8-10 % mediclaim policyholders claim in a year

M Ramadoss, CMD, Oriental Insurance, says, "Although only 1.2 lakh people have reported a claim, the severity of the claim is high. Individual claims are of bigger amount."

Public sector insurers are revamping mediclaim with an increase in premium, for which they will apply to the Insurance Regulatory Development Authority of India this month.

The newer mediclaim premium will be more than double of the previous sum for people above 55 years of age and increase over 50 per cent for people above 20 years. For people up to 20 years, the premium will either be flat or marginally lower than the earlier.

Experts, however, say increasing premium is not the solution to offset the losses and insurers will have to plug in the loopholes that make health insurance a bleeding portfolio.

According to Nayan Shah, director, Paramount Healthcare, a leading TPA, the average claim at about Rs 23,000 is the highest in Mumbai, Bangalore and Delhi, followed by Rs 16,000 in Calcutta and Rs 10, 000-12,000 in rural areas.

However, mediclaim has a standard premium on an all-India basis. Therefore, a metro mediclaim policyholder is subsidising an urban policyholder and, similarly, an individual policyholder is subsidising a corporate poliyholder.

Sandeep Dadia, director, Enam Insurance Brokers, says, "Mediclaim should have different premiums for metros and non-metros. An individual wishing to undergo treatment in a top-grade hospital should be charged a higher premium, while those willing to take treatment in a B or C-grade hospital should be made to pay a lower premium."

"There should be regulation for healthcare providers, and restricted benefits for corporates and billing procedures should be standardised to ensure transparency. Also, ICD codings should be made compulsory for all providers irrespective of insurance," he adds.

Corporates pay Rs 800- 1,200 premium per employee in group covers against Rs 1,800- 2,200 paid by people in case of individual health covers.

Group covers provide the insured maternity benefits, cover for the new-born from day one, cover for all pre-existing illnesses and similar benefits to around four dependent family members. But individual covers provide limited insurance with at least 12 diseases excluded in the first year.