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| Govt insurance firms aim at squeeze on claims |
| Namrata Acharya / Kolkata May 21, 2009, 00:01 IST |
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Public sector general insurance companies are aiming at a more than 10 per cent reduction in the claims ratio for health insurance in this fiscal year.
Already with caps on several components of hospitalisation and periodic loading of premium for group health insurance policies, the companies were able to bring down the claim ratio to 90-100 per cent in 2008-09.
New India Assurance is also mulling steps like reducing brokerage fee and third party administrator (TPA ) charges to reduce costs, said sources.
Apart from loading the premium for group insurance policies by more than 25 per cent if the claims ratio was as high as 110 per cent, the company would also review its retail health policies, and load premium accordingly, said sources.
“At New India Assurance, we are keeping a strict vigil on claims. For example, if the doctors’ bill is not included in the hospital bill, we are not paying for it,” they added.
New India Assurance hopes to bring down the claim ratio to about 80 per cent by the end of the fiscal, from about 90 per cent in 2008-09.
The companies are also looking at family floater policies, which come at a higher premium, to tide over the high claim ratio.
Oriental Insurance is planning to file for an improved mediclaim family floater policy with the Insurance Regulatory and Development Authority (Irda), for better cost control.
With the current claim ratio of about 100 per cent, which was nearly 110 per cent in 2007-08, Oriental Insurance is hopeful of slashing the ratio to about 85 per cent by the end of the fiscal. And is also looking at setting up an in-house TPA for better claim management.
“We are contacting hospitals directly, and are in favour of forming an in-house TPAs to bring down costs. The premiums are also being loaded if the claim ratio are high,” said sources at Oriental Insurance.
United India Insurance, under its Mission 2011, is stressing on high-sum assured policies, covering more than one person (family floater), so as to increase the premium income, according to sources in the company.
This apart, it has formed a separate department in regional offices for managing TPAs, which also undertakes surprise visits to hospitals to verify claims. “Also, we have developed a new software for screening TPA claims. In case of group policies, we have noticed that while earlier companies were reluctant to accept caps on different components for mediclaim at the time of renewal, they are now able to negotiate with their employees on the matter,” said sources at United India, which hopes to bring down the claim ratio from the present level of about 108 per cent to 95 percent by year- end, and 85 per cent by 2011.
National Insurance plans to bring down the claim ratio from about 95 per cent at present, to about 85 per cent by the end of the fiscal.
For this, it has also caps like 50 per cent of the sum assured on medicine, implants, and on items like anaesthesia, and 25 per cent on doctors and consultants’ fee, apart from the usual caps on room rents.
The company is not insisting on renewals of group health insurance policies if corporates are not agreeing to pay the extra premium, if the claim ratios are high at the time of renewal.
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