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IRDA chairman: “We don’t want to make mediclaim renewal notice mandatory as it can get be misused”

Speaking at a closed-door discussion organised by Moneylife Foundation, IRDA chairman J Hari Narayan also said that insurance companies should have a special window for fast-tracking of senior citizens’ grievance redressal 

Insurance Regulatory and Development Authority (IRDA) chairman J Hari Narayan met with a select group of insurance experts and NGOs (non-governmental organisations) before the Moneylife Foundation seminar in Wednesday 16th May.

To complaints that health insurance companies do not renew policies automatically, he clarified that IRDA does not want to mandate renewal notices. "We don't want to mandate renewal notice as it can get gamed. If the regulator mandates it and if the insured say that they have not received it, will the cover be considered as continued? The policyholder will go to court over the dispute. There are certain things that are not mandated. The customer knows the annual cover due date and hence can do the necessary renewal".

The IRDA chairman clarified the insurance regulator's approach to improve the mediclaim product entry and exit age restrictions. He said, "Mediclaim should be offered entry till age 65 years and exit age till minimum 80 years. For new product approval, we are asking for no limit for entry and exit age. The existing mediclaim products may not offer this feature".

Talking about the efforts made to improve senior citizens' health insurance grievance handling; he said "IRDA has suggested insurance companies to offer a special window for fast-tracking on senior citizens grievance redressal. Some companies have started it."

Recently, New India Assurance added reputed Jaslok hospital in Mumbai to its list of Preferred-Provider-Network (PPN). Its mediclaim policy states that there will be 20% co-pay for customers going to Jaslok hospital. The regulator clarified that, "We have issued a circular that customers should have access to current list of hospitals on PPN. If insurance companies have a clause in the policy about a specific hospital on PPN charging co-pay, then it is as per the contract. If customers are not happy with it, they can always move to another insurance company's product."

To complaints that premium on senior citizens is too high, the chairman clarified that premium rates for the young are higher than what really should be due to the need to keep senior citizen premium low. There is a built- in normalisation to benefit senior citizens".

To a suggestion that there is no clarity as to whether the TPAs (third party administrators) can process or settle claims, the IRDA chairman said: "The issue is where demarcation occurs considering the spirit of regulations and recognising the practicality of dealing with claim. A large part will get addressed when medical protocols get standardised. Some work has been done in collaboration with chambers of commerce and industry to develop protocols. So far, they have developed 10 of them. IRDA has written to the ministry of health, which has set up an expert body to finalise the protocols. It has not yet been notified to us, but they should be close to standardising 80 processes (medical protocols)".

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COMMENTS

SURESH GUPTA

5 years ago

pl sent my issue to Hon IRDA CHARIMAN SUJATA MAM PL
Hon sir I am certified financial consultant of HDFC STANDARD LIFE INSURANCE CO LTD Mumabi. my code number is 00041214
My request you as under.

1, Company has terminate me on the basis of false complaint of LOCAL STAFF i.e. BALOTRA branch

2. The both person has left the company

3. Due to my termination and lake of services my innocent client has lost almost 20 lakha INR AND POLICY HAS DEACTIVATED.

4. I very humbly request to company to provide the letters/emails/on which basis the company has terminate me but company has not provide the papers.

5.i also pray to company to provide the clause of agency agreement on which basis i have voilete this clouse but company has not replied my

a singal word. Pl help to resolve my issue and reach a free and fa ir investigation in the interest of INNOCENT CLIENTS

the CEO OF HDFC SLIC MR.AMITABH CHAUDHARY mail id is [email protected]


Regards
suresh kumar gupta
rawali gali
BALOTRA 344022
MOBILE 94141 07928

Samar

5 years ago

Solution to uninterrupted continuity of Mediclaim policy lies with life cover , with premium demand linked to Bank mandate.IRDA , have to ensure common standardized policy cover , chosen by the policy holders. If there are changes , new policy to be issued with new mandate for renewal premium from Bank account.

Samar

5 years ago

As per clarification from a leading TPA , in the event of of claim intimation, when the authorization is given in cashless admission , it is processing the claim.. When , the amount of claim is paid to the hospital , it is settlement of claim.Both stages are handled by TPA , as accredited entity.

REPLY

nagesh kini

In Reply to Samar 5 years ago

Samarji,
may I know who this 'leading TPA' is?
There are inummerable complaints of 'no responses' to their phone numbers, they don't authorize in time, raise frivilous queries raised by so-called ayuverdic and homeopathic under-grads not knowing the basics of medicine and surgery, excessive deductions and disallowances, collecting money from insurance companies and not passing it on to the insureds and service providers.
In one of simple malaria when enquired the hospital denied admission when contacting the TPA the hospital admitted having just one bed released but refused to admit, on telling him that the matter would be taken up with the co. and IRDA the hospital conceded. I had to do the threatening to get this done.
Any way I'd like to know the credentials, if any, of this 'leading TPA - the numbers,qualifications, years of standing of the senior staff employed by each TPA.
It would be a good idea to file a query to IRDA and all PSU insurance cos.
I've heard from a reliable TPA source that the attrition rate of the staff is extremely high as the staff simply can't stand the fury of the harassed insureds' relatives for bad services.

suresh kumar gupta

5 years ago

pl sent my issue to Hon IRDA CHARIMAN SUJATA MAM PL
Hon sir I am certified financial consultant of HDFC STANDARD LIFE INSURANCE CO LTD Mumabi. my code number is 00041214
My request you as under.

1, Company has terminate me on the basis of false complaint of LOCAL STAFF i.e. BALOTRA branch

2. The both person has left the company

3. Due to my termination and lake of services my innocent client has lost almost 20 lakha INR AND POLICY HAS DEACTIVATED.

4. I very humbly request to company to provide the letters/emails/on which basis the company has terminate me but company has not provide the papers.

5.i also pray to company to provide the clause of agency agreement on which basis i have voilete this clouse but company has not replied my

a singal word. Pl help to resolve my issue and reach a free and fa ir investigation in the interest of INNOCENT CLIENTS

the CEO OF HDFC SLIC MR.AMITABH CHAUDHARY mail id is [email protected]


Regards
suresh kumar gupta
rawali gali
BALOTRA 344022
MOBILE 94141 07928

dayananda kamath k

5 years ago

but in my case tata aig general insurance company called me about renewal and i agreed for renewal with enhanced amount but they issued me a new policy form the day i contacted instead of renewing with enhanced amount form the expiry of old policy. hence i have lost almost 25 days cover and also renewal benefits. my letters to their head office have not been replied nor they are bothered when they contact me for offering new products.they do not understand that a person who has been cheated will prefer to go for new product with the same company that too when you dont reply for the grievances.

Nagesh Kini FCA

5 years ago

Thanks Harishbhai for endorsing my demand for IRDA mandating despatch of renewal notices that were hitherto routinely sent as a part of good insurance practices.
The disclaimer that the insurers do not assume responsibility for non-receipt is a fraud on the aam insured.
IRDA should mandate that Life Time Health Cover be extended with fixed premium debited to the insured under standing instructions through ECS.
I had to seek the intervention of the Insurance Ombudsman Mumbai to direct Citibank and New India Chennai to send me the notice and cover note for my Good Health Policy.
I beg to disagree with Mr. Harinarayan's contention that it is misused, on the contrary the companies abuse it as a tool to get rid of insured.
IRDA ought to obtain the numbers and reasons for non-renewals. A RTI application can elicit this.

Harish Shah

5 years ago

Question of misuse for making mandatory sending the renewal notice by insurance co. is non ethical business practice especially when it comes to renewal of Health Policy if a person is aged. With memory failing, nobody to take care at least a renewal notice can alert a person. The clause can always be written in the policy that Insurance Co. is not responsible for sending renewal notice. But do not act unethical. In fact by not sending the renewal notice it is the Insurance Co. who misuses the same as they will be too happy to discontinue the policy renewal, irrespective of policy holder having policy for over 15-20 years, his plea to renew is not considered. Nor the Policy portability will come to the rescue. Chairman remark that a person can change the company if he is not happy with the certain clause in the policy. Easy said than done. Even Portability clause will not come to his rescue. By this IRDA has given a free rope to insurance company to keep amending the Plans, terms and clause in the policy which is done in order that Policy Holder has no escape but to renew. Health Insurance is a must today and to take advantage, be unethical is call of the day by the Insurance Company .

BALWANT GODBOLE

5 years ago

It is a prctical experience that so called APPROVAL from TPA takes minimum 2 working days. Hospitals unnecessary detain the patients for giving discharge. Concerete & immediate steps are required to be taken.

Aban

5 years ago

I concur with Mr. Kini's views and also want to state that the inside story of the IRDA or its decision-making orocess/procedures are indeed far from being transparent and satisfactory.
As regards senior citizens, they are most inhumanly treated everywhere--whether it is the CGHS (in particular the CGHS), or any govt. hospital anywhere in the country (where, of course, except the VVIPs/VIPs and top bureaucrats and the political goons, any other human is treated as a stray dog), and invariably all the private hospitals which simulate the CGHS/govt. model in respect of senior or junior citizens all alike, confining them to ine hospital pending the clearance of mediclaims which does take even days forcing the patients to pay for their forced confinement. A wonderful system of exploitation under the aegis of the Govt. and its arm-the IRDA!

Nagesh Kini FCA

5 years ago

I beg to disagree with the Chairman's response on mandating renewal notices. All along both Life and General Insurers have in fact been sending renewal notices.Absence does lead to policies lapsing, consequential cross correspondence and loss of continuity.
A viable alternative is to seek auto-renewal via ECS mandate.
This can make for better services delivery and less headache more particularly for senior citizens where continunity is a prepodonerant factor.
this can be incorporated in a supplementary memoradum collecting suggestions following this meet.

SURESH GUPTA

5 years ago

pl sent my issue to Hon IRDA CHARIMAN SUJATA MAM PL
Hon sir I am certified financial consultant of HDFC STANDARD LIFE INSURANCE CO LTD Mumabi. my code number is 00041214
My request you as under.

1, Company has terminate me on the basis of false complaint of LOCAL STAFF i.e. BALOTRA branch

2. The both person has left the company

3. Due to my termination and lake of services my innocent client has lost almost 20 lakha INR AND POLICY HAS DEACTIVATED.

4. I very humbly request to company to provide the letters/emails/on which basis the company has terminate me but company has not provide the papers.

5.i also pray to company to provide the clause of agency agreement on which basis i have voilete this clouse but company has not replied my

a singal word. Pl help to resolve my issue and reach a free and fa ir investigation in the interest of INNOCENT CLIENTS

the CEO OF HDFC SLIC MR.AMITABH CHAUDHARY mail id is [email protected]


Regards
suresh kumar gupta
rawali gali
BALOTRA 344022
MOBILE 94141 07928

R Balakrishnan

5 years ago

Yet another 'civil' servant, enjoying the perks of office post his retirement age. Loyalty pays. Subject knowledge irrelevant. Why should a co have a 'special' service effort for senior citizens? Ought not they be equally responsive to all clients?
All his replies seem to be very IAS like, seeming to reply, but saying nothing

Samar

5 years ago

Unlike, other forms of Insurance, health insurance is most complex and a niche by itself.Thanks to the legislative inadequacy,health insurance is under regulated , leaving behind scores of gaps, in governance.All our expectations might remain unsatisfied, since Insurance regulator is not fully empowered e.g role of health care delivery.Most Insurers too are are not full time Health Insurers.So we may have to wait a little longer, till govt enacts reformatory laws, to license fully qualified health insurers, at the soonest possible.I
In the interim , the sector would remain half baked & consumer smarting for a full satisfaction from authorities.This , however sad and unfortunate to say the least after 12 years of Regulation.
Therefore , the efforts for building "some bridges of communication" among the stakeholders, by Money -Life foundation and Investors , is to be appreciated as pioneering.& deserving appreciation..

REPLY

nagesh kini

In Reply to Samar 5 years ago

Entirely agreed that the Health Insurance segment is indeed thoroughly 'half-baked' unlike motor and others that have stood the test of time.
The Health Insurance Forum should induct hard core experts and professionals rather than stuff it with govt. babus, govt. doctors from across govt. depts all over and insurance CEOs who will agree to disagree and spend hours writing minutes.

What is expected from the present IRDA chairman is that he gets the concerns listed in the MLF Memorandum examined thread bare by a one-on-one meet for clarifications.
Mr. Hari Narayan will leave more pleasant memories when he thoroughly revamps this with more reforms that will cost nothing to the system but improvements in service delivery.

Sensex, Nifty may see staggered upmove: Thursday Closing Report

The Nifty has to hold above the low of 4,837 for it to rise from the oversold position it is in

The market overcame the European fears and closed marginally in the positive amid volatility in the late session. We had mentioned in Wednesday’s closing report that the Nifty has to hold above the day’s low of 4,837, for the gains to continue. We continue to maintain this trend. Today the index opened higher; witnessed a higher high and higher low, which was last seen on 2 May 2012, the first day of the current downtrend. The National Stock Exchange (NSE) saw a lower volume of 57.76 crore shares

The market witnessed a gap up opening, supported by gains in the Asian pack in morning trade on reports that the Japanese economy grew at an annualised 4.1% in the January-March quarter following rebuilding efforts after the devastating earthquake and ensuing tsunami that stuck the north-eastern region of the country. On the other hand, markets in the US closed down after reports suggested that the European Central Bank (ECB) has stopped liquidity support to some Greek banks until they are capitalized.

Back home, the Nifty opened 21 points higher at 4,879 and the Sensex moved 89 points up to resume trade at 16,119. Early gains were also aided by a recovery in the rupee, which gained 29 paise to 54.20 against the dollar, from Wednesday’s record low of 54.56 to a dollar.

Buying in fast moving consumer goods, realty, banking and power helped the indices gain momentum in subsequent trade. The benchmarks hit their intraday highs at around 10.40am. At the highs, the Nifty rose to 4,922 and the Sensex scaled 16,240.

However, profit booking at higher levels soon saw the market paring early gains. The losses increased as the European markets opened weak. Downgrades of Ashok Leyland and Larsen & Toubro by global brokerage Nomura also weighed on investors.

The indices pared all gains and ventured into the red on selling in technology, capital goods and healthcare sectors. Besides, the rupee hit its intraday low of 54.48 to a dollar, after witnessing a mild recovery this morning.

Although the fall was short-lived the market continued to face volatility and settled with minor gains. The Nifty closed 12 points higher at 4,870 and the Sensex added 40points to finish at 16,070.

The advance-decline ratio on the NSE was in favour of the gainers at 732:679.

The broader indices settled almost unchanged, with the BSE Mid-cap index adding 0.02% and the BSE Small-cap index inching 0.09% higher.

The sectoral gainers were led by BSE Fast Moving Consumer Goods (up 1.90%); BSE Realty (up 0.89%); BSE Oil & Gas (up 0.44%), BSE Metal (up 0.40%) and BSE PSU (up 0.18%). The key losers were BSE Capital Goods (down 2.14%); BSE Consumer Durables (down 1.19%); BSE Auto (down 0.83%); BSE Power (down 0.41%) and BSE Healthcare (down 0.34%).

ITC (up 3.14%) was the top gainer on the Sensex today. It was followed by Jindal Steel (up 1.98%); DLF (up 1.68%); HDFC (up 1.59%) and State Bank of India (up 1.56%). The main laggards were Mahindra & Mahindra (down 3.57%); Larsen & Toubro (down 3.51%); Cipla (down 2.90%); Bajaj Auto (down2.69%) and BHEL (down 1.51%).

The top performers on the Nifty were Ambuja Cement (up 4.57%); SAIL (up 4.02%); ITC (up 3.56%); Jaiprakash Associates (up 2.97%) and Jindal Steel (up 2.71%). Reliance Infrastructure (down 3.56%); L&T (down 3.50%); M&M (down 3.34%); Bajaj Auto (down 2.74%) and Cipla (down 2.55%) settled in the negative.

Markets across Asia settled mostly higher following bargain hunting after recent losses and reports of better-than-expected Japanese GDP growth in the first quarter. However, the fragile situation in Europe raised concerns about the growth in the global economy.

 The Shanghai Composite surged 1.39%; the KLSE Composite gained 0.53%; the Nikkei 225 advanced 0.86%; the KOSPI Composite rose 0.26% and the Taiwan Weighted climbed 1.69%. Among the losers, the Hang Seng declined 0.31%; the Jakarta Composite tanked 1.61% and Straits Times fell by 0.30%.

At the time of writing, the European indices were down between 0.55% and 1.06% while the US stock futures were mixed.

Back home, foreign institutional investors were net sellers of shares totalling Rs546.85 crore on Wednesday while domestic institutional investors were net buyers of equities amounting to Rs171.83 crore.

Mahindra Satyam has tied up with FirstCarbon Solutions to offer sustainability monitoring services. The Indian IT services major will offer FirstCarbon’s sustainability and environmental consulting solutions and software services initially in the UK with plans to expand it to other areas where the company operates. The stock tanked 3.89% to settle at Rs66.75 on the NSE.

IL&FS Engineering and Construction Company has bagged an order worth Rs233.93 crore from Rail Vikas Nigam, Mumbai. The order is for the construction of Roadbed, Major and Minor bridges, track linking (excluding supply of rails, ordinary track sleepers and thick web switches), outdoor signalling and electrical (general) works in connection with doubling of Bhigwan-Mohol section, part of Daund-Gulbarga doubling in Central Railway’s Solapur division in Maharashtra.

The project is to be completed within 42 months from the date of commencement of work. The stock gained 4.78% to close at Rs57 on the NSE.

DLF, the country's largest realty firm, and Haryana Urban Development Authority (Huda) have joined hands to construct a 16-lane road covering 8.3km in Gurgaon at an investment of up to Rs600 crore to ease heavy traffic flow in the city. DLF gained 1.82% to settle at Rs185 on the NSE.

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Personal Finance Exclusive
Did New India overcharge lakhs of policyholders? – III

IRDA has been watching benignly even though New India Assurance has been stalling queries, confusing issues and has decided to offer refund only to a fraction of the policyholders

For the last 40 months, New India Assurance has tried hard to stall Anant Meghji Nandu, who blew the whistle on New India overcharging certain policyholders, through a RTI query. At a hearing called by the Central Information Commissioner, (CIC) held on 10 May 2012, Insurance Regulatory and Development Authority (IRDA) was told to provide information about IRDA’s actions in this case based on the RTI filed by Mr Nandu with IRDA in September 2010.

At the same hearing, the regulator submitted its response from New India Assurance that they have advised their offices to refund excess premium or adjust it against the next renewal. There is no proof that the insurer has actually done this. The recently updated webpage of New India Assurance still shows that only 3,534 out of 30,187 policyholders were refunded the money. The actual number of policyholders who are affected could be more due to the discrepancy between the date of overcharge (29 May 2008 or 16 August 2007). Instead of grilling New India about this, IRDA accepted its submission without verification.

The CIC is not convinced of the insurer’s actions to bring transparency in its refund information which is evident from its decision notice 12 on April 2012 hearing: “Commission finds it difficult to accept the explaining away of this variance by the respondent Central Public Information Officer (CPIO) in the actual date of reduction/revision of premium rates and the date posted on the website by stating that the automated system of accounting used by the company had automatically revised the rates of the mediclaim of receipt holders and refunded the excess payment. Respondent has not been able to provide any explanation as to why they have declared 29 May 2008 and not 16 August 2007 as the effective date for reduction/revision of the premium rates for renewal of mediclaim policies.” This should have alerted IRDA about something really amiss in this case.

Even New India Assurance has agreed that 30,187 policyholders’ were charged excess premium, without giving the names or policy numbers which were overcharged. Based on rough estimate of minimum Rs1,000 overcharge per customer, the insurance company officials accept that they could owe customers Rs3 crore. In reality, the number could be much higher due to the discrepancy of dates (16 August 2007 instead of 29 May 2008) for which New India Assurance is trying to confuse everyone. At a minimum, can IRDA verify if New India Assurance has refunded the excess for all the 30,187 customers?

Mr Nandu had written to the IRDA chairman on 17 February 2012 urging him to make the insurer refund the policyholders’ who were overcharged for nine months from 16 August 2007, which could be in lakhs. Moneylife had written to IRDA on 12 May 2012, but there has been no response till the time of publishing this article.

Given New India’s attitude and IRDA kid-glove approach, the question is who will protect the genuine interests of individuals? It is always the individual policyholder who is at the receiving end. If this mistake had happened with a company, New India would have behaved differently. The matter would have been settled by the insurance company without escalation to IRDA level. The insurance company knows that most individual policyholders’ cannot really fight for themselves. Many would not even know that they have been shortchanged. Hence, it wants to settle individual complaints on a case-by-case basis rather than offering refund to all. It was IRDA’s responsibility step in on behalf of individuals and this is a perfect case for class action. Will IRDA act or remain on the side of New India?

On 20 March 2012, IRDA had let off the New India on another case. It was a complaint by one policyholder Bhagi Ramanath. The warning states that New India Assurance should refund the excess premium charged to the concerned mediclaim policyholders who have made similar complaints. Is this justice? According to Moneylife, IRDA should have told New India Assurance to refund excess premium to not just those who made complaints, but to everyone who got overcharged

Read 1st part of the article giving details of the issue Did New India Assurance overcharge lakhs of mediclaim policyholders? - I


Read 2nd part of the article on New India Assurance’s tactics to save face Did New India overcharge lakhs of policyholders? – II

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COMMENTS

C H Mahadevan

5 years ago

LIC is having a group mediclaim scheme with New India assurance Company for its employees numbering about 1 lac and retired employees and family pensioners numbering about 40000.From your series of articles it is not clear whether overcharging of premium could have taken place for group mediclaim beneficiaries also due to software glitch?Kindly enlighten.

Nagesh Kini FCA

5 years ago

New India is sadly mistaken if they think they can get away with blue murder.
I've filed an RTI application and a copy has been handed over to the IRDA chairman when he met with MLF.

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