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No shelter from the storm

If you’re 40, you have crossed the hill! At least, that’s what medical insurance companies feel, says Ketan Tanna

 

hey say life begins at 40, but for the health insurance industry in India, life starts ending when one touches 40. How else does one explain why so many people in their 40s are finding it increasingly difficult to get decent medical insurance policies? If they are fortunate enough to get one, it is ridden with ifs, buts, riders and exclusions– insurance lingo for no payment in case of a particular problem or disease.
Take the case of Ashish Narottam, a 41 year-old healthy Gujarati businessman in Mumbai. Married with two kids, Ashish wanted an ordinary mediclaim policy coverage of Rs 5 lakhs. He thought he would have to do the usual—sign a form, give a doctor’s reference, and make a declaration. Not quite, he found out. When Ashish contacted an agent of New India Assurance, the agent handed him a thick wad of forms among which was one for a series of comprehensive medical tests. The tests included: Complete blood count, glycosylated haemoglobin test, serum cholesterol, x-ray chest, eye checkup, medical checkup (general), sonography (full abdomen and pelvis) and electrocardiogram.
Ashish was zapped! But the agent was upfront that without an all-clear health test, there would be no policy. A nervous Ashish then wondered what would happen just
in case his blood pressure was a wee bit
on the higher side. “Oh! then, the policy
would exclude all ailments that could be
a result of BP,” the agent informed him, cheerfully. Protests were met with a calm counterquestion: “Don’t blame New India Assurance, look around and you will see other companies doing the same.”
The agent is right. Look at United India Insurance, another subsidiary of the government-owned General Insurance. Till June 2006, a “basic health package” consisting of the above-mentioned tests were a must for people between 40 and 50 years. After protests by agents, the company revised the age group to 45 years. Those who are above 50, of course, need extra tests, including a stress test and x-ray of both knees. This essentially means that those who have not taken any medical policy before they touch 40 are going to pay a stiff price.
The story gets worse. In July this year, Oriental Insurance told its mediclaim agents that their commission rates for clients between the ages of 40 and 60 years would be reduced by 15-10 %. As for those who are above 60, the agents would not earn any commission either on renewals or on fresh policies. This essentially meant that agents would  have no incentive at all to sell    mediclaim policies to senior
citizens.    “When we took up this    issue with the company,    they said there was a high  claim ratio (meaning    m o re persons were asking for insurance money). When we asked for statistics, they refused to give us any details,” says Anil Ganacharya, ex-development officer at United India Insurance and general secretary of the General Insurance Agents Association.
Senior officers at the insurance companies declined to comment on the hardships being faced by persons over 40 in getting mediclaim policies. C S Rao, chairman at Hyderabad’s Insurance Regulatory and Development Authority (IRDA), the industry regulator, defended the various steps taken by insurers, saying that insurance was based on good faith and trust. “If some mandatory tests are now required for person above 40, it is for the good of the individual. The policy-holder should not have a misconception that he or she will be reimbursed in any case of all eventualities. It is better that the policy-holders satisfy the parameters of the mediclaim policy requirements so that when there is real need, the process of payment is smooth,” says Rao.
On the decision to do away with commission in the case of customers above 60, Rao says that one group (senior citizens) cannot be subsidized by others. “In any case, the insurance companies are trying to reduce the intermediary cost. Senior citizens can approach the companies directly. It is a competitive era that we live in. In a way, even the agents are also being motivated to look for younger policy holders,” says Rao
So there you have it. There are, of course, private companies, but they have their limitations, especially with regard to those between 40 and 50 years. Here too senior citizens are not exactly welcome.
What can one do in such limiting circumstances? Start early as far as health insurance policies are concerned. Renewing health policies is comparatively easier than getting a fresh one. Also, if an agent refused to offer you a policy, or seems disinterested, approach the companies directly. If they refuse, insist that they give you the refusal in writing. There is always the option to write to the insurance ombudsman which has offices in different states. You can also explore other policies which are similar to Mediclaim like Good Health from Oriental or Health Plus of The New India Assurance.

HEALTH IS WEALTH

Start Early

Insure whatever amount you can afford to pay at the time

If Insurance agent is indifferent, approach the company directly

If the companies refuse, insist that the rejection be given in writing

Do not be afraid of approaching an insurance ombudsman

Explore health plus polices where pre-existing illnesses are covered with higher premiums.

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