Medical Insurance Benefits May Be Curtailed

The four state-owned general insurance companies are planning to reduce benefits available to medical insurance policyholders as part of a strategy to reduce claims.

Senior executives told Business Standard that a proposal to link benefits like hospital room tariff would be linked to the size of the policy. For instance, an insured person with a Rs 1 lakh Mediclaim policy would be entitled to a hospital room with a tariff of Rs 2,000 a day, while someone who had bought a Rs 3 lakh cover would be entitled to a much higher tariff of Rs 5,000 a day, they explained.

 

The development assumes significance as only in February this year, medical insurance premiums had been enhanced in a graded manner by 15-25 per cent and a new slab of 35-45 years was introduced. Sources said though some misuse of the policy had been checked, there still was scope for further rationalisation.

Prior to the premium rationalisation, the state-owned general insurers had a claims ratio (claims as a percentage of premiums) ranging between 80 per cent and over 100 per cent. National Insurance accounted for the highest ratio.

"The details are being finalised as we also need to ensure that the honest policyholders are not punished," a senior executive with a general insurance company said.

The proposal is to be shortly taken up by General Insurance (Public Sector) Association or Gipsa, the coordinating body for the four public sector general insurance companies