Mediclaim may need patients to 'co-pay'

Mediclaim policy-holders will not only have to pay a higher premium but also bear a part of the claims if the Insurance Regulatory Development Authority (IRDA) gives its nod to the proposal mooted by the four public sector insurance firms.

According to industry sources, the revamped Mediclaim policy will see the introduction of the concept of "copayment."

In other words, the policy will not cover all expenses, and policy-holders will have to bear a portion of the cost.

For instance, on a hospital bill of Rs 1 lakh, a policy-holder may have to pay Rs 10,000. The concept of "copayment" will apply to both reimbursement as well as cash-less hospitalisation schemes.

However, the concept will be applicable only to those who have crossed the age of 40. Younger policy-holders will continue to get 100 per cent cover.

"We are still working on the nitty-gritty of the new Mediclaim policy. It will take about two months to finalise the new scheme," said sources.

V Ramasaamy, chairman and managing director of National Insurance Company, confirmed the development, and said the IRDA's approval would be sought once the new terms were finalised.

On an average, Mediclaim premiums will go up by 15 to 20 per cent, depending on the age of the policy-holder. Till now, policy-holders pay premiums irrespective of their age.

In the new scheme of things, even the region in which medical treatment is provided will have a bearing on the cost. For instance, policy-holders in Mumbai will have to pay more premium than their counterparts in Chennai.

The floor for the minimum sum insured is also set to go up. At present, the minimum sum insured under Mediclaim is Rs 15,000, and the policy is available in multiples of Rs 5,000.

The revamped Mediclaim policy will raise the level of the minimum sum insured to Rs 25,000, and will be available in multiples of Rs 25,000.

This means that a Mediclaim policy will be available for Rs 25,000, Rs 50,000, Rs 75,000 and so on, instead of Rs 15,000, Rs 20,000 and Rs 25,000 now.

The revamped policy will also have restricted cover on certain diseases. For example, hernia, piles, fibroids in uterus, and prostate gland enlargement are not covered in the first year of the policy now.

They get covered from second year onwards. The revamped Mediclaim will cover these from third year onwards.