Medical insurance: Pre-existing illness norms being defined

In order to keep a check on indiscriminate non-disclosure fee charged by insurance companies, General Insurance Council, the forum of all general insurers under IRDA, is working on guidelines to define pre-existing illness in medical claims.

The council would issue guidelines to insurance companies for conduction medical tests of the clients, said B D Banerjee, former CMD of Oriental Insurance company and National Insurance Company, and a member of committee for senior citizens insurance at IRDA.

He was speaking at a seminar organised by the Bengal Chamber of Commerce and Industry.

Speaking on the occasion Suresh Mathur, joint director of IRDA, said ambiguous policy terms had to be avoided for making the business more transparent. Also, health insurance has to be promoted to ensure proper coverage of the weaker sections of the society and senior citizens.

Banerjee suggested that insurance companies should verify whether a person has pre-existing symptoms of a disease through medical examination through tie-up with diagnostic houses.

In case a person has any symptoms of a disease, the entry load should be increased to adjust the cost. However, in that case, the insurance cover should not commence after two years of buying the policy, but right from the day of purchasing it.

He also said if a person has had a medical treatment for more than 12 months, the entry load should be increased but the benefits of mediclaim should not be denied to the subject.

He felt as cardio- vascular disease was one of the commonest ailments these days, the entry load of an insurance scheme should be adjusted according to the glucose, lipid and hypertension levels of the insured.These steps would help in standardistion of medical costs, he said.

Apart from this, Banerjee said admitted that insurance companies increase the premium on health insurance by 200 per cent for people above the age of 60, which was illogical.

"IRDA has made it clear that the increase should not be more than 50-70 per cent, but the cap is mostly violated by companies," he confessed.

Also, insurance companies should come up with regional tariff plans as done by the National Insurance Company. He claimed that accreditation of health care institutions would bring down the cost of medical insurance.

People who could not afford medical insurance should be offered a product like Medisafe, where employee and employer jointly contributed to a fund that covered all employers.

"Accreditation of hospitals would go a long way in identifying providers which will provide qualitative and cost effective health care," said Mathur.