Medical Health Insurance Companies

**Costs cheaper than American prices! But for many     
   Indians medical costs are becoming unaffordable

**Checklist for buying medical Insurance

Medical costs in India may be cheaper in India when compared to America, but does it mean that medical costs are cheap in India for the average Indian.

Have you ever wondered how local Indians feel about the health costs in India? How does an average Indian middle class family deal with medical emergencies, such as when a loved one suffers from an heart attack?

A patient hospitalized after an heart attack in India may have to cough up about a lakh of rupees in medical costs. This is a conservative figure.

Many  hospitals in India are now money making enterprises. Profit is the main motive behind medical care, not only in India but also in countries like the United States of America. I recently had first hand experience with hospitals in India when a family member had to be admitted in hospital. Having lived abroad for over 35 years, I was amazed and saddened by what I saw.

Medical costs are now becoming a common cause of anxiety not only for the poor but also for middle class people in India. Middle class families have no choice now but to seek medical insurance to protect themselves.

What is a health insurance policy? 

A health insurance policy is a contract between an insurer (the insurance company) and the person getting the insurance.  The insurer agrees to provide specified health insurance at an agreed-upon price the premium. The cost and range of protection provided by the health insurance will depend on the insurance provider and the particular policy purchased.

Health - Medical Insurance Companies motivation - MAKE MONEY

Health/Medical insurance companies not only in India, but worldwide are in the business for one purpose; that is to make money. Don't get fooled into thinking they are there for social reasons. They are selling you a product and IT IS UP TO THE BUYERS TO ENSURE THEY ARE BUYING THE COVERAGE THAT SUITS THEM.

Foreign Insurance Companies are better - Myth

There is a myth in India that foreign goods are better. So if you are thinking of purchasing a policy from a foreign company, then be warned that insurance companies providing health - medical insurance in the United States are experts in denying medical claims. It is not an uncommon for patients to die while  fighting insurance companies to pay for treatment that insured's feel should be covered under their policies and insurance companies refuse to pay due to technicalities.

Most Indian companies offering health insurance are going into partnership with foreign insurance providers to cash in on the Indian market for medical and health insurance. Health insurance advertisements are already targeting NRIs worldwide asking them to buy medical insurance for their loved ones residing in India.

Should you buy medical - health insurance in India?

The vast majority of Indians still do not have any medical insurance.  Health insurance though a common concept in the western countries, has not been a given much thought in India in the past few years. However, now as medical costs soar and become a cause of concern for middle class Indians. Medical insurance is gradually gaining popularity in India. Should you get medical insurance? the answer is a definite yes! However do some research before buying a medical insurance policy.

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FIRST IMPRESSIONS CAN BE MISLEADING

ICICI Lombard are one of the companies that are offering medical insurance in India and of course advertising to NRIs to buy policies for their families in India. So I decided to check their medical insurance policy. They indicate on the front page that their policy would cover the following:

Incurred as an inpatient during hospitalization for more than 24 hours, including room charges, doctor�s / surgeon�s fee, medicines, diagnostic tests, etc.

30 days prior to hospitalization.

60 days post hospitalization.

Pre-existing disease can be covered after the 4th year provided the policy is renewed with us for four consecutive years.

Technologically advanced treatment that do not need 24-hour hospitalization but are covered under this policy are: - Cataract - Lithotripsy (Kidney Stone Removal) - Tonsillectomy - Eye Surgery - Dialysis - Dilatation & Curettage - Chemotherapy - Radiotherapy - Coronary Angiography - Cardiac Catheterization

Reading the above one would believe all of the above (provided they were not pre-existing) would be covered by the policy. However, if one bothers to check the details before signing up for the policy, they would find that some of the above are not covered for two years.

When you actually read the policy wording in section 3.4 you will find the following clarification.

3.4 Expenses incurred on treatment of following diseases within the first two years from the commencement of the Policy, will not be payable:         

• Cataract

• Benign Prostatic Hypertrophy

• Hernia, Hydrocele

• Fistula in anus, Piles

• Arthritis, gout, rheumatism

• Joint replacements unless due to accident

• Sinusitis and related disorders

• Stones in the urinary and biliary systems

• Dilatation and curettage

• Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant/ adenoids and hemorrhoids.

• Dialysis required for chronic renal failure

• Surgery on tonsils and sinuses

• Gastric and Duodenal ulcers

With the above example I am not trying to pass the impression that ICICI Lombard medical policies are inferior in any way compared to other Insurance companies operating in India. In my humble opinion most health insurance companies are motivated to sign up as many customers as possible and increase their profits. You just need to find the one who suits your need.

The point I am trying to make is that before buying a policy make sure you check the fine print and understand fully what is covered and what is not. Don't make assumptions and if in doubt get it in writing. Spend a few minutes when buying a policy rather than face problems when you are ill and need help.

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Points to consider when buying medical & health insurance policies 

• Never buy an insurance policy based on just the companies brochure.

• You should understand the policy, and become familiar with common health insurance provisions, including limitations, exclusions, and riders. It is very important to know what your policy covers and what you have to pay yourself.

• Do not accept verbal confirmation about what is covered or not covered from an insurance agent. Talk is cheap and worthless when it comes to insurance payoffs. If in doubt get it in writing.
  
  Insurance agents may also sometimes not have read the master policy and often in their zeal to sell a policy make statements and promises that turn out not to be true.

• Most companies require a medical examination in India for medical insurance. Some of them want premiums paid before scheduling a medical exam. Check who pays for the medical tests. What happens if the company denies you the policy after the medical exam. Are any paid premiums refunded?

• Check if the policy states that the insurance company can cancel your policy at any time with a few days notice WITHOUT GIVING ANY REASONS.

• The magic word in medical insurance policies is 'Exclusions' where ever you see the world 'exclusions, excluded' read and understand exactly what is written.

• Get clarification for vague points. In one of the policies I read that the insurance policy would not pay to remove a tumor that was not considered life threatening. So now who will decide whether a tumor is life threatening or not? Your doctor or the insurance companies appointed doctors?

• Consider whether the maximum coverage offered is sufficient. If you buy a policy that pays only up to two lakh rupees, is it sufficient?

• Some companies specify in their fine print that they pay only limited amounts for some procedures. For instance:
  Cataract Rs16000 for each eye
  Appendicitis, Hernia Rs 25000
  Tonsillitis Rs12000
  
  I am not sure if these prices are sufficient or not as I do not permanently reside in India.

• Most companies I assume may not cover Aids.  

• Some policies will not pay unless the expenses are incurred in India. Here is a quote from one company's policy wording, "Policy shall not apply to any medical charges incurred by the insured in any place or geographical area other than in India." 

No preventative health care policy in India
Insurance for health care is tied up with only emergency situations. Hopefully in the near future health insurance should be changed from providing cover for preventive methods like medical examinations and tests. Why wait for major illness before insurance pays?

Help for consumers from Governments needed. 
Under the present system, It would appear that Insurance companies usually start investigating your medical history when you file a claim, so they can find some loophole to deny the coverage. Why can't the governments consider legislation that once an insurance company approves an application they have accepted the application as filed. Give the insurance companies a fixed time, say 90 days to investigate, approve or reject declaration of preconditions on an application. Only governments can help ordinary citizens as they do not have the resources to fight large multinational companies.

Health-Medical Insurance companies in India
I am providing some links as a social service so if you wish you can compare policies. It is not my intention to endorse to endorse any company.

  1.   Bajaj Allianz  

  2.   Royal Sundaram  

  3.   New India  Assurance

  4.   ICICI Lombard

  5. General Insurance Corporation through its four subsidiaries: Oriental
      Insurance, New India Assurance, National Insurance Company, United India
      Insurance

Several other Indian Companies, according to news reports are tying up with foreign companies to market medical Insurance in India. Some such companies are:

Indian partner		Foreign Insurer
Aditya Birla Group		Sun Life, Canada
Kotak Mahindra Finance		Old Mutual, South Africa
HDFC		Standard Life, UK
Max India	New York Life, USA
Tata Group	AIG, USA

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