Indian government working on world's largest health insurance scheme

The new Indian government is planning to bring about a 'complete transformation' of the health sector and is working on the blueprint of the world's largest universal health insurance programme.

This was announced by Health Minister Harsh Vardhan as he read out a speech by Prime Minister Modi to a gathering of US-based Indian medical professionals in San Antonio, Texas, underscoring the need for all citizens to involve themselves in the national endeavour for "Healthy India".

"It is my firm belief that our focus needs to go beyond health insurance. The way ahead lies in health assurance. We need to focus on preventive health care where public participation has a major role to play," the Prime Minister said in his address to delegates at the 32nd annual convention of the American Association of Physicians of Indian Origin (AAPI) held in San Antonio.

Modi said the aim of his government is to bring about a 'complete transformation' of the health sector through research, innovation and the latest technology. The AAPI is a professional body of physicians of Indian- origin.

On medical insurance, Harsh Vardhan said that the blueprint of the world's largest universal health insurance programme is in the process of being sharpened under his personal gaze.

It is partially inspired by US President Barack Obama's grand insurance-for-all project which is popularly known as "Obamacare", he said.

"The Prime Minister has authorised me to come up with a brand new policy soon. I need your help to write this all-important document," the Minister said.

The Prime Minister's message also resonated in Harsh Vardhan's address to AAPI members.

He named specific sectors where AAPI members could contribute, like accepting teaching assignments, share knowledge on telemedicine, lend their expertise in fighting disease, help develop model primary health centres, etc.

The Health Minister also unfurled the "Swasth India" portal which, apart from showcasing medical advancement and recommending panacea for the benefit of Indians, would facilitate online permission for Indian American doctors to serve in the areas of their choice in India.

"Swasth India" would make it possible for any US-based Indian doctor to select the areas they wish to serve in India, seek and receive formal approval from Medical Council of India (MCI) on their qualifications, and address all other government issues within 15 days.

"Before leaving on this trip, I had written to MCI that existing bottlenecks should be eased and if permission is held up beyond 15 days, then it should be deemed automatically granted," Harsh Vardhan said.

The president of MCI, Jayashreeben Mehta, was present on the occasion. Harsh Vardhan's theme, "2020: Vision for Healthcare in India" drew warm appreciation from the audience.

He stressed that under Modi's overarching leadership, health policy making and its implementation will not be the monopoly of the government but would be guided by the lived experience of hundreds of experts who will be urged to bring local solutions to local problems.

"For the first time we have a Prime Minister who is committed to serving every mother and child, every Indian young and old, with free and clean hospitals, generic medicines, rational drug policy, healthy lifestyles and, most importantly, enough doctors.

I urge the Indian Diaspora to avail this historic opportunity to contribute to realising this dream," the Health Minister said.

The Minister admitted that in the areas of telemedicine, seminal research, surveillance and early warning systems and, most importantly, medical insurance, he could do with the proven expertise of Indian American doctors.

E. India displays highest propensity to online life insurance purchases: Study

Although life insurance is the second most searched product online in the eastern region, it necessarily does not translate into proportionate purchases, a study by Max Life Insurance and Nielsen has revealed.

According to the study, East India displays highest propensity to purchasing life insurance through online channels. Moreover, people here are driven by price competitiveness.

Interestingly though, people from the East displayed the lowest confidence, around 27 per cent, on family protection; with a large number (67 per cent) planning to purchase life insurance in the next six months.

The study, according to a release issued by the company,​ included a sample size of 1,009 participants. 
Benefits & barriers

It also revealed that people from the East believe that purchasing online would provide benefits like price, competitiveness, better comparison and lesser paperwork; along with easier availability of policy details.

However, there are some barriers in online purchases with issues like lack of transparency and credibility; limited information and excessive time consumption cropping up.

Security and safety at the time of making payments is another issue that has to be looked into here.

A majority of 'Internet savvy Indians', came to know about online life insurance from traditional sources like work colleagues, parents/other family, employer, company, and print advertisements. “Internet, thus, has marginal contribution in creating awareness about Online Life Insurance,” the survey revealed.

Social networking

At the time of purchase, a substantial number carried out research across blogs or social networking sites like Facebook; but a large number​ of them​ also dropped ​out even before the purchases are made.

On the other hand, using e-commerce as an effective channel ​(​for purchases​) was popular in the lower income groups; compared to others (in the eastern region) who still prefer ​the ​traditional model of selling through agents.

Jaitley's maiden Budget likely to focus on health care

The Union Budget is likely to announce the first of the Narendra Modi-led National Democratic Alliance (NDA) government’s social welfare schemes for the health sector — the National Health Assurance Mission. The programme will provide universal health care and offer comprehensive health insurance for the poor.

The Budget could also, sources say, propose the government’s mission-mode approach towards a ‘mosquito-free India’, addressing malnourishment and increasing budgetary spend on the health sector. The NDA government has already committed itself to setting up an All India Institute of Medical Sciences (AIIMS) in each state.

The National Health Assurance Mission is said to be close to Prime Minister Modi’s heart. He has spoken frequently about how diseases debilitate the finances of poor households much more than those of well-off households.

He has also said how the country should focus on wellness rather than sickness and the need to create awareness among people on health issues. The programme will aim to fulfil all these objectives.

The Budget, through the health assurance mission, will try to deliver on Modi’s and the Bharatiya Janata Party’s election promise of a holistic healthcare system that integrates indigenous health systems like Ayurveda and is universally accessible, affordable and effective.

The BJP manifesto had promised such a mission “with a clear mandate to provide universal health care that is not only accessible and affordable but also effective, and reduces the OOP (out-of-pocket) spending for the common man”.

The mission will borrow from Modi’s experiences as chief minister of Gujarat and the existing and new health schemes will be brought under this programme. Some of the new steps proposed will try to replicate the success of some of Gujarat’s health schemes like the Chiranjeevi Yojana and Mukhyamantri Amrutam Yojana.

Chiranjeevi Yojana, launched in 2006 in the state, aimed to reduce the infant mortality rate by encouraging women to deliver in hospitals. It was assisted by the ‘108’ ambulance service, which the new government wants to universalise in India. Mukhyamantri Amrutam Yojana was launched in 2012 to provide an insurance cover of up to Rs 2 lakh for critical illnesses to those below the poverty line.

As Gujarat chief minister, Modi increased the budgetary spending on the health sector from 2.69 per cent of gross state domestic product in 2006-07 to 3.24 per cent by 2009-10, according to CII data.

Modi had claimed last year that the Gujarat government increased its spending on the health sector from Rs 800 crore in 2001 to Rs 5,500 crore.

Other objectives of the new government in the health sector are reviewing the 2002 healthcare policy and initiating a new health policy, augmenting the shortfall of healthcare professionals, universalisation of emergency medical services ‘108’, and introducing sanitation rankings to measure and rank cities and towns for cleanliness.

How much insurance do you need?

Life insurance penetration in India is very low, primarily because of the low level of financial literacy in the country. But, it is surprising that even high income earners are not adequately insured. A study of 3,000 individuals by Bigdecisions. in, a financial services portal, shows that even high income earners may be going about in life with barely 10-20% of the insurance they actually need.

Life insurance is meant to provide financial support to your family and dependants if something untoward happens to you. So, the life insurance cover should be big enough to generate an income for the family of the insured person. This would take care of the living expenses of the family. But, the cover should also settle all outstanding loans as well as provide for big-ticket onetime expenses, such as a child's higher education and wedding.

High-income earners at maximum risk

One may think that high income earners have lower need for insurance. On the contrary, they require higher cover because most people have huge home loans and other big-ticket borrowings. "With higher expense levels the higher income group is at a higher risk," says Manish Shah, co-founder and CEO of Bigdecisions. in. The study by the online portal shows that despite the popularity of online term plans offering huge cover at low rates, individuals in the high income bracket of Rs 35 lakh-40 lakh per annum are inadequately covered. "We also noted that the insurance cover did not increase in the same proportion as the increase in income," says Shah.

Adequate life cover won't cost the earth if you buy the right type of policy. Traditional plans offer a smaller cover because they are essentially investment vehicles. At the age of 30-35 years, a person will be required to pay a premium of almost Rs 8lakh-10 lakh a year for a cover of Rs 1 crore. Only the super rich will be able to afford such a plan. For the average buyer, a better option is a pure protection term plan which can offer the same cover for Rs 8,000-15,000 a year, depending on the age and social habits of the buyer.

One should not be lulled into thinking that the life insurance cover he has is enough. A sum of Rs 1 crore might sound big, but even an inflation-adjusted monthly withdrawal of Rs 50,000 will deplete the entire corpus in less than 20 years. This is when we have assumed annual returns of 9% from the corpus and an inflation of 8%.

Should we blame it on low commission for agents?

Why are people not taking adequate insurance? It's not difficult to see where the problem lies. Traditional life insurance policies, which offer very low cover, but charge a high premium, are the focus of insurance agents because they fetch higher commissions. An agent will pocket Rs 30,000-35,000 if he sells a traditional policy with an insurance cover of Rs 10 lakh. A term insurance policy with a cover of Rs50 lakh, on the other hand, barely earns him Rs 1,000-1,500. The study finds that protection is a lower focus area and a larger portion of the premiums are going into savings-cum-insurance plans.

The good news is that insurance companies are not only offering big covers, but are actively encouraging buyers to take larger covers. Some even offer a discount if the buyer takes a high-value cover. Apart from that, when an online buyer keys in his income details, he is prompted by the website to go for a cover Apart from that, when an online buyer keys in his income details, he is prompted by the website to go for a cover commensurate with his income.

ICICI Lombard, Bajaj Allianz General, Tata AIG General Insurance offer insurance plans for students studying abroad

Parents worried about inadequate insurance cover for their children studying abroad, or the cost of buying a comprehensive policy from a foreign provider, have more options now. Indian insurers such as ICICI Lombard, Bajaj Allianz General and Tata AIG General Insuranceoffer plans that cover unexpected expenses on almost anything that a student could face abroad — bail bonds and drug and alcohol rehabilitation to abortion, suicide attempt and even an emergency visit by a parent to take care of an unwell child. Until few years ago, Indian companies provided bare-bone medical and travel insurance. Universities abroad demand much more, and students often had to buy insurance plans from foreign insurers who have partnered with their institutes. Premiums were usually high.

Student travel insurance isn't yet a big business for local companies, but it is growing fast and they didn't want to lose on that. They launched policies that are comprehensive to meet the demands of foreign institutes. For parents, costs were as low as half the premiums paid to foreign companies. From 2011 to 2014, the number of students opting for local insurers increased from 30% of the total to 60% because of the expanded plans and lower cost, say industry executives.Hemant Ashar of Mumbai, whose 18-year-old son studies in the US, wants to shift his insurance cover from a US based insurer to an Indian company.

'Compassionate visit' covered too

His son joined University of Southern California's Marshall School of Business last year for a BBA degree. The initial policy included a study-interruption cover. This year, he found that he could get similar cover from a local insurer for much less. "ICICI Lombard is one such company that has a study interruption provision," said Ashar. "While I paid Rs 1 lakh for an international one, the domestic ones are available for a premium of around Rs 60,000 per year." Sanjay Datta, chief of underwriting and claims at ICICI Lombard, said local insurers had to "up our game" after universities started demanding wider coverage from 2012. "We marketed aggressively with education counsellors, travel agents and global universities to convince that we can provide similar policies too." According to Datta, out of the company's entire travel insurance portfolio, student travel insurance constitutes approximately 8%, and with the added covers, he expects it to grow 15% year-over-year.

In 2012, the company brought in the ICICI Lombard Gold Plan, which included medical emergencies along with stay and trip-related covers like bail bond, study interruption , sponsor protection, two-way compassionate visit and loss of checked-in baggage. Indian general insurers now offer student travel policies which also cover expenses on cancer screening, organ transplant, sports injuries, childbirth and physiotherapy. The 'compassionate visit' clause takes care of parents' travel and lodgings to attend an unwell son or daughter studying abroad. Also gaining popularity is the study interruption cover, where a student's repeat semester fees are paid for in case he misses studies because of an accident or illness. Bajaj Allianz General Insurance introduced a suicide cover to take care of any hospitalisation bills or other costs from suicide attempts ."There was an increasing demand from universities (in the US) that new batches get suicide cover and 80% of our student clients study in the US," said Renuka Kanvinde, assistant VP of health and travel insurance at Bajaj Allianz.Tata AIG plans to roll out an insurance plan with a $500,000 cover that will include maternity benefits and physiotherapy costs along with drug and alcohol rehabilitation, cancer screening, pregnancy termination and sponsor-protection programmes.

Irda tightens policy norms for insurance agents

Seeking to safeguard interest of customers, Irda has made it mandatory for agents to provide full details in transparent manner before persuading policyholders to shift to another life insurance firm. Tightening of replacement norms would help in retaining the life insurance policy.

"To protect the long-term interests of life insurance policyholders and to discourage intermediaries persuading lapsing, surrendering or making paid-up of an existing life insurance policy with the intent of canvassing or soliciting a new life insurance policy on the same life," Irda said in a draft exposure.

The guidelines envisage the full disclosure and transparent information to the policyholder to avoid a possible misrepresentation as to the factual position of financial consequences of replacing an existing life insurance policy, it said.

Short Change: Pilot project for insurance policy digitisation from July 1

Insurance regulator Irda has recently said that the pilot project for digitisation of insurance policies would start from July 1. “During the pilot launch, each life insurer shall convert a minimum of 1,000 or 5 per cent of the existing individual policies (issued in hard form and currently in force) whichever is less for each of the Insurance Repositories (IRs) into electronic form,” Irda said in statement.  This shall be, however, subject to a minimum of 250 policies per IR, it said. The pilot launch will be for duration of 2 months with effect from July 1 and it would be mandatory for all the life insurers and the ‘Insurance Repositories’ to participate in the pilot launch. During the pilot launch, it said, an insurer will not deny any request for electronic policy-both for conversion of existing policies and for issuance of new policies from any of the policyholders.

Edelweiss Mutual Fund launches open-ended equity scheme

Edelweiss Mutual Fund launched an open-ended equity scheme ‘Edelweiss Arbitrage Fund’ on June 12. The subscription for the fund will close on June 20. It seeks to generate income by predominantly investing in arbitrage opportunities in the cash and derivative segments of the equity markets as well as the arbitrage opportunities available within the derivative segment and invest the balance in debt and money market instruments, the company said in a statement. 

Fund raising via private placement bonds hit 9-month low in May

Indian companies mopped up over Rs 9,000 crore through private placement of corporate debt securities or bonds in May, the lowest in nine months. In debt private placements, firms issue debt securities or bonds to institutional investors to raise capital. According to the data available with the Securities and Exchange Board of India (Sebi), companies garnered in May a total of Rs 9,070 crore from debt on a private placement basis through 83 issues.  This was the lowest amount raised by companies through private placement of debt securities in a month since August 2013, when they had garnered Rs 2,089 crore. 

National Insurance Corporation targets R12,800 crore premium income

Public sector non-life insurer National Insurance Corporation expects to garner premium income worth Rs 12,800 crore in the current financial year, a top company official said. “This fiscal, we are targeting a premium income of Rs 12,800 crore, as compared to Rs 10,261 crore in the previous fiscal,” NIC acting chairman AV Girija Kumar said. During April and May, NIC’s premium income grew higher than the industry, he added. “During April and May this fiscal, NIC’s premium income grew 12.8 per cent, as compared to nine per cent in the overall non-life sector,” Kumar said. Last fiscal, NIC’s growth was higher at 12 per cent against the industry growth of 20 per cent. Asked about market share, Kumar said NIC’s share was 25 per cent among the four public sector non-life insurers.

Insurers go full steam to sell recharge health plans

After the acceptance of top up plans, health insurers are now looking to popularize recharge health option plans. 

Under a recharge health plan, if the person insured exhausts his or her total sum insured, say Rs 3 lakh during a particular year, due to some hospitalization, the plan allows reinstatement of the sum insured. The entire Rs 3 lakh again can be utilized for subsequent hospitalization during the same year for a small charge. 

Of course there are exceptions like the reinstated sum insured cannot be carried forward nor can the insured get claim benefits on account of previous illness for which the sum insured got exhausted earlier. 

"We have introduced the recharge benefit in our newly launched health care supreme plan. The advantage for the insured is that he or she has some cover even if the sum insured gets exhausted during a particular year. Otherwise, he or she would have to wait till the next year," Renuka Kanvinde, associate VP, health insurance, Bajaj Allianz General Insurance said. 

Rising health costs and growing demand for a comprehensive health cover is also driving up the demand for such offerings. HDFC Ergo will introduce an addon recharge policy soon. "Medical inflation is hovering around 15%. Hence people would certainly seek double layers of protection to safeguard themselves. As the average Indian life expectancy is steadily rising it is noted that morbidity i.e. disease prevalence is rising too. 

Also, with medical care becoming less invasive and more costly due to new technology, we envisage that the demand as well as popularity of such comprehensive health covers," Mukesh Kumar (member of the executive management and head, human resources, strategy planning and marketing), HDFC Ergo said. 

Apollo Munich's Optima Restore benefit launched last year has a multiplier benefit under which if customers don't use their plan, the company increases the coverage by 50% the following year and doubles it the year after." Optima Restore has evolved as the fastest growing product in our portfolio and last year it accounted for about 30% of our total retail book," Antony Jacob, CEO of Apollo Munich Health Insurance said. 

Insurers also state that such plans can turn out to be economical in the face of rising medical inflation. Cigna TTK Health Insurance has a restoration benefit under all its plans "Customers looking for sufficient cover at reasonable pricing will go for policies with recharge option". 
"A restore/recharge option makes the health cover more comprehensive especially when you do not have any back up health cover. Persons who can bear some amount of their healthcare costs but are looking to fund the additional risks through an insurance plan will opt for top-up/deductible plans," Sandeep Patel, MD & CEO, Cigna TTK Health Insurance said.

How To Transfer Used Cars Insurance In India?

It is known to each automobile owner that every car complying on Indian roads has to insured as per the regulations of government. It is mandatory for every prospective buyer to obtain a car insurance policy so as to make sure any damages caused to the vehicle or by the vehicle are covered. There are generally two kinds of car insurance policy in India – Third Party Coverage and Comprehensive Package. The former is solely dedicated to covering damages caused to a third party by the insured vehicle and does not deal with the insured and insurer. On the other hand, latter is an all-inclusive package which covers damage for the liability (third party) as well as the insured automobile. While every buyer knows the procedures of obtaining the policy, fewer are aware of how to transfer car insurance.

It must be noted that used car insurance in India can easily be transferred to a new owner or a new car. This process involves the production of basic documents related to the insurance policy, in front of the concerned authority. The following steps provide the necessary information involved in the motor insurance transfer process:

1. The first step is to obtain the registration documents of the car and the title of the vehicle. If one wishes to have the car insurance transfer to new owner, then the necessary documents of the vehicle and a consent form of the new owner needs to be produced among the authority. Also, the documents related to existing car insurance coverage and the specific reasons to change or transfer the coverage should be attached with other documents.

2. People can also contact the professionals or the existing insurance agent in order to successfully complete the motor insurance transfer. After all the documents have been presented, the insurance agent will be giving the concerned person with a certain grace period in which he/she has to notify the authority about the transfer coverage or any further changes in the policy. However, if the insured fails to inform the company within the grace period, then his/her car insurance policy might be ceased without any refund or discount, which was to be provided before.

3. In case the used car insurance in India is to be transferred to a new vehicle purchased by the same user, then he/she can enquire the same from the insurance authority. The aforementioned steps are to be repeated in this case, however, one should make sure to always retain the No Claim Bonus (NCB) from the existing car to new model. In case of car insurance transfer to new owner, the presence of both the parties is needed. Both these parties have to sign in the agreement and then the transaction can be done with ease.

Motor insurance transfer does not require much effort except for the insured to obtain and present all the valid documents. It is also advised to obtain all the documentary proof of the transfer deal from the concerned authority in case of avoiding any issue in the future. Used car insurance in India can be transferred to either a new vehicle or a new owner, and there are also few portals, which comprise information regarding the same. However, it is always recommended to analyse all the information beforehand so that there is no problem while transferring the insurance policy.

Insurance cover umbrella opens to include bariatric surgeries

A bariatric surgery is no longer considered a cosmetic weight loss procedure but a life-saving intervention for morbidly obese patients battling with medical conditions either caused by or related to obesity. 

The wife of a Union government employee became the first person in the city to be reimbursed for a bariatric surgery under the Central Government Health Scheme (CGHS). Besides, a privately employed professional also received a full cashless cover from a public sector insurance company a few days ago. Both underwent bariatric surgeries at the Ruby Hall Clinic in the last week of May. 

Thirty-four-year-old Manisha (name changed) weighed 99 kg at the time of surgery. She had a host of medical conditions like breathlessness even at slightest physical activity, loud snoring, pain in the knees, irregular menstruation, fatty liver disease, mood swings and episodes of depression. Besides, she was battling hormonal imbalances due to which she was unable to conceive. Manisha had attempted non-surgical weight loss programmes in the past but to no avail. She lost 5 kg in a week's time after the surgery. Her mood swings have gone down and her physical activity has increased. "I feel better, lighter and energetic. I have started going on regular walks which was not possible before the surgery," Manisha said. 

Initially, Manisha and her husband faced hassles in availing of benefits under the CGHS. "Many empannelled private hospitals in Pune are not aware that bariatric surgery gets covered under the CGHS. We have a copy of the Union government's recently issued circular with specific guidelines to this effect. We had to get an approval from a government hospital for the surgery. So, we approached Sassoon general hospital which asked us to carry out some investigations and gave us permission after seeing the reports," Manisha said. 

K M Vishwas, additional director of CGHS, Pune, confirmed that Manisha's claim approval for benefit under CGHS was indeed the first case of its kind in Pune. "The Centre's circular fixes criteria for availing of the benefit under CGHS. The benefit is extended on a case-to-case basis," Vishwas said. The circular was issued in November 2013. 

The selection criterion is very stringent and only those with co-morbid conditions like uncontrolled diabetes, hypertension, osteoarthritis or back pain can avail of the benefit. "Those with no associated ailments are not considered for the cover," said another CGHS official. 

Forty-two-year-old Anish (name changed), a resident of NIBM Road, was treated for an abdominal tumour in 2009. He weighed 120 kg. Anish continued to put on weight even after the treatment. He approached doctors again in April 2014 and was advised a surgery. 

Anish presented with complaints like swollen legs, severe breathlessness even at rest, snoring to extreme extent, sleep apnea, severe backache restricting his physical movements. He was unable to sit properly and walk a few extra steps. On investigations, he was found to be pre-diabetic needing appropriate diet control which was a challenging situation in his case. 

Anish's BMI was 62 and was operated upon at Ruby Hall Clinic on May 23 and discharged after three days. All his surgical expenses amounting to Rs 3.51 lakh were sanctioned by the New India Assurance Company. "It was a full cashless sanction," he said. 

Anish has lost 30 kg in 15 days after the surgery. "I can sit and get up with ease and can walk considerable distance now. I am feeling lighter and more energetic," he said. 

A person with a BMI of 30 and above is called obese. And those who have BMI of 40 and above are considered morbidly obese. "But in India, a person having a BMI of 37.5 and above is considered mordbidly obese as Indian population is found at risk of developing complications at the BMI of 37.5 and above. A person with BMI of less than 37 but with a host of other medical conditions can be advised to undergo bariatric surgery," said surgeon Jayshree Todkar, who treated Manisha and Anish.

IndiaFirst Life ramps up presence in Gujarat

Mumbai based insurance company, IndiaFirst Life, has announced its plans to ramp up presence in Gujarat as part of its long-term growth strategy. The company is aiming at a 20% growth in FY 2014-15.

"Gujarat has been a crucial market for us since inception. Its mixed economy and consistent growth rate provide exciting possibilities," said Kamalakar Sai, director sales, IndiaFirst Life.

According to a statement from the company, it has covered 1.62 lakh lives and garnered approximately Rs 1,481 crore of business in Gujarat since inception.

Gujarat today has one of the highest savings and investments rate in the country. Till 2011, the total investment promised was to the tune of Rs 39.6 lakh crore.

For the year 2013-14, IndiaFirst Life posted a growth of 28%.

Bajaj Allianz launches new home insurance product

Christened 'My home insurance all risk policy', this is an all risk policy that covers losses due to perils other than those specifically excluded. Flats and apartments can be covered on an agreed value basis in addition to reinstatement value basis or indemnity basis. The reinstatement value basis is the construction cost excluding value of the land or the apartment. Moreover, flats and independent buildings up to 30 years can be covered under this policy.

The policy offers six plans under the categories of gold, diamond and platinum. Moreover, the policy has eight add on covers like loss of rent, temporary resettlement cover, public liability, dog insurance cover, ATM withdrawal cover, lost wallet cover, key and lock replacement cover, employee's compensation cover for domestic staff. This will help the insured customize their policy.

What do you think about this policy? Please share your feedback.

‘Insurance buyers don’t need to reveal lifestyle diseases’

Not mentioning common lifestyle diseases while applying for insurance is not concealing facts and cannot be a reason for rejection of insurance claims, a district forum has observed while citing a state commission order. 

The forum stated it cannot be concealment of facts unless a patient has undergone long treatment and hospitalization days before taking the policy. 

On Friday, the forum directed New India Assurance to pay the medical insurance amount of Rs 2.3 lakh and compensation of Rs 1 lakh to the family of a man hospitalized for cardiac-related ailments in 2007. 

The insurance company had repudiated the claim that the policy holder had concealed his pre-existing ailments before procuring it. 

"The complainant has clearly mentioned that he was a heart patient and this fact was known to the officer of the insurance company. Hence, in our opinion, the rejection of the complainant's claim is unjust and improper," the forum said. 

The policy holder, Kabiru Dhamani, died but his wife and two children filed the complaint before the South Mumbai Consumer Disputes Redressal Forum on June 13, 2008. 

The Dhamanis told the forum Kabiru had revealed he was a heart patient. He had procured the policy in June 2004 and paid a premium of Rs 6,180. 

The family alleged the insurance company was aware that Kabiru suffered from hypertension with diabetes mellitus. In 2006 and 2007, Kabiru was hospitalized and treated for cardiac problems at a Nagpur hospital. 

In July 2007, the family filed the insurance claim which was rejected later. The insurance company said the claim was not admissible due the exclusion clause relating to pre-existing disease. 

Aggrieved, the family filed a complaint before the forum.