The Telegraph
Since 1st March, 1999
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Insurance for 60-plus on the way
- Cover for lifestyle ailments likely in fresh medical policies

Calcutta, Sept. 16: There’s some good news coming the way of senior citizens who are above 60 and have age-related ailments: you will soon be able to get yourselves medically insured with minimum fuss and bother.

Two insurance companies — National Insurance Company and Oriental Insurance Company — are drawing up medical insurance plans for those between 60 and 90 years of age.

This means that those above 60 will no longer have to run from pillar to post looking for medical insurance or be repeatedly snubbed by insurance companies. They will be able to get fresh policies done at 60 and after, and in spite of their aches and pains.

At present, this is next to impossible — although there is no hard and fast rule, insurance companies only allow renewal of policies made before 60.

The details of the new policies have yet to be finalised, but in all probability the National Insurance policy will be called Varisth Bima. A premium of Rs 7,000 will have to be paid for an Oriental policy that has an assured sum of Rs 1 lakh.

The policies are expected to provide insurance for lifestyle-related ailments like diabetes and hypertension. There will be no cover for terminal diseases like cancer.

National Insurance director and general manager Dilip Burman said the plan was being worked on and would soon be placed for approval before the Insurance Regulatory and Development Authority (IRDA).

“We have collected five years’ data to design the plan for senior citizens. The actuarial department is now working on different aspects, including premium cost,” he said.

Two other plans are on the anvil — a family plan providing medical coverage to husband, wife and two children and a medical insurance plan for students. Both have been cleared by the IRDA.

Currently, the companies don’t provide cover for pre-existing ailments. The good news about the family plan is that those with hypertension or diabetes will still be able to have them covered if they disclose the ailments and pay a higher premium. Over time, more (pre-existing) diseases will be covered by the plan.

“If a person discloses that he or she has hypertension, the premium will be 10 per cent more. If someone has both hypertension and diabetes, the premium will be 25 per cent more,” Burman said.

The students’ insurance plan will be offered to those under 25 “at a nominal premium” and will cover accidents and illness. “The sum assured will vary between Rs 50,000 and Rs 3 lakh,” Burman said.

National Insurance is also planning to restructure existing medical policies to check misuse of insurance money. People often get themselves admitted to hospital for the smallest of ailments to avail of the insurance cover.

“The claim ratio in medical insurance is as high as 128 per cent. We have noticed that 56 per cent of this goes towards paying hospital room charges. So, we have decided to put sub-limits for different expenditure heads, including room rent,” Burman said.

A proposal to make the insured person bear a part of his/her medical bill is also doing the rounds, he said. But nothing has been finalised yet.

“Since hiking the premium may adversely impact our policy sales, we are planning to make insured persons bear a part of the total medical bill so that misuse of insurance money is minimised.”

Oriental Insurance, too, is mulling such changes.

“Another problem is that hospitals and medical service providers indulge in over-billing once they know a patient is insured,” said Nayan C. Shah, managing director of Paramount Health Services Pvt Ltd, which provides third party administrator (liaison) services to insurance companies.

To get around this, talks are on to standardise medical costs. At present, estimates given by third-party administrators and hospitals and doctors differ by 20 per cent.

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