Category Archives: Health Insurance

Jeevan Arogya: An add-on to a basic health policy
Posted by:V.K. sharma, June - 29 - 2011

Jeevan Arogya is the first defined health insurance product to be introduced by India’s largest life insurance company, LIC of India. It will pay the customer a fixed daily cash amount as well as cover specific surgeries.

The product is a Hospital Cash Benefit Plan (HCB) that offers daily hospital cash benefit for a fixed number of days that one is hospitalised. Besides that, it will cover 140 surgeries with the maximum amount one can avail for surgeries being 100 times the daily limit.

The product also offers a lump sum amount that is twice the daily cash limit per hospitalisation day, even for surgeries not listed. This feature is similar to the HCB plan offered by Aegon Religare Life Insurance. Life insurer Tata AIG’s Wellsurance Family Classic offers a standard daily cash plan without  any surgery benefits.

Jeevan Arogya has a number of features that should take care of rising health care costs.

For instance, it increases the limits on the initial daily benefits every year. So, one’s daily cash limits will rise to a maximum of five per cent or up to 1.5 times of the initial amount each year. This would be in addition to the five per cent added to one’s daily cash limit as part of one’s cumulative or no-claim bonus. Together, this could lead to a 10 per cent rise in one’s daily cash benefit.

No doubt, even other health insurers (both life and general) offer a nearly five per cent rise in the sum assured as part of one’s cumulative bonus. However, Jeevan Arogya customers are assured of getting a five per cent rise, even if they are not eligible for no-claim benefits.

Besides, since all other benefits are linked to the person’s daily limits, a rise in the daily limit translates into higher day care and major surgery benefits.

Another feature allows automatic waiver of the subsequent year’s annual premium for customers who make a claim for major surgical benefits.

However, Jeevan Arogya is a complicated product with both yearly and lifetime limits on how many times a claim can be made. So, one is allowed only three day care claims and only one major surgery claim in a year.

In terms of costs, it is much cheaper than the Aegon Religare product. If you opt for a daily cash limit of Rs 2,000, you would be paying an annual premium of Rs 4,000 for Jeevan Arogya. For the same limit, Aegon Religare’s premium would be Rs 13,800.

However, health products from life insurers are more restrictive in nature. While HCBs pay a lump sum, the hospital cash offered by general insurers covers the actual expenses falling within the amount sum insured.

Also, HCBs only cover illnesses mentioned in their policy document. They also permanently exclude pre-existing ailments. In comparison, four years of continuous cover with a general insurer will get you a cover for a pre-existing disease. Except hospitalisation due to accidents, life insurers’ policies usually have longer cooling periods of 90 days from the effective date of the policy.

Insurance experts caution consumers against opting for such HCBs as a standalone health insurance product. Instead, they advise customers to buy health products from a life insurer as an add-on to a basic health policy that will cover actual expenses.

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Three years ago, Mumbai-based Ashish Shah bought a family floater health cover for Rs 5 lakh. This year, he was in for a shock when his insurer decided to raise the premium from Rs 5,415 to Rs 26,719 despite the fact that he had made no claims. 

But Shah did not want to let go of the policy because he had completed three years, the period after which specific diseases, such as hernia, cataract, dysfunctional uterine bleeding, are covered. He was also just one year short of getting a cover for other pre-existing conditions. What was Shah to do?

He needn’t have worried. With health insurance portability likely to come into effect from 1 July this year, there may be respite for people like Shah. Portability allows you to carry over the pre-existing disease (PED) benefits in your previous policy to the new service provider.

This was one of the biggest deterrents for switching because the customer had to serve the waiting period all over again and PED claims were covered only after a waiting period of 2-4 years. However, Irda has waived this condition, making for a smooth shift to a new insurer provided the previous policy has been maintained without a break.

When to move

You can look for a new insurer not only because of a sudden jump in premium but because a job shift has landed you in a place where the coverage of the existing insurer is inadequate. “People shifting from one place to another face problems due to lack of policy servicing at the new location,” states Irda. Service standards, network of hospitals, lack of coverage in areas such as dental treatment, maternity benefits, etc, could also prompt you to shift.

Portability can be carried out only at the time of renewing a policy, not at any time during the year. However, it is advisable to approach the new insurer at least 45-60 days before the renewal date in order to ensure a smooth transition. Says Sanjay Datta, head of customer service, ICICI Lombard General Insurance Company: “A smooth sharing of data between insurance companies is a must to facilitate portability. For this, the industry wants to move to an IT-based platform for exchange of information regarding waiting period, existing claims, etc. The glitch is that all insurance companies don’t have data that is online and in a standardised format.”

If you don’t start the procedure well in advance, there is a chance that you could go coverless for a certain period. “To avoid such a situation, one can look at a short-term extension of the policy. Besides, a 60-day period is given before a break in cover is considered,” says Arun Mehrotra, head, retail underwriting & product development, Iffco Tokio General Insurance .

Insurance companies have been advised by Irda to acknowledge all applications for portability within three working days. Also, the previous insurer has been advised to share the policyholder’s claim history with their counterparts within seven working days

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