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No beating about the bush.
Speaking at a Moneylife Foundation seminar, IRDA chairman J Hari Narayan said that the need for various implants is real and it has to be addressed as disability can happen due to accidents, medical condition or at birth
In most cases, medical treatment under insurance does not cover prosthetics/artificial limb, when in fact, this is absolutely essential for an amputee to live a normal life. Col (retd) Satish Mallik, a Kargil war veteran and amputee himself, brought this to the attention of the insurance regulator at a special meeting organised by Moneylife Foundation on 16th May. Col Mallik and Lt Col Prakash represented The Challenging Ones, a not-for-profit organisation that encourages and helps amputees not only to lead a normal life, but look beyond and participate in sports and other activities.
Col Mallik said, "There is need to cover repair and replacement of a prosthesis, if this is deemed appropriate by the insured's treating physician/prosthetist". He said that at present, only few mediclaim policies cover prosthetics and out of them only Max Bupa covers up to the sum insured. While the Employee State Insurance Corporation (ESIC) does give limited facility for fresh amputees, some group plans cover prosthetics for even existing amputees. "Individual mediclaim should cover fresh amputee and possibly existing amputees too", he requested.
Insurance Regulatory and Development Authority (IRDA) chairman J Hari Narayan immediately acknowledged the need for mediclaim to cover prosthesis. He said, "The need for various implants is real and it has to be addressed. Some mediclaim policies cover prosthesis and there is need for others to cover. We will advice companies about it. There is increasing need for various types of implants. Disability can happen due to accidents, medical condition or at birth. Prosthesis is essential part of the treatment for loss of limb. However, certain embellishments may be viewed as cosmetics and may not be covered and we too will not support it."
The Challenging Ones NGO gave a memorandum to the IRDA chairman requesting him to ensure that all insurance providers be mandated by regulations to offer mediclaim and accident cover policies to cover the cost of provision of prosthesis/ artificial limbs to the insured person, up to the sum insured and without any artificial cap.
The memorandum states that "The exclusions like war and war-like situations, natural calamity, act of terrorism may also be waived off to cover the provisions of Prosthetics under all medical/accidental insurance policies. This waiver may be given to the insurer on an enhanced/additional premium. Worldwide, in countries which have a market economy, insurance companies are mandated by regulations to provide prosthetic coverage under Medical/Accident insurance policies".
The Challenging Ones is a platform for the challengers (people call them physically challenged). It is a peer support group to hold hands of new amputees. It promotes sports for amputees.
Here is the memorandum written by Maj D P Singh and submitted by Col (retd) Satish Mallik and Lt Col Prakash of The Challenging Ones to the IRDA chairman:
Speaking at a closed-door discussion organised by Moneylife Foundation, IRDA chairman J Hari Narayan said that draft guidelines assert that disadvantaged persons should not be ground for rejection or increase in premium
The Blind Graduates Forum of India (TBGFI) has requested the insurance regulator to issue a circular to all insurance providers clearly instructing them not to discriminate in many manner whatsoever against persons with disabilities, specially those who are blind and have low vision.
At a select meeting organised by Moneylife Foundation with Insurance Regulatory and Development Authority (IRDA) chairman J Hari Narayan on 16th May, Suhas Karnik, a representative of the blind graduates forum, pointed out that the Delhi High Court has already struck down one such arbitrary practice by Postal Life Insurance which used to charge a higher premium from the disabled and also restrict the sum assured to Rs1 lakh, instead of the normally available Rs5 lakh. Yet, those who are blind are being discriminated even when they are earning and in a position to pay for insurance protection for themselves and their families like anyone else.
The forum submitted a memorandum to the IRDA chairman with regard to the discrimination that they face from insurance companies including Life Insurance Corporation of India (LIC). This varies from outright denial of mediclaim and sometimes life insurance, charging extra premium due to perceived higher medical risk for death, lower sum insured and no risk cover for insuring against accidents or diseases.
Responding to their plea, Mr Hari Narayan said, "The Insurance Council and the insurance industry should come up with a minimum standard to cover these. We have to respond as an industry to this demand and the need of the society. Minimum cover for the disadvantaged and the HIV-positive will necessarily have to be offered and there should not be ground for increase in price or rejecting any case. Anything above the minimum will have to be gradually improved with build up of more experience".
Mr Hari Narayan also spoke about an exposure draft prepared by IRDA regarding coverage for disadvantaged persons and cover for HIV-positive for submission to the Supreme Court in connection with a litigation. That draft, he said, is looking at two issues-first, where does India stand with regard to insurance coverage for persons' disadvantaged one way or other? And secondly, where do we stand on providing cover for HIV-positive people?
However, this is not exactly what the Forum was looking for. They want a level playing field with those who have no disability. The forum said that it is not asking for any subsidy and emphasized that many disabled are earning and need insurance to cover their family against risks (life, health, etc), just like others in the society. They want equal footing because as per them, "Disability by itself does not entail any higher risk of life or limb as compared to non-disabled, the disabled are not at all more likely to die early, either due to disease or accident. No empirical study corroborates the fallacious argument advanced by agents and officers of various insurance companies in unduly denying the disabled their legitimate claims".
As their articulate representative Kanchan Pamnani said, "I am no more likely to fall down a flight of stairs than anyone else, and I am just as capable of providing for myself and my family as anyone else". Mr Hari Narayan agreed and clarified that the minimum cover applied to the HIV-positive group and not in the context of other disadvantaged group.
Here is the memorandum submitted by Suhas Karnik and Kanchan Pamnani of Blind Graduates Forum of India to IRDA Chairman:
The Chairman Insurance Regulatory and Development Authority
Sub: removing undue discrimination towards persons with disabilities in the insurance sector
We are a non-government non-profit organization working for the empowerment of the visually-challenged for the last 25 years. We are indeed thankful to you and think ourselves honoured as you have granted audience to us.
As persons with disabilities including the visually-challenged form an integral part of society and are equally, nay more in the need of insurance services, we wish to submit a few points for your kind perusal, considered and considerate action:
1. Your honour would appreciate the fact that visually-challenged, i.e. persons with blindness or low vision along with other persons with disabilities, are engaged in various vocations and activities and are trying their best to lead meaningful and productive life in society. However, their stake in many life activities is often made more perilous by societal attitudes and negative bias toward persons with disabilities in general. So, they like all others try to insure themselves and their family members against various risks including early death. It is in fitness of things that their insurance needs are duly catered to by the insurers on equal footing with others. However, it is precisely this which many insurance companies often do not do under the garb of risk assessment.
2. We have been receiving a steady flow of aggrieved persons who have been denied their legitimate insurance needs often arbitrarily due to their disability by various insurance providers under your jurisdiction including LIC. The main complaints of the aggrieved chiefly relate to:
A) Outright denial: Certain policies are denied to them on the ground that they are disabled, blind, and so do not form an acceptable subject for insurance. The policies denied mainly include joint policies, marital policies, mediclaim policies and even sometimes life insurance for the disabled person.
B) Charging extra premium: Even when sometimes the policy is given, the premium charged is higher than that for non-disabled on the ground that disability constitutes higher medical risk for death.
C) Lower sum ensured: At other times, even after charging higher premia, the sum insured for disabled is substantially lower than that for non disabled. When extra premium is not charged, the disabled gets lower sum insured for same premium as compared to the non-disabled, the same discrimination in different disguise.
D) No risk cover: More often than not, the disabled including the blind are flatly denied any extra risk cover due to accident or disease which is normally made available to non-disabled in various policies. This is based on the faulty presumption of greater risk necessarily resulting from disability.
All these practices may not reach up to you as on the ground level, the agents or at most development officers refuse all these genuine demands and that too without showing any relevant guidelines or notifications issued by insurance company, let alone IRDA.
Often, the policy is rejected orally without even furnishing any written reply even when the applicant demands it.
We can furnish documentary evidence in a few instances where the applicant perseveres enough, should your honour so desire.
3. Your honour would clearly appreciate that disability by itself does not entail any higher risk of life or limb as compared to non-disabled; the disabled are not at all more likely to die early either due to disease or accident. No empirical study corroborates the fallacious argument advanced by agents and officers of various insurance companies in unduly denying the disabled their legitimate claims.
4. The matter has been earlier taken up with LIC by some NGOs. However, LIC has flatly denied any such happenings in the letter issued by their executive director to the NAB (National Association of the Blind) on 18 May 2007. It clearly indicates that the insurance providers are not at all aware of undue discrimination happening with persons with disabilities. The executive director further went on to say that LIC does not discriminate with persons with disabilities in any way; however, he has not been able to provide any clear cut directions by LIC prohibiting the discrimination which is quite rampant.
5. Your honour would definitely appreciate that the Constitution of India confers the right of equality before law and equal protection of laws to all citizens, including persons with disabilities. This right clearly implies that there should not be any undue discrimination against persons with disabilities including blind when it comes to affording them insurance cover. Pre existing disease may constitute extra risk in insurance parlance, but disability cannot be equated with disease and the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, clearly defines disabilities and mandates equal treatment to persons with disabilities in all walks of life including all services.
6. The United Nations has adopted an international convention on the rights of persons with disabilities which also talks of equal, accessible and non-discriminatory services to all persons with disabilities. UNCRPD mandates, in Article 25 that the states parties shall …. "(e) Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance where such insurance is permitted by national law, which shall be provided in a fair and reasonable manner".
Recently, the Delhi High Court struck down one such arbitrary policy by the Postal Life Insurance wherein they were charging higher premium from disabled and also restricting sum assured to Rs1 lakh instead of normally available Rs5 lakh.
All this amply demonstrates that the various insurance providers in India are unduly discriminating against persons with disabilities including blind. Such discrimination is based on the patently false premise that the persons with disabilities are at a higher risk and so constitute an unviable target of insurance. This premise stands uncontrovertibly refuted by various studies and there is not even a single study supporting such presumptions on the part of insurance providers. Further, international and national legal provisions do clearly require that such discrimination in insurance should be done away forthwith.
Such discrimination in banking has already been prohibited by the Reserve Bank of India (RBI) by issuing binding circulars to all the banks way back in 2008, which mandates that all the banking services be provided to blind customers on equal basis with others. Disability or blindness should be taken into account only relevantly at the time of providing services at par with others. It is high time that the august body like IRDA issue a general circular to all the insurance providers clearly instructing them not to discriminate against persons with disabilities, specially blind and low-vision individuals, in any manner while providing insurance in matters including but not limited to, availability of various policies, premia to be paid, amount insured, risk and other covers, etc.
We sincerely pray your honour to kindly consider issuing such a notification which would immensely benefit the already marginalized community of blind and visually-challenged customers who desire to avail insurance like all others.
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)".