The health insurance sector must be sensitive and transparent, more so when it comes to senior citizens

Health insurance is more important for the elderly than the others, for the simple reason that, as age advances, one’s vulnerability to diseases and physical conditions increases. Thus, a medical emergency could result in severe financial crisis, especially considering the phenomenal and constant increase in the health care costs today, unless covered under a comprehensive medical insurance policy.

Earlier, insurance companies used to shun away from the elderly, but the situation has changed today, thanks to Insurance Regulatory and Development Authority for the circular on Health Insurance for senior citizens, issued in 2009. Nevertheless, medical cover for senior citizens comes with ‘co-pay’. This means that, for all medical expenses, customers will have to pay a certain portion of the bill, which may go even up to 50 per cent! Co-pay exists mainly because the risk of hospitalisation is very high at old age and the insurers do not want to a take a chance.

But, why? Society and the State should never begrudge the cost of caring for the elderly. When the nation is spending a huge sum towards subsidising various goods and services, for even people who could afford to pay, it is time something was done in this area as well. Having said this, it is always advisable to go in for a mediclaim policy at a younger age, as this, on prompt renewals, would continue to run into old age as well, with sustained benefits.

As a person handling consumer complaints for the last few years, my observation is that, insurance companies need to be more rational, responsible and transparent in their approach. I would like to share the plight of an elderly person, who sought our assistance recently. Ravikumar has had the mediclaim policy of a public sector insurance company since his retirement. The sum assured was for Rs.3,00,000 and he was under a plan, where, if there were no claims, he was eligible for accrued bonus. Thus, over the years, the bonus alone added to Rs. 75,000. However, four years ago, he received a communication from the insurance company stating they were cancelling the present plan and therefore, there would be no bonus and instead, something called the ‘No Claims Discount’ (NDC) was being introduced. The premium amount of Rs. 7,250 he had paid the previous year was raised to Rs.12,240 on which a discount of Rs. 3,000 towards NDC was deducted and he was asked to pay Rs. 9,240. When Ravikumar questioned this, he was told those were policy decisions and therefore consumers had to abide by them.

In the next year, the plan was again reversed. Bonus was reintroduced and there was no NDC. Last year, the premium amount to be paid by him was raised to Rs. 13,350 and in the present year, he was asked to pay a premium of Rs. 16,250. Completely mystified by this continued, steep increase year after year, despite him being within the age group of 70 to 75, Ravikumar had been writing to the insurance company since March, seeking an explanation. But not a single response was received. He then sought our intervention and it is almost a month now since we represented the matter, and we are yet to hear from the company!

(The writer works with CAG, which offers free advice on consumer complaints to its members. For membership details / queries contact 2491 4358 / 2446 0387 or helpdesk@cag.org.in)

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