Wednesday 10 August 2011

Have you used your cashless card yet?


The concept of health insurance in India is seeing a continual improvement in the past few years. One such result is cashless medical insurance which allows the policyholder to be hospitalized without the harassment of immediate payment, especially during emergencies. You just intimate your Third Party Administrator (TPA) of your situation and avail the medical treatment. TPA verifies your policy details, on behalf of the insurer, and gives clearance for the cashless services to be processed. In case of a planned visit, you should first inform the TPA and then avail treatment under the network of hospitals. Thus the most important research here is the number of tie-ups your cashless insurance carrier has with hospitals across the country.
Needless to say, the more hospitals your medical insurance provider has in its network, the easier it will be for you to avail its benefits.
Though Insurance companies hype cashless settlement policies as customer-friendly and convenient, for many who have bought these policies, the experience has not lived up to the promise. Many-a-times the insured has to either pay the hospital himself and get it reimbursed later, or run from pillar to post for the 'pre-paid'
facility, in which case the entire essence of a cashless facility vaporizes. Reasons behind it are many, the primary ones being the ignorance of the user and the hospitals overcharging patients under cashless claims.
It is thus worthwhile to keep the following in mind, when availing cashless -
  • For planned hospitalisation, send the pre-authorisation form to the TPA, at least a week before the surgery.
  • In case of accidents, make sure the doctor fills in fields like time of accident and evidence of alcohol abuse. A partially filled or illegible form sent to the medical team means it will be sent back to the hospital for clarification and cause more delay.
  • If you are accompanying the patient then mention your cell phone number on the pre-authorisation request to ensure that the TPA can get in touch with you immediately.
  • Carry your cashless settlement card at all times. This is of significant help in case of an emergency.
  • Find out which of the network hospitals is close to your house or place of work.
  • Be clear about which expenses and surgeries are covered by your policy.
  • Don't forget to renew your policy every year.

Monday 1 August 2011

Can the Insurers walk out of contracts mid-term?


According to the regulations, a policy can be cancelled only if there is a case of fraud, misrepresentation or non-disclosure of material fact from the insured.
But, few corporate have faced the problem of cancellation in their group health in the mid-term because of high claims, which according to IRDA isn’t allowed.

There were a series of complaints from group health insurance customers which lead to this move by IRDA. A circular has been issued to all the companies stating that insurance policies cannot be cancelled mid-term.

Both the insurance industry and the insurance policy holders have their own stand on the decision. According to the people in industry, after giving enough notice to make alternative changes, including cancellation clause has been a regular practice internationally and historically. Plus, in the cases where cover has been provided on the basis of reinsurance, it is important to have a cancellation clause because the reinsurance companies have the similar clause.

But again, there are different views as well. If we think from the side of the policy holder, he takes the policy trusting that his claims will be settled. Just to increase the top line, insurance companies should not overlook the risk involved with the client. A proper underwriting should be done before the policy is issued to the client.

So, what is your take on the issue? Do you think IRDA did the right thing?

Source: Times of India