Moneylife Events
Health Insurance Portability: Stakeholders want more clarity, at ML Foundation seminar

At a Round Table on health insurance portability hosted by Moneylife Foundation, leaders from the insurance business express concerns over unresolved issues, ranging from data sharing to the cost to customers

Insurance leaders are unanimous that health insurance portability is a positive for the business and customers. But they have several questions over how it will pan out, when it is introduced in July this year.

At a Round Table hosted by Moneylife Foundation on Tuesday, top bosses raised several issues on this matter that are not resolved, and they made suggestions on how it could be best implemented. The programme at Rachana Sansad hall, in Dadar, was well attended and highly interactive.

According to M Ramadoss, chairman & managing director, The New India Assurance Company Limited, the Insurance Regulatory and Development Authority (IRDA) has come up with this announcement as insurance companies were not able to evolve a common standard product over the last one year.

Portability will allow policyholders to switch over to another insurance company with the same conditions. "The accepting insurer shall provide cover, at least up to the sum assured in the previous insurance policy," the insurance regulator has said. The new facility will also help those policyholders who stick to one insurer throughout, for fear of losing the cover for pre-existing diseases (PED).

Dr Amarnath Ananthanaryanan, CEO and managing director, Bharati AXA General Insurance, said that in spite of teething problems, which will be there in data transfer between insurers, it will lead to the evolution of a common database across insurers.

Sudhir Sarnobat, managing director, Medimanage Insurance Broking, stressed that an independent agency should come forward to create a database of insured in an authentic manner and make it accessible to all insurers and brokers.

According to Pawan Singhal, director - legal and regulatory affairs, Max Bupa Health Insurance, health insurance portability is a win-win situation for both the insurer and insured. There would be challenges in implementation, but in a country like India, where health insurance should be accessible to all and offered to the masses, portability is a clear step forward.

Fali Poncha, executive chairman of IRICS Broking Services and a veteran of the insurance industry, cautioned there were a host of issues still unresolved when a customer is expected to move from one insurance company to another, and that the customer may not get all the benefits he enjoyed previously when he moves to a new insurance company at the same premium. Portability, therefore, would be only due to unhappiness with the service by the old insurer. When an employee who enjoys a group mediclaim policy moves to another employer/location within the country, there is lack of clarity over whether the benefits would be the same on portability.

Mr Ramadoss explained that there was a problem of low awareness on health insurance, as well as low penetration by insurers. He underlined the need to educate customers and said health insurance portability was a minor advantage.

The insurer must have patience, not to make profits from the first year onwards, and the customer must have commitment to stay with the insurance company for long years. Portability may lead to poaching of customers with low claims, leading to public sector insurance companies being left with a larger share of customers in the older age groups.

Portability is available to only 2% of the population which is already insured. Further, portability is limited to carrying forward of only the sum assured and relief on pre-existing diseases (PED). Other issues will be as per the terms and conditions of the new insurance company's products.

Dr P Nandagopal, CEO & managing director, IndiaFirst Life Insurance, said portability should help customers in both intra-insurance company mobility (from one plan to another) and inter-insurance company (from one insurer to another). Insurers who are long-term players would not be affected adversely by health insurance portability.

Moneylife Foundation will present a detailed note to IRDA on the round table discussion with clear suggestions for implementation of portability.



Nagesh KiniFCA

6 years ago

In have response to deepaksb's comment, i'd like to point out the TPAs have proved to be worse than the malady - the corruption at claims departments. Entities with no track record of dealing in health issues or any infrastructure worth the name that includes medical professionals to scrutinize the claims. Some of them are operating from holes in the walls. Some in Hospital premises as one in Chembur at Mumbai, doctoring medical admission records for 'smoother claim' processing. Another at an Insurance Co DO in South Mumbai. They simply follow the rule of the thumb method of 'passing by percentage method' anywhere between 25 to 50%. Ins. Cos. don't entertain queries.
They are known to collect large sums from the companies and pass on only a smaller sum to the claimants and hospitals, playing away with the balance as float.
In 2009-10 New India alone has paid more than Rs.68 crores to TPAs as per a RTI response.
The entire setup even if it means outsourcing needs an urgent revisit to make it accountable and not arbitrary and autocratic that it is today.
I was CAG empaneled Statutory Auditor of GIC, New India, United India and earlier Indian Mercantile and South India. In the recent past have interacted with service providing hospitals and dealt with TPAs for pre-admission clearances during the last malaria epidemic and my experience was horrible.


6 years ago

a decade back TPA's were created due to CORRUPTION within claims department of General Insurance cos.-For all claims including Health,Fire,Motor,Marine etc.Now General Insurance cos are in process of removing TPAs.Can someone clarify as to why will it not lead to corruption.

( If someone asks -off the record-a decade back it was possible to approve false/forged claims - by agreeing to pay % of claim settelement amount to GIC claims officials).

Anna hazare is fighting to curb corruption -where as General Insurance co.s are doing just OPPOSITE.TPA model is successfully working in many countries.One participant from Banglore confirmed that his parent running a call centre at Banglore for his overseas client as TPA.Can someone throw some more light on this.

(Most of TPA's are directly or indirectly owned by politicians and they exhert pressure or pay kickbacks on PSU General Insurance co.s to avail servicies of their TPAs.-

(comments welcome from ALL).One PSU co changed three TPA's in four years-adding extra work and hasseles for policy holders and agents.Total confusion over ID cards and transfer of claims data to NEW TPA.

This lead to delayed/rejection of claims and hasseles for cashless facilities where ever it was available.

Nagesh KiniFCA

6 years ago

Thanks MoneyLife for getting an expert panel from insurance broking professionals, PSU and private Sector CEOs and a overwhelmingly learned houseful participants from a wide spectrum of professionals with doctors travelling all the way from Pune.
MoneyLife needs to ensure that the White Paper on Portability reaches IRDA well in time but also implemented in toto and not accept the half baked Feb. notification listing only two concerns. Each and every matter listed has necessarily to be addressed.

Samar Mahapatra SAMAR

6 years ago

A well organised and hugely attended Seminar , that explored the un- opened issues in health insurance , still in its infancy, in our country.
IRDA is expected to take their role of development of the health insurance domain more actively.They need a focused approach.There is no such Dept yet in the IRDA.Much desired Health Insurance Council, is waiting still in the wings.Such a body could address new issues and give some advisories.Well done ,Money Life.


Raj Pradhan

In Reply to Samar Mahapatra SAMAR 6 years ago

Appreciate your inputs!

Chetan Bordawekar

6 years ago

I was indeed an informative seminar. But I doubt the sucess of insurance portability because of following reasons:
1. If decide to move from one company to another then Will it have any lock-in period? Whether it will have same or lesser premium than the previous insurance company? Whether I would be able to get immediate NoC from the previous company?
2. There are many companies, providing various products. Unfortunately IRDA has not provided summary picture of all the insurance products on its website. So While choosing new company, consumer will get confused while choosing right product.
3. I feel that Why insurance companies should bring a situation that consumer should thinking about one company to another? Instead Insurance companies, with the feedback from consumers, should think about improving their own service so that consumer will not move out of the company.

I fully agree with Mr.Sudhir Sarnobat that we must have an agency like CIBIL, in the insurance sector, with centralized databank, so that consumers can be rated based their claim pattern.

Thank you MoneyLIFE for organizing such an informative seminar.


Raj Pradhan

In Reply to Chetan Bordawekar 6 years ago

Thanks for your feedback!

Do private organisations come under the purview of RTI?

While the RTI Act states that only those private organisations which have “substantial” funding from the government come under the purview of the RTI Act, in cases where these entities are in partnership with the government, it is possible to get necessary information. The Pune-Mumbai Expressway toll matter is a sterling example

With municipal corporations, state and central governments increasingly opting for Public Private Partnerships (PPP), transparency could take a beating, as private organisations have been given an opportunity to duck under the Right to Information (RTI) Act. The Act says that only if private organisations are "substantially" funded then they come under the purview of public domain. Who's to decide what is "substantial funding"? And here's where private bodies take cover and refuse to give information.

A sterling case is that of the Ideal Road Builders (IRB), a private agency which collects toll fees from most of the highways in Maharashtra, including the Pune-Mumbai Expressway. It is impossible to procure information regarding the data of toll collection. However, in such cases, since their partnership is with a government body, the citizen can get access to such information from the government organisation.

Strangely, the Maharashtra State Road Development Corporation (MSRDC), the government body in this case which is mandated to monitor whether IRB is collecting toll honestly or is cheating people, itself has not monitored the revenues of the IRB, despite appointing an independent engineering consultant, STUP Consultants Pvt Ltd, headed by RY Deshpande. However, thanks to citizens demanding this information under RTI, the MSRDC was compelled to request the IRB to send the data of toll collection, year-wise. When this writer conducted inspection of files under Section 4, one of the officials confessed that they had only recently asked the IRB to supply information due to pressure of RTI queries, otherwise they had nothing to do with the information. The fact is that it is binding on the MSRDC to do proper auditing of the toll revenue collected by IRB and gauge whether it is usurping more profits than what it is supposed to get.

Similarly, Metros that are being "forced" upon citizens in several towns and cities across the country, without proper planning, are mostly constructed by the Delhi Metro Rail Corporation (DMRC). Here too, the DMRC is a private body and any query under RTI is denied. In the case of the Pune Metro, the DMRC has disastrously planned the metro and submitted a shoddy and superficial Detailed Project Report (DPR). Despite the project report not satisfying the Pune Municipal Corporation's (PMC) terms of reference and it not abiding by the central government guidelines while making the DPR, the PMC's general body and the administration has blindly passed the project. It now lies with the state government, which failed to allot finance for it in the current budget. The scandal of this Rs10,000-odd crore infrastructure that is going to add to the chaos of the already congested roads in Pune and become a heavy tax burden for citizens for many years, came to light due to the RTI invoked at the PMC. Thus, in private-public partnerships one can get access to public documents by putting a query to the 'public partner'.

However, as per a high court judgment, co-operative banks do not come under the RTI. A few years back, the Reserve Bank of India (RBI) declared that co-operative banks do not come under the purview of the RTI Act. At that time, the Gujarat State Cooperative Bank Ltd, which is an apex institute of co-operative banks, had sought the opinion of the RBI. The RBI stated that since co-operative banks come under the Co-operative Act of the respective states and not under any parliamentary statute, they are not public authorities as defined by the Act.

According to Shailesh Gandhi, central information commissioner, the Company Law gives significant rights to those who own 26% of the shares in a company. Perhaps this could be taken to define the criterion of "substantial finance".

"Subclause d(i) and (ii) together mean any non-government organisations which are substantially owned, controlled or financed directly or indirectly by the government would be covered. Thus aided schools and colleges are public authorities, as also any trusts or NGOs which have significant government nominees; or companies where the government either owns substantial stake, or has given substantial finance, are directly covered under the RTI Act. The substantial finance can take into account tax incentives, subsidies and other concessions as well.

Elaborating further, Mr Gandhi states, "There is some confusion about the words owned and substantial finance. This confusion is evident in the various decisions of the information commissions. Let us look at the words carefully. "Public authority" means any authority or body or institution of self-government established or constituted, … and includes any

(i) body owned, controlled or substantially financed;

(ii) non-government organisation substantially financed, directly or indirectly by funds provided by the appropriate government."

The finance could be either as investment, or towards expenses, or both. The way in which the words have been placed, indicates that perhaps (i) relates to investments and (ii) relates to the running expenses.

"Thus every institution which is owned by the government is clearly covered. By any norms, whenever over 50% of the investment in a body lies with any entity, it is said to be owned by that entity. Since bodies owned by government have been mentioned separately, the words 'controlled' and 'substantially financed' will have to be assigned some meaning not covered by ownership. Thus it is evident that the intention of Parliament is to extend the scope of the right to other organisations, which are not owned by it. No words in an Act can be considered to be superfluous, unless the contradiction is so much as to render a significant part meaningless, or it violates the preamble. Therefore, it becomes necessary to consider a situation where an entity may be controlled by the government without ownership or substantial finance. Such a situation exists when a charity commissioner or registrar of societies appoints an administrator to run the affairs of a trust or society, or a court liquidator takes over administration of some body.

Thus concludes Mr Gandhi: "It is therefore obvious that as per Section 2 (h) (i) 'a body …substantially financed' would be a body where the ownership may not lie with the government, nor the control. Hence, clearly the wording 'substantially financed' would have to be given meaning at less than 50% holding. Company law gives significant rights to those who own 26% of the shares in a company. Perhaps, this could be taken to define the criterion of 'substantially financed'. The finance could be as equity, or subsidies in land or concessions in taxation.

"Similarly some definition is required where the State provides money for the running expenses of an institution as covered under (ii). Presently, aided schools and colleges have all clearly been accepted as 'public authorities', though there appears to be no clarity in the matter of NGOs and other organisations which are receiving significant amounts of finance.

"The key approach and philosophy of the RTI Act appears to be that since the State acts on behalf of the citizens, wherever the State gives money, the citizen has a right to know. In my opinion, if the money given for the running expenses is over either 20% of the running expenses, or Rs1 crore, the body should be considered as receiving 'substantial finance' and is covered in the definition of a 'public authority'."
Putting up information in the public domain, especially where infrastructure is concerned, is very important in the case of roads. The Economic Survey of India estimates that over the next five years (the survey was of February 2008) the investment needs in physical infrastructure will be $500 billion, out of which the share of the private sector will be $150 billion-odd, which comes to over 30%.

It is time to know the truth, as the truth involves us all!

(Vinita Deshmukh is a senior editor, author and convener of Pune Metro Jagruti Abhiyaan. She can be reached at [email protected].)




Vijesh Kaushik

5 years ago

What are the Rate of Interest for Crane, Hydra of M/Ssrei Equipments Finance Co. Ltd.


6 years ago

It is stated in the article "However, as per a high court judgment, co-operative banks do not come under the RTI. A few years back, the Reserve Bank of India (RBI) declared that co-operative banks do not come under the purview of the RTI Act. At that time, the Gujarat State Cooperative Bank Ltd, which is an apex institute of co-operative banks, had sought the opinion of the RBI. The RBI stated that since co-operative banks come under the Co-operative Act of the respective states and not under any parliamentary statute, they are not public authorities as defined by the Act. "

In this connection I have to submit as under:

1) as per sec. 2(h)(c) RTI Act 2005 public authority could be one which s established or constituted by any other law made by State legislature.

2) As per the said act it is only CIC or SIC can ecide whether a particular entity is a public authority or not under RTI act. RBI, to my mind does not have any authority to give such opinion. One has to approach CIC/SIC for this.

Indian shares likely to open on a cautious note: Wednesday Market Preview

Economies across the world are focussing at rate-tightening measures to curb spending in a bid to bring down inflation

The local market is likely to see a cautious opening on fluctuating global markets. Wall Street closed mixed for the second day amid speculations that the Federal Reserve might begin withdrawing stimulus initiatives in the wake of an overall strength in the economy. Bank of China’s rate hike, after the regional bourses closed yesterday, spooked stock markets across the region, as a result of which key indices in the region were mixed in early trade on Wednesday. The SGX Nifty gained 8.50 points at 5,934.50 from its previous close of 5,926.  

The market opened flat on Tuesday on the back of mixed cues from the global arena. The Sensex was up 29 points at 19,731 at the opening and the Nifty gained 16 points at 5,924. The indices scaled the day's high in the first few minutes of trading with the Sensex at 19,770 and the Nifty at 5,929. However, the market could not sustain the gains and slipped into the red thereafter on profit booking. Amid sharp volatility, the indices made a feeble attempt to push into positive territory in mid-morning trade, but sellers had strong control and ensured that the market stayed in the red.

Trading remained range-bound in the noon session, with the benchmarks touching the day's lows at around 12.40pm. Erasing most of the gains accrued yesterday, the Sensex tanked 179 points to 19,524 and the Nifty was down 52 points at 5,856 at the intra-day lows. The indices crawled into the green for a brief moment in the last half hour, but soon slipped and closed almost unchanged, albeit with a mixed bias. The Sensex ended 15 points lower at 19,687 and the Nifty settled two points up at 5,910.

Markets in the US closed mixed for the second day on speculations that the Fed might begin withdrawing stimulus measures in the wake of a gradual rebound in the economy. The biggest component on the Nasdaq 100, Apple Inc’s saw a cut in its weightage, resulting in the stock falling 0.7% in trade. Marketmen viewed the index rebalancing as a positive for other major technology stocks such as Microsoft, which gained 0.9% and Cisco Systems, which added 0.9%.

Meanwhile, the US House Republicans on Tuesday unveiled a plan to overhaul the federal budget and slash the deficit in coming years by about three-quarters, with a $6 trillion cut in spending and 25% cap on tax rates.

The Dow fell 6.13 points (0.05%) to close at 12,393.90. The S&P 500 shed 0.24 of a point (0.02%) to 1,332.63 and the Nasdaq added two points (0.07%) to 2,791.19.

Markets in Asia were mixed in early trade today following a rate hike by the Chinese central bank, the fourth time since October, in a bid to curb rising prices. Benchmark one-year deposit rates will be raised by 25 basis points to 3.25% and one-year lending rates will be hiked by 25 basis points to 6.31%. The increase takes effect from 6th April.
Speculations that the US Fed implementing controls on interest rates also weighed on investors in the region.

The Shanghai Composite gained 0.45%, the Hang Seng rose 0.06%, the Straits Times added 0.01% and the Taiwan Weighted surged 1.17%. On the other hand, the Jakarta Composite declined 0.21%, the KLSE Composite fell 0.17%, the Nikkei 225 was down 0.21% and the Seoul Composite shed 0.07%.

Brent crude jumped to a two and half year peak above $122 a barrel on Tuesday, gaining for a fourth straight day. Brent crude for May rose $1.16 to settle at $122.22 a barrel after reaching $122.89, the highest front-month price since August 2008.

US crude for May delivery fell 13 cents to settle at $108.34, off Monday's $108.78 intraday peak, which was the highest since September 2008.

Back home, Reserve Bank of India deputy governor Subir Gokarn on Tuesday said high inflation in India, previously considered unacceptable, should not be accepted as “the new normal” and the central bank cannot afford to drop its guard. The central bank has raised interest rates eight times since March 2010, with more rises expected, but headline inflation still topped expectations at 8.31% in February.

Mr Gokarn said high growth—the economy is expected to have expanded by 8.6% in the year that ended in March—was contributing to high inflation.


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