Medi for each other

PERSONAL FINANCE: Through innovative medicare plans, private hospitals attempt to close in the need-based policy void left by the existing insurance companies.

Healthcare providers have found a novel way of driving their topline growth "" by offering comprehensive health plans in association with insurance companies.

These health plans are a combination of an outdoor patient department plan (OPD) offering fixed number of consultation visits to its specialists and super specialists besides pharmacy and diagnostic benefits along with an optional hospitalisation plan (indoor patient department plan).

Close on the heels of Max Healthcare launching Max Happy Family (a comprehensive OPD and IPD plan) in August, Gurgaon based Privat Hospital is launching similar plans called Privat Health plans.

Today, the health insurance market is devoid of need-based health insurance products. Mediclaim/health insurance policies available in the market do not cover visits to specialists/doctors and treatment for common ailments like flu, stomach ache or migraine. And though the need for a policy covering day-to-day healthcare is much more, these policies only cover medical treatment requiring at least 24-hour hospitalisation.

Healthcare providers are now tapping the market by offering OPD plans that gives them a look in to customers and guaranteed revenues to the network hospitals.

Take, for instance, Max Healthcare that currently has six hospitals comprising of 800 beds in east and north Delhi, Noida and Gurgaon.

The corporate has major expansion plans and will have 1,100 beds by April 2007 and 1,500 beds by April 2008. The hospital in Saket has 75 per cent occupancy and 90 per cent at hospitals in north and east Delhi and Noida.

Says Sanjay Rai, director (sales and marketing), Max Healthcare Institute, "We have created this product for customers who don't know us. We are expanding and need more customers. Such products help in customer retention and acquisition."

In the last three months, MHF has got an above average response. Max Healthcare will launch direct marketing and advertising campaigns and use agents to promote its plans. By March 31, 2007, the institute hopes to sell the product to 5,000 people.

Though the Privat OPD plan can be availed by people of all age groups, the eligibility for Privat IPD plan is 0-65 years. For an OPD plan, the premium is Rs 1,800 for an individual with unlimited access to general physician, two visits to a specialist and diagnostic checks worth Rs 500.

In case the OPD plan is bought for two or more people, the number of visits covered increase and the premium decreases. An OPD plan offering unlimited access to all benefits has a price tag of Rs 9,900.

Privat IPD Plan, that is the hospitalisation plan, covers pre-existing diseases and maternity benefits offered in association with National Insurance Company. The premium for the hospitalisation cover offered by Privat and Max Healthcare depends on the sum insured ranging from Rs 1-5 lakh, and the age of the person.

Says Deepak Mendiratta, managing director, Health and Insurance Integrated, who has designed Privat's plans: "Unlimited access to doctors offered in the plan reduces the barrier to usage of healthcare services, thus ailments will be caught faster and chances of high-end hospitalisation will be reduced."

A pilot study to know the feasibility of the plan will begin from November 21 at Privat Hospital, which has a surrounding population of 3 lakh. Privat hospital hopes to cater to the needs of about 5,000 clients a year.

The pilot project will give the hospital data to prove that the risks involved are not high and the same product can be designed and offered by an insurance company on a pan-India basis.

Says Abhijeet Sachdeva, vice president, Privat Hospital, "To launch the plan on a pan-India basis, we will partner with TPAs across the country who will send patients to their network hospitals."

The Max Happy Family IPD plan is being offered by United India Insurance Company. Privat Hospital and Max Healthcare have tied up E-Meditec, a third party administrator, for the administration of the policy.