An open letter to Health Insurance Company from its customer

POSTED BY manish ON April 28, 2011 COMMENTS (77)

    Dear Insurance Company,

    Hi, I am your Mediclaim Customer. I am 30 years old, married, have a kid. I own a house in the suburbs of Mumbai and have recently bought a small car. I am well read, and hence fairly aware of basics of financial planning and securing my future. Yes, I believe in Insurance. I bought my first insurance policy (term life) when I was 23 years old. Yes, I know, I am the type of customer, who you vie for – I am the one who appears as “Sec A2” – target customer right at the top of all your sales spreadsheets and presentations.

    Health Insurance India

    I have been your customer since 2007. It started off pretty well. I received fairly good service from your end. But…lately, I have been very uneasy with our relationship. In fact, I think I have lost trust in you. OK. Stop getting surprised; I know you are  part of a group valued in Multi billion dollars ; I know you have presence in 100s of countries worldwide, you surpass all the solvency norms set by the regulator, and yes, your claims settlements are improving . But I have still lost trust in you. Can you help? Please give me your 5 minutes to explain.

    4 years back, when I was 26 years old, I decided to buy my own health insurance policy. I had a cover in my dad’s policy, but my calculations showed that I was not covered adequately. I therefore approached a health insurance broker. He did a good job, helping me compare various mediclaim policies available in the market, and took me through how this whole mediclaim thing works. I signed up for the most attractive one (the one which had the best features and the lowest price).  I was proud I had done my homework, just like my dad would.

    Two renewals had passed, when I received the 3rd years’ Renewal Notice. The renewal notice talked about increase in premium by a shocking 500%, with the reason “adverse claims ratio and Medical Inflation” mentioned on the letter. A premium of Rs. 3000 for 2 Lakhs coverage for a family of 3, has increased to Rs. 13000! OK, I understand Medical  inflation, but I am sure it wouldn’t have been grown more than 50%, then how was the remaining 450% increase in premium to be understood? Did I have a role to play in the adverse claims ratio you faced? Could I have helped avoiding it? At first, I was sure, the premium mentioned was a printing error, but when I realized it was correct, I felt cheated and went berserk. I called the Broker (who himself was shocked, and worried), set up con-calls with the Insurance Company’s representatives, escalated the matter to the regional office, all I received were templated/recorded answers….Phew…I finally gave up.

    I refused to renew the policy with this company, and heroicly pledged not to deal with this organization ever. My Broker suggested I port my mediclaim policy to another player. This time, I made sure this player was an ethical, reliable name. I finally zeroed on to a large Insurance company which had an alliance with supposedly “the world’s largest insurance company”.

    I moved on.

    Cut to today, I recently received a call from my Broker, the health insurance company had removed the No Claim Bonus of Discount completely from my renewed policy this year, without citing any reasons at all. I got this strange feeling of déjà vu.  Forget prior information, I was expecting some communication from this big brand, but there was none. In this world of extreme transparency and hyper competition, I am amazed at this unusual apathy shown by the best of world Health Insurance Companies in India. (Read 17 Most asked questions in Health Insurance)

    When I called the Insurance Company representative, all he said is that Medical Insurance is a “yearly contract”, and terms are subject to change on renewal.  A yearly contract!??!!? Whoa? When this medical policy was sold (twice by different providers) to me, I was explained various clauses in details like 2 years waiting periods, 4 years continuous renewals and the USP – “lifetime guaranteed renewal”. How can a mediclaim which assures lifetime renewal be a yearly contract?? Isn’t this a classic paradox?

    OK, I know you are busy….So let me stop complaining, forget the past, and give you one more chance, the last one. Let me plan for my all critical post retirement/old age Healthcare costs. So now I understand the mediclaim policy is a yearly contract. I understand, you are making losses, you are unable to control the claims in Health Insurance and you are “forced” to make these “small” changes in the contract, every year. And yes, I should feel fortunate, that second time on, you atleast did not increase the premium by 500%.

    I understand all that, but looking at the rampant changes you have been making in the policy wordings and process, I am really in a fix. I am now not sure what the policy would evolve into when I reach my old age. The way things are moving, the one thing, I am sure of is that the policy would be gravely different from what it is today (I am sure, a money making product for you, by then)

    So, How do I predict the policy conditions and plan my post retirement healthcare expenditure?

    Till when, and to what extent you would keep changing the terms? How do I assure myself, that the terms would be favorable for someone like me who bought his policy at 26, paid you premium, without claims for 14 years, from someone who is 40 that time and is buying a fresh policy??

    Now, I am getting really confused. When you sold the product you encouraged me to buy these, clearly calling them “long term investment”, and now, on renewal you are calling it a “yearly contact”. Would you continue to guarantee lifetime renewals, or would you add restrictions on co-pay, remove no claim bonus, remove all large hospitals from the cashless network or worse, spike the rates by 500% every year, when I am growing older?.

    Now, it’s all boiling down to plain trust. How should I trust a selectively transparent, for-profit organization like you? Is Mediclaim a policy with long term commitments or is it a yearly contract?

    Would love to hear an answer. Can you help?

    Thanks,

    Your Health Insurance Customer.

    Disclaimer : Though, the concern being raised is real, please do note that, this is a work of fiction by the writer. The Insurance companies described in this post, do not add up to targeting any specific company.

    This article originally appeared on Medimanage blog and reproduced on this blog with their permission.

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77 replies on this article “An open letter to Health Insurance Company from its customer”

  1. raj says:

    Dear Manish,

    What are your views/differences about Health Insurance directly from Insurance Company versus same health Policy through a Bank from same Insurance Company

    Regards

    1. Raj

      You always get policy from Insurance company only , if you take it with bank , its just an agent for you , nothing else ,even then the policy is from company

      Manish

      1. raj says:

        1. I understand that a health policy taken through a Bank is a Group Health policy? Then what happens if the contract between Bank & Insurance company terminates?
        (a) The pee-existing cover is transferred i.e. is taken to One’s next Policy from same insurance company? OR
        (b) Loose all the benefits incurred till that date & Start afresh.

        2. Is it possible, there could be difference in coverage aspects between policies taken from same Insurance Company through an Agent or BANK AS AN AGENT?

        3. What about portability differences of these health policies? (Same insurance company but one purchased through an Agent & other through a Bank (as an agent))

        4. Why such a huge difference between premium of Policy taken through an agent VERSUS Policy taken from BANK (as an agent) from same insurance company?

        Regards and thanks

      2. himanshu says:

        Hi Manish,

        i do not understand this health insurance thing.

        In term insurance we pay premium every year upto the maturity date and the sum insured always remains same.

        does the same happens in health insurance also??

        for example i took a health insurance of 500,000 with a premium of 6000.. i paid the premium for first year.. then what?? what will happen from 2nd year onward and subsequent years that follow..do i need to buy health insurance every year ??

        1. The premiums on health insurance is NOT FIXED like term plan .. Each year you have to pay the premium so that your policy is in force . HOwever its not correct to say that the premiums will rise each year without any justifications .

          However it can happen for few reasons , which I cant explain at this moment .

  2. HARJINDER JUNEJA says:

    From: HARJINDER JUNEJA
    Date: Thu, 05 May 2011 00:18:48 -0700 (PDT)
    To: nimisha irda
    Cc: meena irda; utvmoney
    Subject: Fw: Re: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010 (reminder-4)

    To
    Nimisha Srivastava
    Assistant Director (HEALTH)
    IRDA, MUMBAI

    Dear, Madam

    This is my 4th reminder in response to your mail dated 06-03-2011 where you said that you are sending me a reply for my e-mail dated 22-02-2011 regarding your approval to increase renewal premium by 500% in reliance mediclaim policy .

    I want to reminds that I have not receive any reply from your side till date. your department take only 1 month to approve reliance application to increase renewal premium by 500% which was against the 10 lacs of policy holder but your department can not reply our letter in last 3 months. as per your letter dated 06-03-2011 reply is pending for approval, now two month lapse and still reply is pending.

    I again reminde you to send reply of my letter dated 22-02-2011 which is attached with this e-mail

    Harjinder Juneja
    Harjinder Juneja
    1/639, Sect-H, Jankipuram
    Lucknow-226021

    — On Wed, 3/16/11, HARJINDER JUNEJA wrote:

    From: HARJINDER JUNEJA
    Subject: Re: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010 (reminder-3)
    To: “Nimisha Srivastava”
    Cc: “meena irda”
    Date: Wednesday, March 16, 2011, 4:03 PM

    To
    Nimisha Srivastava
    Assistant Director (HEALTH)
    IRDA

    This is with regards to our letter dated 22nd February 2011, I hereby want to reminde that we have not recieve any letter from your side till date.
    I feel that 23 days is more than reasonable time to reply.

    I again request to please send your reply urgently.

    Harjinder Juneja
    1/639, Sect-H, Jankipuram
    Lucknow-226021

    ________________________________
    From: Nimisha Srivastava
    To: HARJINDER JUNEJA
    Cc: J. Meena Kumari
    Sent: Sun, March 6, 2011 3:10:21 PM
    Subject: RE: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED
    23-03-2010 (reminder-3)

    Dear Mr. Juneja,

    Please be informed that Authority does not work at the discretion of one person.

    Every health insruance product is examined and processed by the health
    department team based on our F& U guidelines as well as other pertinent
    circulars issued to insurers from time to time. The health department then puts
    up the product for the consideration of Chairman. Once our Chairman approves the
    product, the decision on the product is communicated to the CEO of the insurer
    through a letter (even the format of this letter is formerly approved). Hope
    this clarifies the concerns you raised in the email below.

    As regards your email of 22nd February, a draft reply on your letter has been
    placed for approval before the competent Authority. You shall receive a reply,
    through post, once the draft is approved.

    Regards,
    Nimisha Srivastava
    AD(Health)

    ________________________________

    From: HARJINDER JUNEJA [mailto:harjinder_juneja@yahoo.com]
    Sent: Fri 3/4/2011 12:59 PM
    To: Nimisha Srivastava
    Cc: J. Meena Kumari
    Subject: Fw: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED
    23-03-2010 (reminder-3)

    To
    Nimisha Srivastava
    Assistant Director (HEALTH)
    IRDA

    You have still not reply a very simple query raised by us. your silence is
    making a very negative thought about you. and we feel that you have done this
    with a malafide intention to benefit reliance and to cheat thousands of policy
    holder. Because you are a woman so i again request you to please clarify your
    position because after this all will go in public domain and that time every
    body will ask a question why you have not clarify your position in this matter.

    Harjinder Juneja
    1/639, Sect-H, Jankipuram
    Lucknow-226021

    —– Forwarded Message —-
    From: HARJINDER JUNEJA
    To: nimisha irda
    Cc: meena irda
    Sent: Mon, February 28, 2011 1:26:34 PM
    Subject: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010

    To
    Nimisha Srivastava
    Assistant Director (HEALTH)
    IRDA

    Madam

    I still not receive your reply . please reply whether this hike in premium will
    be applicable to renewal policy or not. people who paid premium 9000/- last
    year, this year reliance demand 38000/- to 45000/- .

    Please reply yes or now .

    Harjinder Juneja
    9794714109

    —– Forwarded Message —-
    From: HARJINDER JUNEJA
    To: nimisha@irda.gov.in
    Cc: meena irda
    Sent: Thu, February 24, 2011 4:56:04 PM
    Subject: Re: Your email of 22nd February regarding reliance healthwise policy

    I will be very greatfull if u reply as earliest as possible.

    harjinder juneja

    ________________________________
    From: nimisha
    To: HARJINDER JUNEJA
    Cc: Meena Kumari
    Sent: Thu, February 24, 2011 4:53:29 PM
    Subject: RE: Your email of 22nd February regarding reliance healthwise policy

    Sir,

    Your email of 22nd February has been received by the Authority.

    Please be informed that the concerns expressed in your email are currently being
    examined and we will revert back to you shortly.

    Yours faithfully,

    Nimisha Srivastava
    Assistant Director (Health)
    IRDA

    From:HARJINDER JUNEJA [mailto:harjinder_juneja@yahoo.com]
    Sent: 24 February 2011 16:13
    To: nimisha irda
    Cc: meena irda
    Subject: Fw: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED
    23-03-2010 (Reminder )

    To
    Nimisha Srivastava
    Assistant Director
    IRDA

    REF: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010
    sUB: REVISION IN RELIANCE HEALTHWISE POLICY.

    we have not receive any reply from your side till now. we again remind you to
    please clarify your position in this matter.

    Harjinder Juneja
    1/639 Sect-H Jankipuram
    Lucknow
    9794714109

    —– Forwarded Message —-
    From: HARJINDER JUNEJA
    To: nimisha@irda.gov.in
    Cc: meena@irda.gov.in
    Sent: Tue, February 22, 2011 11:05:56 PM
    Subject: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010

    To
    Nimisha Srivastava
    Assistant Director
    IRDA

    REF: your letter no. IRDA/NL/RGI/P/MISC(H)1677/V.II/09-10 DATED 23-03-2010
    sUB: REVISION IN RELIANCE HEALTHWISE POLICY.

    Dear Madam

    With refrence to your above refer letter by which you approve revision in
    reliance Health wise policy i want a clarification.

    1. reliance increase premium rate by 400% to % 500% with this approval letter .
    Revision application show that this increament in premium will be only for new
    sale but reliance make applicable this premium on renewal of all policy issued
    since beginning of this product 4 years back.

    2. Due to this increment I have to pay Rs. 10000/- premium from last two year I
    was paying Rs. 2860/- premium.

    3. I just want to know whether your approval will be applicable on policy sold
    by Reliance in last 4 years.

    4. If yes please explain the reason of 500% increment in renewal premium and how
    a common man will pay this . and how this is in interest of policy holder.

    5. As per reliance policy document issued two year back reliance can
    not increase renewal premium until we add some addiction in our habit
    and increment can not be more than 100%. But after your letter
    they increase premium by 500% and now they are claiming that IRDA approve this
    renewal premium.

    6. Thousand of policy holder lost their policy because they are not able to pay
    500% hike in renewal premium.

    Please reply and clarify urgently. because we are going to file a court case in
    this matter against You and other official of IRDA but we want your
    clarification in this matter.

    Harjinder Juneja
    1/639 Sect-H Jankipuram
    Lucknow
    9794714109

    1. srinivau says:

      yes agree.
      Hope you will get a reply !
      thanks for this good work.

      1. DV says:

        Very sorry for Mr. Harjinder.

        Relience and founders are known for the corruption. I don’t understand why people are not staying away from any of the relience product. just stay away from relience prometed financial/investment product e.g. Health Insurance/Gold MF/Life Insurance/MF etc…

        1. AK says:

          Why blame Reliance? If there was corruption then obviously IRDA was involved and took money.
          So, if the watchdog IRDA takes money then why not others will follow the same route. Every insurance company shall love to get 1000s more from their customers, wouldn’t they?

  3. HARJINDER JUNEJA says:

    Thats why most of the reliance bosses are in jail. Reliance and IRDA nexus which is behinde this massive hike in renewal premium. nimisha srivastava (nimisha@irda.gov.in) Assistant Director (Health) IRDA who have sign this letter. Reliance file application to hike premium for new sale only but now charging change premium in renewal policy and we have written to Nimisha srivastava to clarify because increase in renewal premium is against the guideline of IRDA itself , but she is promising from last 2 month to reply. but everybody is silent . we have also written to under secretary ministry of finance (insurance division) . cvc (chief vigilance commisioner) every body is either silent or passing the matter to IRDA chairman.

    Now this is the time to stand with people like anna hajare. because system is totally corrupt.

    1. Harjinder

      Thanks for letting us know that 🙂 . It was useful

      Manish

  4. raju says:

    Hi Manish,
    Can you/anybody(blog followers) suggest the good plan/providers to consider with your experience and knowledge?
    It is really very difficult to come out with a conclusion,at least 2-3 providers to short list,since lack of experience with health insurance agents.

    Most of the people suggest good Life insurance or mutual funds,but i could not find out an advice ,which suggests to a health insurance provider.

    I found many articles on web with all lists of comparison, even one website did not recommend a few to shortlist.

    Regards,
    Raju

    1. You are completely right, a Compare & Buy Website, is not the solution, it is a part of the solution, or a tool to come closer to your decision to purchase. As mentioned earlier, you need to spend more time, zeroing on a good health insurance advisor, who is a specialist in Health Insurance, provides unbiased recommendations, provides claims assistance.

      1. raju says:

        Thanks Mahavir,

        I have done some analysis on this some time back to health insurance for my parents.I have shortlisted StarHelath & Apollo ,because of their Network Hospitals near to my Hometown where my parents live.I could not get much information on their services or claim settlements.

        Looking to get feedback on these providers from anybody’s exp.

        Regards,
        Raju

  5. amol says:

    My 2 cents are here

    One of the reader recommended NOT to go for cashless facility and later get the claim settle by insurance company. The reason he told that if the hospital knows that you are insured then they would do many malpractices to charge as much as possible to insurance company when they know that you are not paying but the company will pay. This might result into insurance company will later increase premium to the clients.

    In general what should be happening or how that works in western countries is that the insurance company always have standard rates defined for most of the treatments and pays to the doctor or hospital using those standard. So tomorrow even though hospital charges 5 lacs for heart surgery the insurance company has evaluated that particular surgery for 3 lacs and will bargain with the hospital and finally will pay them near to 3 lacs only.

    In short insurance industry must dominate the medical industry at one point.
    If the hospital doesnt agree then they are not in deal with that insurance company and suffer the loss because no one will visit their hospital because insurance company do not support it.

  6. BHARAT PUROHIT says:

    Query : Manish, I bought health insurance for my mother 02years back with 03lac rupees coverage with premium of Rs. 3300/-p.a from ICICI lombard.

    now company is offering me one more policy for my mother with 08lac rupees additional coverage with Fix. premium of Rs. 3300/-p.a. which will not change till policy continue. till age of 65 i think. my mother’s age is 45 years now.

    is it worth to have 11 lac rupees coverage? i have to pay annual premium of Rs. 6600/- for this policy. I have not claimed anything in last 2 years.
    or do u have any suggestion? or other policy in ur mind?

    1. Bharat

      its mostly the “top up” insurance, its like when they know that you have 3 lacs of health insurance and with high probability you will never reach a high cost (based on your history) , then they offer you very high cover with additional premium ,it makes you feel as if “Wow , i am g etting 11 lac cover in just 6600” , but remember that with extremelly high chances you will not reach 11 lacs of expenses ! .

      Think like this , what if they offer 1 crore of health insurance in 20000 , will you buy ?

      Manish

      1. BHARAT PUROHIT says:

        agree….

    2. Chander Kant Goyal says:

      which will not change till policy continue. till age of 65 i think”
      Does any company really provide assurance of not increasing the premium till certain age,

      Manish wha is your taken on that part?

      1. There can policies now a days like Optima Insure which is not going to change the premiums , but this had to be mentioned in the policy documents … Have a look at documents .. one cant say this as a general rule !

  7. Rajesh says:

    Here’s a list of questions that I asked a Max Bupa agent in an email conversation:

    1) My preferred hospital is Columbia Asia, Hebbal, Bangalore? Does it have cashless facility?
    2) Is renewal life long? If life long, is there co-pay or any other restrictions after a certain age?
    3) Can I get a list of day care procedures that are covered?
    4) Does it pay for annual health checkups? If yes, is it treated as a claim for a year and subject to loading on renewal?
    5) What is the loading policy? Is it defined in the brochure? Are there age slabs?
    6) Can I get a copy of all the documents that I would have to sign so that I can go through them at my leisure?
    7) Premium covered under Section 80D?
    8) Do you offer an online portal for customers to view their details and claim histories?
    9) What is the pre and post hospital coverage? 30/60 or 60/90? What are the sublimits on them?
    10) What is the coverage for ambulance charges? Private room? Expenses on accompanying person (especially in case of minor)? Domiciliary treatment?
    11) Pre-existing conditions not covered until?
    12) Does it cover Maternity from Day 1? If not, whats the waiting period?
    13) When does new born coverage start? Vaccinations covered?
    14) What is the cooling period? .i.e. coverage after the plan is signed?
    15) What if I wish to go for higher coverage or downgrade to a lower coverage after few years? Is it treated as continuous coverage or is the history lost?
    16) What if my child drops off the coverage when she gets married or when she turns 25, or a new-born addition to the family? Will the policy continue to be treated as continuous coverage?
    17) TPA is in-house or third party?
    18) In family floater, say of 3 members for 6 Lakh total, are there limits on how much father/mother/child can use? For example, each cannot use more than 50%?
    19) I also have a coverage from my employer (Oriental Insurace). Will the claims be pro-rated depending on the sum covered among both of you? What happens if Oriental does not cover a treatment that you do. Will you reimburse the full costs?
    20) Whats the cancellation policy?
    21) In Family floater, will my family have to open fresh policies in case of my death (primary member) and thus lose their claim history and coverage?
    22) Are there any service charges on the claims settled through TPA?
    23) Do you provide a relationship manager?
    24) Do you offer grace period for renewals?
    25) What is the Bonus for no-claim years? Renewal Discount?
    26) If any medical tests are needed before start of proposal, who to pay for it, especially of coverage is denied?

    While all the answers have been to my satisfaction, few of them (like the no-loading policy) are not officially documented. Hence, I have my doubts and have not availed. The premiums are higher than the PSU’s but I am ready to pay a price for quality. Just not sure if the quality is guaranteed.

    1. srinivau says:

      yes.every word is true.
      I can only request insurance co and their agents to inform clients about EXCLUSIONS beffore taking money.
      thanks for your good work.

      1. rakesh says:

        We have Max Buppa Agents who reply on this blog, lets wait for their comments.

        Rakesh

    2. Rajesh

      Thanks for sharing that list of questions , why dont you share the answers as well with me on my email manish at jagoinvestor dot com

      Manish

      1. Rajesh says:

        Manish … Answers have been emailed.

          1. Karthik says:

            Hey Manish,

            Why dont u share the answers with the readers (If its ok with Rajesh ofcourse). It will be very useful.

            Cheers,
            Karthik

            1. Karthik

              Here are the answers as sent by Rajesh

              1) Yes, Columbia Asia, Hebbal is a part of our network hospital where you can use the respective cashless card.
              2) Yes, Renewal is for life long with assured renewablity for life. There is only a co pay after the age of 65.
              3) All day care procedures are covered in you and your wife policy.
              4) As per the plan that you choose you would be provided with the free health check ups. There are no loading charges in our policy.
              5 No, there are no loading charges and we do not have any age slabs.
              6) Its a recording line process, i would be filling up your application form on telephone itself.
              7) Yes, it is covered under section 80 D.
              8) We are working on the same.
              9) Pre & Post hospitalisation expenses are covered for 30/60 days, As per the plan you choose there are sub limits.
              10) Ambulance charges incase of network hospital is upto your sum insured, whereas incase of non network hospital it is Rs.2000 per event. There is no cap on the room charges. We do not cover expenses on accompanying person, we only take into consideration the medical expenses of the insured person.
              11) Pre existing is not covered for the 4yrs consequtive years of the policy.
              12) Maternity is covered aftr 24 months of the policy.
              13) If a delivery takes place after 24 months, he or she is covered from day 1 and is provided with the first yr vaccinations.
              14) Cooling period is of 90 days from the starting of the policy only.
              15) Yes, it is considered as a continous policy.
              16) In a family floater, kids age can be maximum considered as 21, and after that you need to opt for a Individual cover for her, it would be considered as a continous policy.
              17) There is no TPA involved.
              18) In a family floater there is no sub limits, anyone can use upto there sum insured.
              19) There are 2 options in this scenario, 1. You can claim the whole amount from one co. 2. If you want to claim from both the co. at the same time, the claim would be divided in the same proportion as you hold the cover from both the co.
              Any disease that is not covered from your corporate cover and if covered from Max Bupa, you can claim the whole amount from our co.
              20)If you want to cancel the policy you will have to give 7 days prior notice to the co.
              21)They can continue with the same policy.
              22) No TPA is involved.
              23) Yes, in gold and platinum.
              24) Yes, 30 days is provided.
              25) It is decided as per the plan that you choose
              26) Medicals if required are conducted after you take the policy and you do not have to pay for the same.

  8. Atul says:

    Hi Manish,

    Nicely summed up in letter format above.

    Trust is something we Indians culturally believe in, from parents to siblings to teachers. When it comes to money matters trust takes backstep.All Insurance companies are here to make money and not social service.

    Part of the fault lies with regulators who are not doing enough to curb such malpractices.

    Cheers

    Atul

    1. Atul

      Yes . Trust is the biggest thing when it comes to Financial advice , atleast in India 🙂 .

      Manish

  9. mani says:

    Dear Mahavir Chopra,

    Wonder which ‘health insurance Advisor’ you have in mind!!

    A health insurance Advisor is in no way a guarantee against the kind of difficulties list in the letter. The hard truth is many private non-life insurance players are running with huge losses. They need to cut their losses and hence the premium increase.

    Websites such as your provide a easy way to compare products. Final choice will should be made only after the client reads the policy documents and makes an informed choice.

    Websites such as yours are good tools but are solutions to the above listed problems. If facts I believe it could tempt customers into make hurried choices.

    You may give unbiased advice which I dont doubt, but you dont control industry/company policy. So the future for every mediclaim customer is uncertain whether they have an advisor or not.

    Wish you the best.

    1. mani says:

      Sorry I meant
      Websites such as yours are good tools but are NOT solutions to the above listed problems.

      1. Hi Pattu,

        Insurance advisors who understand Health insurance, as a product, the claims process are the Health Insurance advisors I am talking about. To be specific, someone who “own” the advice he gives – right through.

        I NEVER mentioned that Health Insurance Advisors are “guarantee” against the difficulties. I said ” you can be rest assured to be able to tread past any change in the industry.” – which meant he can explain, guide the customer, why such changes are happening, and the right way to move forward.

        The website, as you rightly mentioned is just a tool. We are not a website. We are much more than a website. Please go through the link provided by Manish at the end of the article to understand more. (I don’t want to write more here, else, you will again say – that I am promoting myself 🙂 )

        I agree, future is always uncertain. Intermediaries, don’t control policies and products. A blind decision on selection of the advisor can worsen things. On the other hand, a good advisor, who is unbiased, – can keep you posted, guide you, help you with options to change course, if necessary, in such cases.

        Cheers!

      2. Mani

        I think thats true for all the websites , and there cant be websites which can replace a individual effort at the end . One has to think and act themselves no matter what !

        Manish

  10. Dhawal Sharma says:

    Hi Manish,

    This article has painted HEALTH INSURANCE INDUSTRY as a typical HINDI MOVIE’s EVIL MAMA “jo kehta hai ki mein aapne bhaanje ke 18 saal ke hone tak uski jayedaad ki dekh-bhaal karunga aur plan banane lagta hai ki kaise wo saari daulat uski ho jaye.” 😉

    Me being a part of this industry wants to put forward certain points which i believe can be of some help to everybody on our blog
    1) All the MEDICLAIM policies are NON-TERIFF products, i.e. there premiums are not fixed by the authorities..Companies are free to fix premium according to their own CLAIM HISTORY/MEDICAL COST etc..That is why premium for same FAMILY/INDIVIDUAL may differ from one mediclaim policy to another..

    2) A Company can change its premium structure ONLY AFTER its being into operations for at least 3 to 5 years with approval of IRDA..So if some company has revised its premium rates, it has done so only through the consent of IRDA (So IRDA is not sleeping, as someone had writtern earlier)..
    Most noticeable example is RELIANCE GENERAL INSURANCE which has hiked its premium almost 5 times..but the most important thing to understand in this case is that RELIANCE launched FAMILY FLOATER for Rs 999 which was later revised to Rs 5,999..First things first, FAMILY FLOATER of Rs 1 lakh for a family of 4 is not feasable financially at all..This premium hike was imminent, sooner than later..Even a common man can say that this deal for Rs 999 is too good to be true..And so, most of the people who have taken up this policy because it is REALLY-REALLY CHEAP are suddenly facing the harsh reality and feeling the pinch that premium has been hiked and so on..Its just a ploy by the new company entering into the market to extract its share with rock bottom prices and then eventually raise their price to the level of actuality..Even the MAIN ARTICLE above also says that “I have selected the product with best features and LOWEST PRICE..” No sir, it does not work this way – Best features bhi aur LOWEST price bhi..Its upto us, the common man to see through this game that PREMIUM of such less level must have a catch and if not, then it is sure to spike in the future..and now i believe for next at least 20 years, there would be no complaint from anybody that there is a hike of PREMIUM by 500% because now most of the companies are charging REALISTICALLY HIGH premium..

    3) Unlike life insurance, MEDICLAIM or GENERAL INSURANCE contracts are on yearly basis..You are required to renew your policy (Car insurance/two-wheeler insurance/mediclaim) every year but unlike in LIFE INSURANCE plans, there is no specific TERM for mediclaim..Your TERM PLAN, ULIP, ENDOWMENT, or MONEYBACK plan are bounded for a particular term; say 1o years or 20 years and you just pay renewal premium to keep that contract in force..But MEDICLAIM are in fact YEARLY CONTRACTs because your claim again starts from the scratch even if you have availed the entire COVER AMOUNT in the previous year..In ULIP, if you make partial withdrawl, you FUND VALUE stands reduced from amount X to amount Y, and on next year renewal, your FUND VALUE will start from amount Y and not amount X..Whereas in the case of MEDICLAIM, if you have a cover of Rs 3 lakhs and you have availed Rs 2 lakh out of this, on renewal your cover amount will again start from Rs 3 lakh and not 2 lakhs..So this is an YEARLY RENEWABLE contract..This policy can be a LIFETIME CONTRACT in a way that you continue to pay your YEARLY RENEWAL PREMIUM as long as you live and your policy will be active as long as you are alive..Plain and simple, nothing confusing i suppose..ASSURANCE of LIFETIME RENEWABILITY means if you continue to pay your RENEWAL PREMIUM till the age 90 (Lets say) then your policy will be renewed till the age 90..

    Let me finally add that everybody is out there to do business and nobody wants to continue with LOSS-MAKING PROPOSITION..PSUs in MEDICLAIM INDUSTRY are annually incurring a loss of 926 crore and that is why even they have to resort to some strict measures like FLOATING THEIR OWN TPA and STOPPING CASHLESS FACILITY AT TOP END HOSPITALS..and its has nothing to do with PRIVATE or PUBLIC companies..What would a POLICYHOLDER from PSU would do when he sees that his CASHLESS FACILITY is withdrawn from Apollo hospital or Max Hospital in Delhi??

    I myself has an INDIVIDUAL mediclaim policy for myself from ICICI LOMBARD for last 9 years and a FAMILY FLOATER for Me + my wife + my daughter from MAX BUPA for last 1.5 years and have no issues from either of them, either or service part or claim settlement or premium..Just select a reasonable product with reasonable cost, the one which gives you the features you are looking for plus the premium you can afford, and i dont think there will be any problem AT ALL..

    Dhawal Sharma
    URJA WEALTH CREATORS

    1. pattu says:

      Dhawalji,

      I never thought I will say this but for once I completely agree with you!

      “Just select a reasonable product with reasonable cost, the one which gives you the features you are looking for plus the premium you can afford, and i dont think there will be any problem AT ALL..”

      “everybody is out there to do business ”
      This includes the health insurance Advisors who wish to use popular blogs to promote themselves!

      Very well Said.

      1. Dhawal Sharma says:

        Dear PATTU JI,

        I am confused somewhat with your sataristic comments, whether to feel pinched or elated??

        So let me start with telling you some facts..YES, i have managed to sell few MAX BUPA & KOTAK policies to the readers of the blog (Actually they are the ones who contacted me, then we met personally, discuss the pros and cons of the product, and then purchased the policy)..I feel proud to help few people out to make a choice by offering them quality product, for which i am not ashamed of..It also adds to my SELF-ESTEEM and PRIDE that these people contact me via mail or phone and tell me that we have read your views and articles, liked them, and wants to move forward with you..Even MANISH has written in one of the blog when stuck with some QUESTION or QUEARY, “Let me ask Dhawal, Our trouble-shooter..” I feel proud to be associated with such POPULAR BLOG and in the process, involved in MUTUALLY BENEFICIALLY relationship with the readers, which you put as “HEALTH INSURANCE ADVISORS PROMOTING THEMSELVES..”

        No hard feelings, i can understand your position and anger..There are lot many people out there who think that agents are minting free money, notwithstanding their knowledge – hardwork – effort..Do you have the same outlook for manish’s PAID-SERVICES??

        You can continue to think what you feel and put it here anytime..

        Dhawal Sharma
        URJA WEALTH CREATORS

    2. Hi Dhawal,

      I dont know, whether the article fits into your Mama-Bhanja story, but it is surely a story of one sided love… Customer being sold the the product for lifetime,

      The point the article wants to make is as follows:
      1. The general customer understands that the premium was low and the increase was inevitable. What took everyone for surprise is a 500% jump. From being the cheapest product, to being one of the most expensive in one shot, was a big jolt. No one could have predicted such a ruthless move. You would agree, Health Insurance is bought for the long term. You would plan how much you can pay in the future, such changes freak many customers.
      2. There is NO TRANSPARENCY when such changes are made. Customers are not explained. Its taken for granted. This again results in mis-trust.
      3. There is no regulation on, TO WHAT EXTENT can changes be made. Can an Insurance Company offering Lifetime Renewal Guarantee, convince IRDA to increase its already expensive premiums for age band 60-100 by 200%, due to high claims?? Can they make it unaffordable for the customer to renew ( like what Reliance did?)

      Agreed, Insurance Companies are making losses, but the steps taken to curb them are mere shortcuts. Removing Hospitals from the Network, Removing TPAs, Introducing impractical norms for claims. The frauds and giants are still enjoying, and the genuine customer has suffered.
      4. The 926 Crores losses have incurred more due to INEFFICIENCIES IN THE SYSTEMS OF INSURANCE COMPANIES , more than just claims being high. India is not paranoid about health, like the USA, generally people like to use alternate therapy etc. before going under the knife.

      Here are some of the inefficiencies:
      a. GREED FOR TURNOVER & Large Accounts. Crazy premiums (without any underwriting) and benefits offered to Corporates. The major losses are caused by the corporate business. Claims ratios are more than 140% here.
      b. NO SCIENTIFIC UNDERWRITING: There is no underwriting. Premiums are calculated based on last year’s claims history. There is a major issue of lack of data. Even after 7 years of privatization, the IRDA has flawed data published for Health Claims.
      c. Insurers NEVER GAVE A CLEAR MANDATE TO THE TPA. TPAs are asked to control costs on one hand, and on the other hand pressurized to include top hospitals for large corporates. INSURERS HAVE FAVORED LARGE CORPORATES, and then blamed TPAs. There are some fine TPAs, which are good
      d. Look at Star, as a business model ( I am not talking about service standards), it is focussing only on Retail Health Insurance and Government Business, it is making underwriting profits. Star does not do Large Corporates, on a mass scale. What is Star doing in around 5 years, what PSU insurers cannot understand???
      e. RETAIL business did not need the jolt, when it was not such a big part of the losses, made by Insurance Companies.

      So without making any major changes on their own way of functioning. Insurers (specially PSU) have relied on simpler.

      You have been lucky to have ICICI Lombard, which has not made changes in the premium since almost 7 years now. Every Insurance Company in the same level is making changes today.

      PS: If you know, how PSU Insurance Cos work, believe me, the common TPA is only going to make things worse for the customer.

      1. Dhawal Sharma says:

        @MAHAVIR – I believe there is a VICIOUS CIRCLE which is hampering the all health insuranc industry all round..

        It starts with the company which has drafted a product (With capping on room rent – ICU – copay charges) and advertise it in such a way that shows only the goody things to the customer..taken forward by an agent who has entered into the market purely for minting money (backed by PART-TIME nature of his work plus half-baked knowledge of the product and industry)..lapped up by the public who are happy with 10% DISCOUNT which the agent is passing them on, not taking out enough time to read the finer points (and in many cases, hide their past medical history not bothering to disclose past illnesses/disease/accidents etc)..and engineered by TPAs who have SETTING with HOSPITALs/NURSING HOMES/DOCTORs to get approve each and every bill of their clients with UNDERSTANDING..

        I dont think there is only one party who is at fault..In fact, in today’s TIMES OF INDIA – there is a report that TPAs and certain hospitals on the PSP list of PSU companies in MUMBAI are advising the policyholders to opt for REIMBURSEMENT rather than CASHLESS so that they have a scope of inflating the bills…

        So it all goes hand-in-hand..It takes all kind of people to make this world and ALL TYPE OF CORRUPT PARTIES TO SPOIL THE INDUSTRY..

        1. Dhawal

          Nice comment , Can you share more on that “Understanding” by TPA’s with the hospital , seems like a scam is on its way in health industry !

          Manish

          1. 13 says:

            I once overheard a conversation between two people. I cannot guaruntee the veracity of the details especially since I was traveling in a noisy public transport at this time. They were discussing about health insurance and one chap had a relative/friend who worked in an insurance company. He said that if the doctors know that the person is working for an insurance company they will ask them to get admitted for the flimsiest of reasons. And that some employees of the company took advantage of the company by getting “”admitted” on paper with small hospitals who have a Cashless facility with their employer and splitting the proceeds.

            1. May be Mahavir Chopra will be able to comment on this ! . Let me drag him here !

      2. Mahavir

        Thats really a deep insights on how things work out ! .

        Manish

    3. srin iasu says:

      sir,
      yes, every word is true.
      But let me share one small case for your reference.
      I too work as a agent for icici lombard general insurance.after selling one health policy to a very rich man with a high social status, who is a well wisher of mine.
      the policy is fo 3 lacs for self plus spouse as the customer has no kids yet.
      After a few months his wife driving her two wheeler fell and hospitalised for a fracture (imagine what a bad luck and pain for such a person having 4 cars and drivers !)
      i came to know immediately at 10 pm and told the hospital duty doctor about the cash less policy.
      to my surprise doctor told me at that time 10 30 pm, office staff who are incharge of such admission are not available ,so asked the customer to pay hospital admn, security and others.
      as i said in the begining the customer is not short of any money simply paid all the deposits.
      THE story begins now,
      the person in the hospital next morning asked me about the CARD given by the insurer. the customer in the shock and mental pain went home and found the card which i submitted in the hospital.
      the lady due to gods GRACE recovered and duly discharged the next day.
      immediately i went to lombard office and gave all medical bills to my sales manager on monday evening( the incident happened on friday night 10 pm ).
      to my horror the 3 rd rate sm who is still working in that co… told me that some more documents required like FIR from police, ambulance admit plus orthpedic surgeon certificate plus some more forms with a claim form sig ned by the customer .
      i could not meet the customer due to customers bad mood and busy with relatives and freinds who happened to be there after this bad incedent.
      But his office staff helped me and i got all the documents.
      again to my hurror the 4 th rate SM told me as per company norms the customer should call the help line nos within 3 hrs of hospitalisation.
      here my first question to lombard is have you told your agents any thing about claim procedures ?
      then he told me to send all the papers to tpa chennai address
      after making unknown mails direct calls we received a mail that this policy does not cover hospitalisation due TO ACCIDENT.
      end of the day i simply confess before all the readers that for my own foolishness or ignorence or simple trust in brand names made me a fool before others
      the customer after a few days told me this is a part of life !
      this happened 1 year 8 months ago i rember today evening.
      so my advice to u all is do ur work before signing any documents.
      thanks

      1. Srinivasu

        Thanks for sharing that incident , so what i take from this incident is that one has to really understand their health policy and not just run around assuming things . Also health insurance products should become simple and easy to claim , because what you mentioned in the incident is too much and a common man will not do so much

        Manish

    4. Dhawal

      Thanks for sharing the points , it really gives some deep insights and food for thoughts !

      Manish

  11. mani says:

    I have mediclaim from United India. I am very satisfied. They settle claims, don’t load premium and have thus far charges only reasonable premiums.

    Term insurance or mediclaim I have zero trust
    in private players incl the one which ostensibly doesnt load put increases premium every year.

    1. Sandriano says:

      Hi mani,

      How long ago did you buy the policy and how many times have you claimed the insurance? I am deciding between New India Assurance and United India. Your information will be helpful.

      Also to the general audience, I am planning to buy a family floater plicy from one of the following 4. Please give inputs on these 4 if you have or considered these 4. Also, is it better to go for Family floater or individual insurance?

      1. New India Assurance
      2. National Insurance
      3. United Insurance
      4. Oriental Insurance

      1. mani says:

        The policy was purchased nearly 3.5 years ago. I made a single 2.75 lakh claim by reimbursement for my wife. The policy was not loaded thereafter. There has not be any inflation related increase in premium so far. I increase sum assured by 0.25 laksh every year and the increase in premium only reflects that.

        One important lesson I have learnt is there is HUGE difference between cashless claim and reimbursement claim with respect to how the hospitals treat it.

        Cashless it the most abused product (more abused than ULIP selling!)
        In fact this is a major factor in premium increase.

        Once hospitals know that a client (not patient!) has lahks of mediclaim they will make sure they suck it out.

        The best way is to save for a separate medical corpus. When hospitalization occurs use it to pay. Make it clear to the doctors that you are paying your own money (then they say ‘some’ tests are not necessary!!). Then get it reimbursed by following procedure pre- and post hospitalization for reimbursement. The client(patient) will not then be harassed and if procedure is followed the claim will be processed.

        Good luck with your research.

        1. Sandriano says:

          Hi Mani,

          Thanks for your reply. Just one question though. If you don’t mind, could you let me know why you chose United Insurance? Also, did you consider any other insurance houses as well?

          1. mani says:

            Honestly, when I got it I had no idea about medicalim. Jago investor didn’t exist! I don’t trust private players and chose a PSU. suggested by my agent which has worked out so far for me.

            I know that doesn’t help. but that’s the truth!

          2. Siddharth Shah says:

            But United India has so many capping,like 25% of SI for treatments of Cataract,Hysterectomy,Hernia & 70% for Major Diseases,Room Rent-15 pf Si,ICU Expenses-2% of SI……I dont find it a good Product.Please give Opinions

            1. All the products will have some kind of cappings . Did you try for other policies as well !

        2. Mani

          thats really a big point and worth Noting . Can you share any more experiences which says that Cashless creates more issues than “reimbursment” ?

          Manish

  12. Mitr Singh says:

    What is the other option than ?
    Which Mediclaim company is fairly doing its business ?

    Either We accumulate such big amount by own or we have to go for mediclaim policy. No other choice. I needed a policy of 3 lacs for a family of 3 person then I need 300000/5000*12=5Yr (Perhaps 4 Yr by better financial planing) for accumulating this amount. This is not feasible

    If someone has the answer, Please share it.

    Best Regards
    Mitr Singh

  13. raju says:

    Hi Manish,

    Good post Again.
    Does somebody have a good recommendation and comparison on the Health Insurance policies?

    Regards,
    Raju

  14. Vivek says:

    Hi All,
    My both paternal and maternal grand parents lived till their 80’s, they followed simple lifestyle. And never worried and never had an health insurance.
    Change eating habits, regularly exercise, do some yoga, drink less wine, watch less TV.

    Please comment,
    Thank you,

    1. Hi Amit,

      You are right. There is no better insurance, than preventing disease through lifestyle modification.

      You need to still consider a Health Insurance for costs incurred on Health, related to
      1) degeneration (like Cataract)
      2) Non-lifestyle ailments like Cancer
      3) Accidents.

    2. Vivek

      I really agree with that . Prevention is better than cure is the ultimate answer in case of health 🙂

      Manish

  15. Rakesh says:

    An eye-opener. Even though we pay the yearly insurance to these companies without any claims, we are not sure when they will increase the premium. This is very bad, are they allowed to do so. Is IRDA sleeping?

    Rakesh

    1. Rakesh

      No , its not fine and yes IRDA has to wake up , may be we need to start something like jagoIRDA.com 🙂

      Manish

      1. Hoshang Nekoo says:

        The move must be made to wake up IRDA and make themalso accountable. In health insurance policy they have let lose the reins with insurance companies and are in no postion to control them. Complaints to IRDA false on deaf ears. The response on complaint one gets is that the matter is taken up with the H.O. of particular Insurance co. from whom you will hear. You just have to keep waiting to hear. IRDA helpline which was advertised in media on everyday basis ” Do you have a Complaint with Insurance co. Dial…..” In reply all that you will hear is that the person is directed to contact nearest Insurance Ombudsman. This advt. is no longer advertised.

        1. Hoshang

          Yea .. IRDA needs to deliver what they promise .. .not sure when will these regulators become more stronger

          Manish

      2. krantivir says:

        Yes. If we do JAGOIRDA many many ppl will get good insurance products in all categories!!!!!

        1. Thanks for that appreciation !

  16. Sushil Girdher says:

    The story is real…almost same things happened with me. I was having a mediclaim policy of Reliance known as Healthwise….it increased its premium to 13000 from 3300 just next year….but unfortunately i was having no other option because my friends was satisfied with the services and some hospitals of my city was on cashless list of reliance.and thats why i renewed at higher rates. this is my second claim free year but next year onward i m not going to renew it just on the cost of service…i hope other companies also provide good services…..though i have not claimed anything…otherwise that experiece is also terriffic as told by some persons on some websites

    1. Sushil

      thanks for sharing your experience . Nice to know that you had good experence with Reliance, i personally never heard anyone saying that they had reliance !

      Manish

  17. Deepesh Chandra says:

    These are no new tricks at all. Most of the these companies have alliance partners who are global operators particularly in US where health insurance is money minting business. They are simply implying their “best practices” from west.
    Wait for the age when UID will be live along with Health Information Exchange setup in India; that way your medical history and claims history will be shared by all the companies and the end customer will loose the leverage of going to another company for better rate and keeping them blind about claim history. The era when “co-pay” and “deductibles” would become traumatizing for public at large.
    The competition will bring better practices but the cost wont go down as they all will run like a nexus with no respite from any player.
    With no social security net in India, healthcare expense will take lion’s share in your budget.

    1. Deepesh

      With UID thing really expose the health data for a common man to such a level ?

      Manish

      1. brijesh says:

        Dear ,

        My health insurance policy is rejected by one company on medical grounds which were because of wrong way of taking medical tests (nonexpert team). Now I wish to apply once again but to another company.

        Am I expected to give this rejection information to the next company on my own?(In the light of UID data) The new company document does not mention of any such disclosure explicitly, however it says ‘disclosure of material facts!’.

        Pl help me in this regard.

        Thanks a lot,

        BSJamadar

        1. HOw do you prove that the medical tests were done in wrong way ? If you can do that , you can talk to next company customer care and not mention these details !

          1. brijesh says:

            Thanks a lot for your reply. Is it necessary / compulsory for me to disclose this rejection unless the next company asks for?

            1. Yes it is, because every company asks for it in their form, there is no choice ! . its a standard thing in every form !

  18. pankaj vasudeo says:

    I took individual policy for me nd my wife nd my 4 months old daughter
    this year on 16th feb my wife was operated for apendix (stomach)
    my policy is cashless
    but i have to pay 10000 immd for operation ……..
    story is long
    right now my file is sent for claim
    i will write story on mediclaim within 15 days
    my exp nd all

    1. Pankaj

      Thansk for sharing your expeirenece , We would love to read what exactly happened in your case ?

      Manish

  19. I completely agree with the writer of this letter. These private sector companies are making a fool of Investors and have garnered so much cash that half of India’s Prime Real Estate is owned by them. And that is also the reason why we have started advising our clients to opt for LIC as there are no hidden charges.

    1. Hmm.. Who is suggesting LIC to your clients ? I didnt get that part ?

      Manish

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