Federal health insurance exchanges face uphill battles

The marketplaces may run into adverse selection problems and struggle to comply with state laws, says a report — concerns echoed by some physician organizations.

Washington Federally operated health insurance exchanges may find it more challenging than other exchange models to attract healthy patients and maintain stable insurance markets, said the author of a new policy brief by Health Affairs and the Robert Wood Johnson Foundation.

The Affordable Care Act created the exchanges to provide individuals and small businesses with a means to shop for coverage options. Although some states have opted to develop their own marketplaces, about half are leaving it up to the federal government to run exchanges in their states. A handful have chosen a state-federal partnership approach, in which states would retain traditional insurance regulatory authority.

In so-called federally facilitated exchanges, the federal government will operate the marketplaces, not just facilitate them, wrote the brief’s author, Sarah Goodell, an independent health policy consultant. Depending on the arrangement they strike with the Dept. of Health and Human Services, states could end up performing some duties, such as administering the states’ reinsurance programs and making final eligibility determinations for Medicaid and the Children’s Health Insurance Program.

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More city nursing homes to provide cashless insurance

More nursing homes in Mumbai will soon provide cashless insurance treatments, as the Association of Medical Consultants (AMC) is set to create a cell to ease the paperwork required in such cases.

A cashless medical insurance implies that in case the insured person is hospitalised

in any of the network hospitals, the claim is settled by the health insurance company directly with the hospital.

The AMC has formed a body, the Network of AMC Hospitals (NoAH), to help private and public sector insurance companies come together so that patients can avail of cashless insurance treatment.

The NoAH has also partnered with an outsourced knowledge partner who will handle the authorisation process. 

Since 2010, nursing homes have not been offering cashless insurance treatment for its patients.

“The cell will deal exclusively with the problems associated with nursing homes. It will be a self-regulated group which will promote uniform billing standards and voluntary accreditation.

"170 of the 217 members attached with NoAH already have accreditation. We are in talks with the other insurance companies,” said Dr Sudhir Naik, chairperson, NoAH.

The lack of cashless insurance was driving nursing home patients to hospitals, said doctors.

“Many people are going straight to private hospitals because they have the option of cashless insurance. However, what they do not realise is that in the bargain, the claims are higher,” said Dr Sangeeta Pikale, convener, NoAH.

The nursing homes that have not been accreditated yet have promised to do so in a year.

The nursing homes under NoAH will have a common billing format, common insurance and cashless procedural format, and will display the tariff of services provided in the nursing homes.

“They will not have the problem of following up on paper work. This will benefit the nursing home, insurance company and the patient,” said Dr Naik.

Insurance sector looking for remunerative tax incentives

The Indian insurance sector is looking for remunerative tax incentives in Budget 2013-14 to boost sales volumes and increase penetration. While life insurers demand separate deduction limits for long-term insurance products, non-life insurers want special exemption categories for home and property insurance.

Amitabh Chaudhry, managing director and chief executive officer (CEO) of HDFC Life Insurance, said while the government was aiming to shift savings from real asset classes such as gold to financial asset classes, the Budget would provide an opportunity to introduce some long-standing demands of the life insurance industry.

According to T R Ramachandran, CEO and managing director of Aviva Life Insurance, separate sub-limit for long-term savings such as insurance is crucial to spur demand for life insurance products. “Currently, the deduction under Section 80C is a combined limit shared with other investment products, including provident fund contributions, savings certificates, bank tax saver deposits, and insurance and life insurance premiums. Hence, the government should look at encouraging people to save for long-term by providing a separate sub-limit of Rs 1 lakh for long-term savings,” he said.

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Motor insurance for dummies

A vehicle is a valuable possession for its owner. Motor insurance is mandatory by law so every car or bike owner must have a motor insurance. But not all are aware about its features, what is actually covered and what is not.

 A vehicle is a valuable possession for its owner. Motor insurance is mandatory by law so every car or bike owner must have a motor insurance. But not all are aware about its features, what is actually covered and what is not.

Your vehicle can be covered under either Third Party Insurance or Comprehensive Car Insurance.

Third Party Insurance only covers your liability towards a third party in case of death, injury or property damage caused to them by your vehicle. It doesnt do any good to your vehicle. If you love your car or bike you must have a Comprehensive Insurance policy which covers both third party liability and damage to your vehicle. But this is not much of a worry since most private players offer only Comprehensive Insurance policy. The insurance policy is valid for one year. It becomes effective from the moment the payment of premium is received by the insurance company and ends at midnight exactly a year later.

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Claimed insurance? Health, motor covers will sting you

Get ready to pay more for your health or motor insurance covers if you have made a claim in the past.

The Insurance Regulatory and Development Authority (Irda) has proposed a new set of rules, effective from March 2014, giving general insurers the leeway to charge differential prices for motor and health plans, based on individual claims experiences. So, if you have made a claim, you end up paying more.

“Pricing is a function of product feature and the risk perceived by insurers after taking into various factors. Differential pricing will benefit customers as there will be a wide difference between policyholders who made claims and who didn’t,” said Sampath Kumar, chief financial officer, Bharti Axa General Insurance.

On the other hand, at least theoretically, you could be paying less if there is no claim against your name.

The Irda has also proposed that insurers to set aside more capital for policies where the risk is higher — mainly those offering guaranteed returns.

In an exposure draft put out on Thursday, it said it has decided to move from the current factor-based pricing regime to one based on solvency. Accordingly, life insurance policies offering guaranteed returns will require higher solvency margins, or more capital, to be set aside. This will push up premiums for traditional products, said a senior actuary.

However, unit-linked policies will be less expensive as insurers need to set aside less capital against them.

Good Health Insurance - How Do You Find One

Health Insurance in Simple Words:

Health insurance is a type of insurance that provides financial coverage for medical costs incurred from illnesses and injuries. The rise in illnesses and injuries in today fast-moving world have made health insurance a must-have for everyone. Health insurance also gives you peace of mind when in times of stress incurred from the hospitalization of a loved one.

Buying Health Insurance Today:

The insurance industry has witnessed a boom in the past decade with many young and dynamic companies offering smart, economic policies. This has made the customer choice a vital and careful one. Choosing the right kind of insurance means a lot as policies differ in terms of coverage and flexibility. In most cases, your health insurance will become inadequate in terms of financial coverage. Hence, it is a must to choose a good health insurance for your family.

Defining Good Health Insurance: 

A good health insurance policy is one that protects you from medical expenses you can’t afford on your own. It also covers a wide range of medical expenses including doctor fees, outpatient treatment, hospitalization expenses, prescription medicines, emergency ambulance services, and diagnostics. A good health insurance not only provides you with better access to health care, but also reduces your out-of-pocket expenses.

Choosing Good Health Insurance:

There has been a rise in health risks and health care costs, making it extremely important to choose a good health insurance that not only covers your basic health care needs, but also miscellaneous expenses such as eye care, dental treatments and maternity. However, the amount of health insurance policies available is vast making the task of choosing a good health insurance policy a tiring one.

Here are some things to look for while choosing a good health insurance policy:

-          Which insurance plan best suits the needs of you and your family?

-          What are the coverage options available?

-          Does the policy cover disabilities and other critical illnesses?

-          Does the policy provide extra health covers that could benefit you?

-          Are there any pre-existing clauses that you should know?

-          Most importantly, is the policy affordable?

What Should Your Policy Cover?

Apart from standard hospitalization expenses and medical bills, health insurance policies nowadays offer coverage for a lot of miscellaneous expenses too. Policies cover dental treatments and eye care as part of their plan while maternity expenses are covered with a waiting period that differs from one policy to another. Some policies also cover ayurvedic treatments. A good health insurance plan must also cover out-of-pocket expenses incurred before, during and after hospitalization.

A good health insurance policy is one that covers you for what you require and what you don’t. Remember, a good policy can help you stay covered from unexpected eventualities. Secure yours and your family health with an ideal health insurance policy that fits your needs and budget.

Repeat offender? car insurance may cost more

Are you a repeat offender of traffic rules? Soon, driving may turn out to be costlier for you. Or, you may be forced to even stop driving. The Delhi traffic police are planning to send details of the cars of habitual offenders to insurance companies so that they can be forced to pay more
on premiums.

The companies can even refuse to renew their insurance plans and the police regularly impound uninsured cars.

The police said the initiative would come into effect once the e-challan system — which would store digitally the details of vehicles of high-risk drivers — becomes operational by March.

“The data would either be uploaded on our website or be sent to the insurance companies,” said Anil Shukla, additional commissioner (traffic). He said the insurance companies would then have to decide on policy renewal and premium hike.

Claiming that “it will deter the rash driver on city roads”, Sudhir Yadav, special commissioner of police (traffic), said drivers would be more careful now that getting traffic citations repeatedly would mean an increase in premiums.