facility,patients don’t have to pay anything from their pockets.
When a patient gets admitted to a hospital on the grounds ofan emergency or planned hospitalization, he has to merely show his cashless card, provided by the TPA, to the hospital. The hospital sends a cashless request form to the TPA mentioning complaints of the patient, provisional diagnosis, estimated expenses and stay duration. The TPA analyses the details and sends its first response in a couple of hours after receiving the request form.
The TPA issues a pre-authorization certificate that is an assurance from them to the hospital that they will pay the authorized amount at the time of claim settlement. The cost of the amount to be authorized is then decided by the GIPSA PPN package (General Insurance-Public Sector Association Company, Preferred Provider Network).

The future of Mediclaim: healthcare made simple
Mediclaim policies are like ATM cards for the doctor as well as associates such as pathological laboratories, medical shops, blood banks and scanning centers. “If each customer is provided with a unique card, the process would be simple and effective,” suggests an insurance manager with a reputed private insurance company.

Change in lifestyle habits of people.
Increased awareness of its benefits.
Advertisements pertaining to health insurance through media and print.
Market competition between public and private sector companies.
Change of medico-technology and introduction of new hospitals. Increase in cost of hospital expenses, doctor’s fees and specialized treatments that even people from the middle-income group find unaffordable.
Mediclaim facilities provided by corporates to employees and family members, as an additional benefit.
Apart from insuring allopathic treatment, health insurance companies have now started policies that cover for alternative forms of treatment, especially Ayurveda.Cholamandalam, New India Assurance, Star Health and Allied Insurance provide cover for Ayurvedic treatments under individual policies while ICICI Lombard covers it under the government scheme and Future Generali Insurance under a corporate group insurance scheme.
80 D deduction becomes a tax benefit for health insurance premiums.

Increase in the number of TPA.
Insurers should have their own special arrangement with major hospitals in major cities for major operations only.
A unique web-based application for the registration of health policies, claim intimation and settlement of claim data. This would have statistical information about the number of persons covered along with age, sex and demographic details.

“The health insurance market continues to be dominated by the four state-owned non-life insurers, which together accounted for about 58 per cent of the health premiums written during the first quarter of 2011-12,” says Jani.
The break-up:
United India Insurance and National Insurance registered strong growth rates of over 30 per cent year on year.  
Among private players, ICICI Lombard occupied the top position with growth of close to six per cent and a market share of 11.6 per cent.
They were followed by Star Health & Allied Insurance (Star Health) with growth of 28.3 per cent and market share of 11 per cent.
“The two private players, along with the four public insurers, accounted for over 80 per cent of the health insurance business during the first quarter of this year,” says Jani.

Looking to invest in life or medical insurance?
Contact Kewal Talwar- 022-9820838316 ( Mumbai)

Monday, 25 February 2013

House To Home

Make your home look stunning with something beyond the regular store-bought options

A couple of months ago, when Lotika and Vikram Talwar wanted to re-furnish their house, they explored many options in the market. But, they were disappointed with the regular store-bought options. It is then that they consulted home accessory designer, Ruchit Kapoor, who lent his ideas to create customised accessories for their home.With a little bit of imagination, you too can add a unique and creative touch to your home to brighten up any corner or wall.Here are a few options:

Cushions and curtains

Cushions and Curtains- Spazio designs
A few colourful cushions can make a house look vibrant. Options are plenty:embroidered and patterned cushions in silk, velvette and cotton for starters. Curtains, blinds and bed-spreads too create resplendency and add to a cheerful atmosphere to the house."Cushions and curtains in different hues and textures definitely add quirkiness to an otherwise dull space,” says Meenakshi Kapoor, Spazio Designs.

Crafted candles
“Customized home accessories can give your house a feel of home,” says Amrita Kukreja, Aarna Designs, who makes exclusive hand-crafted candles, tissue-boxes, table-covers and bedspreads.Her collection of home accessories is only on silks ranges between Rs 650 toRs 6,000.
Crafted candles- Aarna Designs
Expensive fabrics such as leather and jamevar prints are used to decorate the candlesand give them a distinctive look.

Recycle your refrigerator
Have an old refrigerator in your home? Get creative. “Don’t discard your old refrigerator, it can be used as a coffee table,” says architect Arjun Rathi. The surface of the coffee table is made from the door of the refrigerator, while the supports are made frommild steel scrap and recycled refrigerator evaporator coils. The table surface is restored to its original colour using the same shade of duco paint with a coat of lacquer.
Refrigerator table- An Arjun Rathi design
“It makes a great indoor or outdoor centre-piece. The lacquered surface is water-resistant and can be cleaned easily,” adds Rathi.

Get artsy, get quirky

Artifacts- Sobo Store
Out-of-the-box artifacts such as a pair of sun-glasses can be converted into a photo-frame or a metal mug can serve as a planter and aluminium tea-kettles as chandeliers.“Such quirky ideas can make great artifacts and are economical too,” says Shagun Doshi, Sobo Store.

Colourful cabinets
Colourful Cabinets- Baaya Design
If your d├ęcor is brown polished wooden furniture, try adding a bright, hand-painted art furniture piece. For instance, a side cabinet. “This will break the monotony and add cheer to your home,”says Shibani Jain, Baaya Design.

Take an18x18 cotton or silk fabric.
Trace a figure or design of your choice with the help of a tracing paper.
Paint with fabric paints.
Highlight them with 3D outliners.
Add finishing touches to the cushion by adding brocade or velvette at the back, piping ortassles or stich      in some sequins and beads to add the bling.
Your cushion is ready to adorn your house.