An entirely new health insurance landscape awaits us. The recent
draft health insurance regulations proposed by the Insurance Regulatory and Development Authority (Irda), if accepted in their current form, will bring about a world of change in the way the business is transacted.
The proposals, which are largely aimed at protecting consumers' interest, promise to usher in greater transparency and reduce the causes of friction between the insurance provider and the insured. For instance, the regulator has sought to impose a limit of 30 days for claim settlement, while suggesting that reasons for rejection of claims have to be explained in writing to the insured.
Insurers will not have the freedom to arbitrarily hike premium rates or decide on loading, which means an increase in premium at the time of renewal. Stricter controls have been proposed on third-party administrators, who act as intermediaries facilitating transactions between the insurer and the insured.
Health insurance, one of the fastest
growing segments in non-life insurance, has also been one of the most contentious ones between the stakeholders. There are complaints galore on the insured being shortchanged at the time of settling claims, while the insurance providers are wary of frauds or inflated claims often perpetrated by hospitals and the insured in connivance.
To help separate the warring parties, Irda had allowed portability of health insurance policies in October 2011 that allowed the insured to shift to a new provider if there is friction in an ongoing contract. How well is portability working? Irda Chairman, J Hari Narayan, indicates it is working fine. In an interview with us, he points out that in the current quarter, 1,061 policies have been ported, while only 31 cases have been rejected and 81 requests are under process.
But as we tell you in
our cover story on portability, things might not be all that smooth should you want to shift to a new insurer. Insurers are placing unwritten barriers relating to age and adverse claims history to ensure that porting applications that could cause potential losses to them are spiked at the agents' end itself.
Many of these will not show up in the figures forwarded to the regulator. Since most porting requests would be from those who are squabbling with the current insurer on claims settlement, be prepared to come back disheartened when you seek to shift.
Staying on with health insurance, our cover story package also tells you how to tackle the dilemmas arising from having multiple health covers. We also alert you to the need to factor in rising healthcare costs while buying a health insurance contract, which is an absolute must in everybody's financial portfolio.
Well, it is better to have a decent health cover even if you end up having a dispute with the provider than not having one and regretting it when crunch time comes.
SARBAJEET K SEN
Executive Editor
