Health insurance frauds: Experts warn of sharp rise in mediclaim scams

Nine out of ten health insurance frauds in country's insurance sector occur in the mediclaim policy segment and there is a need to adopt measures to reduce the trust deficit between insured and insurer to curb the scams, experts have said.

"In insurance industry, number of grievances received or number of frauds committed is an indicator of growth trend of particular segment. In entire insurance sector, 90 per cent of frauds and grievances come from health policies," said Niraj Kumar, General Manager, Oriental Insurance Company.

He was addressing a seminar on health insurance at Amity University yesterday.

Kumar said if one has to draw two curves for health insurance segment, one indicating growth and second learning curve, it can be observed that the growth curve is ahead of learning curve.

This, he added, implies that industry's main aim is only to sell and market health policies, but there are important takeaways in such shortcomings so that the level of mistrust between insured and insurer can be minimised.

Richard Kipp, Managing Director, consulting firm Milliman said, health insurance in India has increased tremendously over few years but India needs to be cautious in its growth vis-à-vis the US where growth has now become stagnant.

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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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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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Third party motor insurance premium may rise further

Mumbai: Lakhs of vehicle owners across the country may have to pay more for buying the mandatory insurance cover — third party motor cover — for their vehicles.

The third party motor insurance premium is likely to go up within the range of 15-50 per cent in 2013, the second hike in the last one year.

“The hike may come within a fortnight . The premium may increase between 15-50 per cent in various vehicle categories,” said the chairman of a public sector insurance company.

As the third party motor insurance is still regulated by IRDA, it has already decided to hike the rates to make up the huge losses in this portfolio — a lion’s share of total losses of over Rs 10,000 crore suffered by the insurance sector is accounted by third party motor cover.

“Our claim ratio is 175 per cent in the third party motor segment,” said G Srinivasan, CMD, New India Assurance.

In fact, the earlier hike which was done in March 2012 was disputed by the transporters’ association which had fought a legal battle with IRDA and general insurers in Calcutta High Court. However after eight months of litigation, the court had passed verdict in favour of the hike.

Earlier in 2012, while asking the domestic general insurers to hike the provisioning — capital to be set aside to pay the future claims as it takes years settle claims under this category — against the third party motor portfolio, the IRDA had assured

Soon, you can hold insurance policies in electronic form

You will soon be able to hold your insurance policies electronically. At its board meeting here on Wednesday, the Insurance Regulatory Development Authority (IRDA) board licensed the National Securities Depository Limited (NSDL), Central Depository Services Limited (CDSL), Stock Holding Corporation of India, Karvy Group and Computer Age Management (CAMS) Repository Services to act as repositories for insurance policies. This move will enable policyholders to maintain insurance policies in electronic form and make changes, modifications and revisions to them. Policyholders will not be levied any charges for using such facilities as the insurance repositories will be paid directly by the insurance companies.