Mr.
Gogia then introduced Mr.
R. Narasimhan, Sr. Manager Technical,
Bajaj Allianz General Insurance Company Limited,
and requested him to commence his presentation.
Mr.
Narasimhan in his presentation highlighted the facilities
provided by insurance companies. He further stated the need for Health
Insurance. He also stated that there are policies available on Health
Insurance from four PSUs including reimbursement policies.
But there was no policy available for non medical expenses during
hospitalization. Now there are Eight
Private Companies providing Health Insurance Policies.
They provide compensation policy called ‘Hospital
Cash’ for reimbursement of Non-medical expenses
during the period of hospitalization. Amount of this policy is decided
in advance at the time of taking the policy. It helps to take care
of incidental expenses. This policy provides lump sum compensation
for the non-medical expenses to the insurer. It is a reimbursement
policy.
Health
Insurance assists to cover unforeseen / accidental.
And hence cannot cover which is not unforeseen and accidental. In
which case the illness and diseases not predictable are covered. Certain
policies are also providing pre and post hospitalization expenses
for specific time [i.e. 30 days prior and 60 days after hospitalization]
Certain policies also cover Ambulance charges upto amount of Rs. 1,000/-.
He further suggested to have Medical check up at regular interval
of 4 years. The amount of expenses incurred on check up could be reimbursed
up to 1% of total sum insured.
Many
a times consumers face the problem of non settlement of their claims.
Following are some of the examples
excluded from Health Insurance:
1.
Pre existing disease: Specific disease excluded for first
1 or 2 years depending upon policies (i.e. Cataract, Kidney stone,
hernia etc.)
2.
Any illness contracted during the first 30 days period of taking the
policy. It is not applicable for renewal of policy. (Exclude accidental
injuries)
3.
Joints replacement surgery of first 4 years of taking the policy.
4.
General exclusions i.e. War, Acts of foreign enemy, Nuclear weapons
attack. These are International exclusions under all policies all
over the world.
5.
Plastic Surgery, cosmetic surgery are excluded since they are not
anyway connected to illness or accidental injury. But plastic surgery
due to accidental injury is covered under the policy.
6.
Expenses for Contact lenses, Hearing aid, spectacles.
7.
Dental treatment or surgeries are excluded except in case of accident.
8.
Expenses towards Rest cure Centers are excluded.
9.
Dieses by birth are excluded.
10.
AIDS & intentional self-injuries are excluded
11.
Treatment for pregnancy, child birth, fertility test which are intentional
and not an accidental and hence excluded.
12.
Expenses related to donor, for removal of organs in case of transplant.
Policy covers
the insurer and hence cannot pay any expenses for treatment of the
donor.
13.
Treatments, which are experimental and unproven in nature.
He
further narrated some important definitions for the purpose of Health
Insurance, which were
He further
stated that the Cash Less Facility is a sensitive and important issue,
which needs to be addressed properly. All the TPA’s have the
systems of storing personal data on the computers. TPA’s also
issue photo identity cards to the policy holders with alpha numerical
number. Generally the problems occur on delay for providing details.
Normally letters are issued to the hospitals for initial payment.
The second
types of services provided by TPA’s
are reimbursement of the claims. He then elaborated
the procedure in detail. He suggested submitting the documents with
in 10 to 15 days to TPA’s on discharge from the hospitals. Many
a times the delay occurs due to insufficient data provided by the
insurers. Normally payments are made within a month by the TPA’s
on receipt of the amount from insurance companies.
Mr.
Gogia then introduced Mr.
Ashok Israni, Financial &
Insurance Consultant and Advocate and requested him to address
the gathering.
Mr.
Israni stated that the Financial planning is very
important to face the incidental expenses towards health problems.
He further stated that Health Insurance is an important issue. The
medical expenses had gone up tremendously in recent years. He also
said that there are 1 crore out of 150
crore people availing the facility of Health Insurance.
He also suggested to continue to pay the premium regularly to avail
the facilities properly. He said that the prevention is always better
than cure. He also suggested to undergo regular health check up once
in four years. Keep cash in bank as well as at home and maintain good
relations with the relatives. While concluding he recommended to observe
‘Health Insurance Day’
on 29th September, 2004.
All the
Speakers including Mr. Chandrakant Khatri,
Assistant Manager, New
India Assurance Company Limited then satisfactorily answered
queries raised by the audience.
Mr.
Dinesh Parekh, Vice President,
CFBP then gave Vote
of thanks and expressed his gratitude towards speakers, sponsors,
representatives of various newspapers – News Channels and the
gathering. He also assured the gathering that CFBP
will take concrete steps to take their issues with the insurance companies.
The
next seminar will be held on issues related to purchase of flats /
builders on October 29, 2004.
