State Planning Commission

Workshop Series : 1 / HSW / 2014
State Planning Commission
07 th February 2014
Workshop Series : 1 / HSW / 2014
Health Insurance Schemes for
Senior Citizens
State Planning Commission
07th February 2014
State Planning Commission
11
Tamil Nadu State Planning Commission
The State Planning Commission was constituted in Tamil Nadu as an Advisory body on
th
25 May 1971 under the Chairmanship of the Hon’ble Chief Minister to make recommendations
to the Government on various matters pertaining to the development of the State. The Chairman
of the Commission is assisted by Vice Chairman, Full Time Member & Part Time Members who
are experts in various fields. The Principal Secretary to Government, Planning, Development and
Special Initiatives and the Principal Secretary to Government, Finance Department are the exofficio members. The Member Secretary is responsible for administration in the Commission.
The Commission has the following technical divisions:
1. Agricultural Policy and Planning
2. Industries, Power and Transport
3. Land Use
4. Education and Employment
5. Health and Social Welfare
6. District Planning and Rural Development
7. Plan Co-ordination.
Main activities of SPC:
1. Preparation of Five Year and Annual Plans based on the policies and priorities of the Government.
2. Undertake Mid Term review of the Five Year Plan, other special reviews on the Economy and
advise the Government on appropriate modification and restructuring of the schemes.
3.Monitor development indicators that influence the Human Development Index, Gender
Development Index, etc., at a disaggregated level and suggest correctional measures.
4. Undertakes special studies as required for formulation and implementation of plan projects
and programmes. The State Planning Commission also organizes seminars/workshops.
5. Tamil Nadu State Land Use Research Board (TNSLURB) is functioning under the chairmanship
of Vice Chairman, State Planning Commission as a permanent body in the State Planning
Commission. This Board is intended to promote interaction and study the vital areas of Land
Use. The State Planning Commission organizes seminars/workshops and undertakes studies on
Land Use.
6. Human Development Reports (HDRs) were prepared for Dindigul, Sivagangai, Tiruvannamalai,
Cuddalore, Nagapattinam, the Nilgiris, Kanyakumari and Dharmapuri districts. The concept of
Human Development has been disseminated to all districts through workshops organized in
the concerned districts. Preparation of District Human Development Reports (DHDR) for the
remaining districts is under process.
7. State Balanced Growth Fund (SBGF) is operated to bridge the regional imbalances among the
districts.
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State Planning Commission
CONTENTS
Page No
Workshop Team
4
Executive Summary
6
Introduction
7
Health Insurance Policy
7
Health Insurance Industry in India
8
Features of Health Insurance Schemes
10
Health Insurance Policies for Senior Citizens
11
Chief Minister’s Comprehensive Health Insurance Scheme
12
New Health Insurance Scheme - 2012
13
Comparison of Senior Citizens Mediclaim Policies in India
13
Best Health Insurance Plans as reported by HelpAge India
15
Remarks / Suggestions of the Participants
16
Recommendations made by the State Planning Commission
21
List of Participants
22
State Planning Commission
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WORKSHOP TEAM
State Planning Commission
Tmt. Santha Sheela Nair, I.A.S. (Retd.)
Vice Chairman
Dr. V. Shantha
Member (Health)
Dr. K. Sridhar
Member (Health)
Tmt. S.R. Navaneetham
Head of Division - Health and Social Welfare Division
Tmt. S. Rajalakshmi
Planning Officer - Health and Social Welfare Division
Th. S. Boopathy Mohan
System Analyst
Tmt. K.S. Jayanthi
Technical Assistant - Health and Social Welfare Division
Tmt. S. Vijayalakshmi
Typist - Health and Social Welfare Division
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State Planning Commission
WORKSHOP TEAM
Presentations by
Dr. V. Sathish Raghavan
Deputy Director
Tamil Nadu Health System Project
Th. V. Kumaravelu
Regional Manager
United India Insurance Company Ltd.
Th. H. Srinivasan
Assistant Vice-President
Star Health and Allied Insurance Company Ltd.
Th. R. Muthukrishnan
Senior Manager
HelpAge India
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Executive Summary.......................................................................................................
Health an asset for all irrespective of age,
becomes a major concern once age advances
and there arises a need for adequate health
cover. When a person crosses retirement age,
steady income stops and any expense due
to health problems eats into the savings. The
increased healthcare cost stands as a huge
impediment and it hinders the path of the
elderly in taking good care of personal health.
This is where a Health Insurance Policy comes
into assistance by extending reimbursement
of hospitalisation costs incurred due to an
unfortunate health problem, subject to terms
and conditions. People in general consider
investment in health insurance as an additional
expenditure. But, it is something that can
bring best healthcare well in reach of all. Giving
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State Planning Commission
an option of affordable premium instead
of bearing high medical care costs, health
insurance makes the medical care journey
simple.
There are Insurance Companies who
provide such Health Policies for Senior Citizens
and to know and understand the details of
the benefits extended under these policies, a
workshop was organized in the State Planning
Commission under the Chairmanship of the
Vice-Chairman. Resource persons working
in the domain of Insurance sector and
representatives of organizations working for
the welfare of Senior Citizens contributed vital
inputs for improving the services.
Introduction......................................................................................................................
Health insurance is defined as coverage
that provides for the payments of benefits
as a result of sickness or injury. It provides
protection against financial losses resulting
from injury, illness and disability.
Health insurance is insurance against
the risk of incurring medical expenses among
individuals. By estimating the overall risk
of health care and health system expenses
among a targeted group, an insurer can
develop a routine finance structure, such as a
monthly premium or payroll tax to ensure that
money is available to pay for the health care
benefits specified in the insurance agreement.
The benefit is administered by a central
organisation such as a government agency,
private business or not-for-profit entity.
Health Insurance Policy
The term ‘Health Insurance’ relates to
a type of insurance that essentially covers the
medical expenses. A health insurance policy
like other policies is a contract between an
insurance provider (e.g. an insurance company
or a government) and an individual / group
or his/her sponsor (e.g. an employer or a
community organization) in which the insurer
agrees to provide specified health insurance
cover at a particular “premium” subject to
terms and conditions specified in the policy.
The premium is the amount the policy-holder
or their sponsor (e.g. an employer) pays to the
health plan to purchase health coverage.
The Contract / policy is generally
renewable on yearly basis by payment of annual
premium. The renewals are guaranteed lifelong
by the insurance companies unless there is an
element of fraud / non disclosure of material
facts by the insured. In the case of National
plans by the Governments or organized by the
Government, generally the cover is available
for life long. The type and amount of health
care costs that will be covered by the health
insurance provider are specified in writing, in
a member contract or "Evidence of Coverage"
booklet for private insurance or in a national
health policy for public insurance.
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Health Insurance Industry in India
In India, the Insurance Industry can be broadly classified as Life Insurance and General / NonLife Insurance. Under General Insurance, there are various types of Insurance, among which Health
Insurance, which was once given least importance, is nowadays being given prime importance
because of the high incidence of diseases and the huge costs involved in treatments.
The uninsured population is very high in
India. However, Health insurance has become
one of the fastest growing segments of India's
economy. Launched in 1986, the health
insurance industry has grown significantly,
mainly due to liberalisation of economy and
general awareness. The first health policies in
India were Mediclaim Policies. In the year 2000,
the Government of India liberalised insurance
and allowed private players into the insurance
sector. By 2010, more than 25% of India’s
population had access to some form of health
insurance.
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State Planning Commission
The reports on the Health Insurance
indicate that, the total Health Premium which
was Rs.2,222/- crore in 2005-06 has increased
to Rs.17,620/- crore in 2013-14. The Share of
Health Insurance premium has improved from
11% in 2005-06 to 23% in 2013-14.
1.
United India Insurance Co. Ltd
2.
The New India Assurance Co. Ltd.
3.
The Oriental Insurance Co. Ltd
4.
National Insurance Co.Ltd.
5.
Bajaj Allianz General Insurance Co. Ltd.
6.
ICICI Lombard general Insurance Co. Ltd.
7.
IFFCO Tokio General Insurance Co. Ltd.
8.
Reliance General Insurance Co. Ltd
9.
Royal Sundaram Alliance Insurance Co. Ltd
10. Tata AIG General Insurance Co. Ltd.
11. Cholamandalam MS General Insurance Co. Ltd.
12. HDFC-ERGO General Insurance Co. Ltd.
13. L&T General Insurance Company Ltd.
14. Religare Health Insurance Company Ltd.
15. Magma HDI General Insurance Company Ltd.
16. Liberty Videocon General Insurance Company Ltd.
17. Star Health and Allied Insurance Company Ltd.
18. Apollo Munich Health Insurance Company Ltd.
19. Future General India Insurance Company Ltd.
20. Universal Sompo General Insurance Co. Ltd.
21. Shriram General Insurance Company Ltd.
There are standalone health insurers
along with Government sponsored health
insurance providers. The following are the
26 General Insurance Companies including 5
stand alone health insurance companies.
22. Bharti AXA General Insurance Company Ltd.
23. Raheja QBE General Insurance Company Ltd.
24. SBI General Insurance Company Ltd.
25. Max Bupa Health Insurance Company Ltd.
26. Cigna TTK Health Insurance Company Ltd.
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The public sectors have in the past
introduced a number of innovative products
even before entry of private insurers like Floater
family mediclaim policy, Industrial All risk
policy, Top up and Super Top up Health policy
etc. To improve the awareness and reduce the
procrastination in taking cover under health
insurance policies, the General Insurance
Corporation of India and the Insurance
Regulatory and Development Authority (IRDA)
are conducting awareness campaigns for all
segments of the population. The IRDA serves
both as Licensing authority and Grievance
redressal cell.
Features of Health Insurance Schemes
The key aspects of health insurance
schemes are the claim payment options. In
the Direct Payment or Cashless Facility, the
person does not need to pay the hospital as
the insurer pays directly to the hospital. The
policyholder and all those who are mentioned
in the policy can take treatment from those
hospitals approved by the insurer. Under the
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Reimbursement facility, after completing the
treatment, the patient pays the money to
the hospital at the time of discharge and the
patient can take a reimbursement from the
insurer for the treatment that is covered under
the policy.
The schemes mainly cover the
Hospitalisation
expenses
(incurred
as
inpatient) of treating the Disease, Sickness,
Injury etc. In most of the Health Insurance
Policies, the hospitalization expenses such
as Room rent, Nursing care, ICU expenses,
Medical Practitioners fees, Operation Theatre
expenses, Surgical appliances, Medicines &
drugs, Dialysis, Chemotherapy, Radiotherapy
etc. are covered. Under the United India
Insurance Health Policies, AYUSH (Ayurvedha,
Yoga, Unani, Siddha, Homoeopathy treatments
are also covered. Certain exclusions like Preexisting diseases, Pregnancy/ Childbirth, dental
treatment, Psychiatric treatments and nonmedical expenses like Registration charges are
not covered.
reported that among the age group of 50-60
years, the claim ratio is more whereas above
65/ 70 years, the claim is very less.
The insurance companies offer health
insurance from a sum insured of Rs. 5000/for micro-insurance policies to a higher
sum insured of Rs. 50 lakh and above. The
common health insurance policies are usually
available in the range of Rs.1-5 lakh. The health
insurance policies offered by non-Life insurance
companies usually last for a period of one year
and the Life insurance companies offer policies
for a period of several years. Under section 80D
of Income Tax Act, the insured person who takes
out the policy can claim for tax deductions.
Health Insurance Policies for Senior
Citizens
The various types of policies available for
elderly in the age group of the 61-80 years are
Individual Health, Group Health, Tailor Made,
Family Medicare, Trauma care/ Critical care
Illness etc. About 14 insurance companies are
offering specific Products for Senior Citizens or
Products with entry age above 65 years. It is
The Health Insurance Policies exclusively
offered for Senior Citizens by various companies
are listed below :
1.
2.
3.
4.
5.
6.
The New India
Assurance
Company Ltd.
National
Insurance Co. Ltd.
Senior Citizens
Mediclaim Policy
VARISTHA
Mediclaim for
Senior Citizens
Senior Citizens
United India
Insurance Company Health Insurance
Policy
Ltd.
Optima Senior
Apollo Munich
Health Insurance
Company Ltd.
Bajaj Allianz General Silver Health
Insurance Company Plan
Ltd.
Star Health
Senior Citizens
Insurance Company Red Carpet
Ltd.
State Planning Commission
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Chief
Minister’s
Comprehensive
Health Insurance Scheme
To achieve the objective of Universal
Health care to the people of Tamil Nadu,
the Government is implementing the
Chief Minister’s Comprehensive Health
Insurance Scheme (CMCHIS) through United
India Insurance Company for the past two
years. The basic eligibility criteria for the
claim is annual income should be below
Rs. 72,000/- per annum and in respect of
disabled, there is no income limit. The sum
assured is Rs. 1.00 lakh per year per family along
with a provision to pay upto Rs. 1.5 lakh per
year per family for certain specified procedures.
The scheme provides coverage for meeting
all the expenses relating to hospitalisation of
the beneficiary. The scheme covers 1016 life
saving procedures including 23 diagnostic
services and follow up procedures. For certain
procedures like Kidney, Liver, Stem Cell, Bone
marrow transplants, Cochlear implant which
cost much higher than the ceiling of Rs. 1.50
lakh stipulated under the CMCHIS, a corpus
fund has been created to bear the additional
expenditure. So far, 1.30 crore Smart Cards
have been distributed. currently, 769 Hospitals
have been empanelled to provide treatments
including all the medical college hospitals.
Old Age Pensioners are also included in
the scheme, the cover being given by United
India Insurance Company. The specialities
covered for elders are listed below :
Cardiology
Nephrology
Cardiothoracic
Surgeries
Neurology
Chest Surgery
Neurosurgery
Dermatology
Ophthalmology
Surgeries
Diagnostics
Orthopedic Trauma
Endocrinology
Plastic Surgery
Ent
Poly Trauma
Follow Up Procedures Pulmonology
Gastroenterology
Radiation Oncology
General Medicine
Replacement
General Surgery
Rheumatology
Genitourinary
Surgery
Surgical Gastro
Enterology
Gynaecology &
Obstetric Surgery
Surgical Oncology
Hepatology
Transplantation
Interventional
Radiology
Vascular Surgeries
Medical Oncology
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State Planning Commission
The age group-wise distribution of the
beneficiaries of CMCHIS is given below :
New Health Insurance Scheme - 2012
The New Health Insurance Scheme
provides cashless health insurance coverage to
the families of all the Employees of the State
Government, State Public Sector Undertakings,
Local Bodies in Tamil Nadu, State Government
Universities and Statutory Boards under the
control of the Government of Tamil Nadu. The
United India Insurance Company Ltd. has been
appointed as the insurance company for the
above scheme. This Scheme is also extended to
Pensioners of the State Government, PSU etc.
from July 2014.
attendant fees, room charges, diagnostic
charges, dietary charges availed in the
approved hospitals. A total of 144 medical
procedures and 599 surgical procedures are
covered in the scheme. The coverage shall
also include pre-existing illnesses which have
been included but the transport charges will
be excluded. The Scheme provides coverage
for the treatments upto a maximum of Rupees
Four lakh per Family of the Employee for a block
of four years. The benefit will be on floater basis
i.e. the total coverage up to Rupees Four lakh
can be availed of individually or collectively
by members of the Family during the block of
four years with no restriction on the number of
times the benefit is availed.
Comparison of Senior
Mediclaim Policies in India
Citizens
The Scheme provides coverage for the
eligible expenses incurred by the Employee
on behalf of himself or any member of his or
her family for the treatments and surgeries.
The coverage includes the cost of medicines,
laproscopic or open surgeries, doctor and
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Best Health Insurance Plans as
reported by HelpAge India
HelpAge India set up in 1978 is a secular,
not-for-profit organisation whose mission is to
work for the cause and care of disadvantaged
Older Persons in order to improve the quality
of their lives. It serves to protect the rights of
100 million grey population (India’s elderly)
and provide relief to them through various
interventions and help them live with dignity,
independence & self-fulfilment.
Some of the best Health Insurance Plans
for Senior Citizens as reported by HelpAge
India are furnished below :
after 4
years
State Planning Commission
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Remarks / Suggestions of the Participants........................................................
antsThe
Vice-Chairman, State Planning
Commission observed an increase in the
population of totally abandoned, homeless
older people in the State and suggested to take
necessary steps for their betterment in life by
establishing an exclusive service home in each
village for older people who are totally helpless.
She observed that beggars have increased
manifold because sickness/ disability is an
incentive for begging and pave way for easy
income. She also stated that women begging
is more rampant nowadays and needs to be
addressed.
and also the risk involved due to ageing is high,
non-coverage of Geriatric medicine is illogical.
Also, when she enquired as to what happens
to cases of medical negligence and whether
any coverage is provided in such cases,
Thiru. Srinivasan from Star Health Insurance
Company replied that, in such cases of
negligence by the Doctor, the doctor will
become liable for payment of compensation
to the patient. Generally, the doctors and the
hospitals protect themselves against such
contingency by taking cover under professional
indemnity insurance policy.
Finally, she suggested the following:
She enquired about the claims of elderly
women under Insurance schemes and it was
replied that approximately 40% of women
make claims. She was distressed when it was
informed about the non-coverage of the noncommunicable diseases and also about the
most life-threatening communicable disease HIV under the Health Insurance schemes and
insisted to take initiatives for covering these
diseases under insurance scheme. In this regard,
Thiru Srinivasan, Assistant Vice-President,
Star Health Insurance Company replied that,
normal HIV +ve persons are insured under a
group policy called Star net plus. Further, HIV
persons with a CD count of more than 350 are
also covered under the health insurance policy
available in retail group policies in India.
She stated that as ageing process is not
uniform and differs from individual to individual
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State Planning Commission
•
Geriatric treatment should be covered
in the Policies for senior citizens.
•
Inbuilt incentives should be made
through the insurance companies to
take care of senior citizens.
•
Insurance
Companies
should
announce / provide attractive schemes
for senior citizens so as to cover
80-90% of them under the health
policies.
•
There should also be insurance
coverage for psychiatric treatments.
•
Rashtriya Swasthya Bima Yojana RSBY (National Health Insurance
programme) may be linked with the
State scheme in Tamil Nadu.
•
NGOs like HelpAge may be used to
enroll Senior Citizens for the Health
Insurance Schemes.
•
Physiotherapy may be covered under
Insurance.
•
Youngsters should be encouraged
by providing additional incentives
towards working on senior citizens
so that the insurance company could
extend their best service to senior
citizens.
•
Premium for age above 65 years should
be brought down since empirical data
shows that claims are less when age is
above 70 years.
•
The insurance companies should
carry over the prevailing good health
insurance model of Karnataka and
universalize to Tamil Nadu.
•
Concept papers from insurance
companies are invited and a unique
policy which should be set as a model
for the rest of the country should be
developed.
Th. Ashish kumar, I.A.S., Deputy
Secretary to Government, SW & NMP Dept.
mentioned that the Government Social Welfare
and Nutritious Meal Programme Department
is planning to frame a State Policy for Senior
citizens with a holistic view.
Dr. K. Sridhar, Member (Health), SPC
remarked that most of the insurance schemes
do not provide coverage for the expenses
incurred on post-hospitalisation treatment. He
suggested the insurance companies to provide
coverage atleast for elders for post-cancer pain
treatment, since nowadays “Cancer”, one of the
life threatening diseases is wide spreading in
the State in a rapid manner.
He remarked that while the people
with annual income of less than Rs.72000/are covered in the CM’s Health Insurance
Scheme, the people with annual income
above Rs.72,000/- are left in lurch and so the
Government should moot out a proposal for
people who cannot avail private insurance. He
suggested to go for a scheme that covers even
the Above Poverty Line with some contribution
by the policy holder.
He also suggested that usage of the
term plastic surgery should be removed and
renamed as aesthetic surgery or cosmetic
surgery since it is reconstructive in nature.
State Planning Commission
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He insisted that the insurance companies
must work on public senior citizen health
insurance schemes and atleast some company
should give a comprehensive insurance scheme
covering all exclusions. When he asked about
the portability of the insurance schemes, it was
replied that policy portability is allowed.
He further stated that in the case of old
age people, the definition of illness itself would
be different from normal persons and hence,
it should be studied and worked out properly
before framing the insurance policy and the
monthly geriatric health check up should also
be covered in the policy.
He informed that for the past 30 years, he
is paying Health Insurance premium and as of
now he is paying high premium. He suggested
that the premium for Senior Citizens may be
brought down and if the claim is less after the
age of 65 years, the company could further
decrease the rate of premium.
Dr. V.Sathish Raghavan, Deputy
Director, Tamil Nadu Health System Project
made a detailed presentation on the Chief
Minister’s Comprehensive Health Insurance
Scheme. He informed that out of the total
claims of 5,56,096 upto Jan’ 2014, 71,408 are
elders. As such, 13% of the beneficiaries of
CMCHIS are elders and the amount spent for
them is around Rs.138.58 crore.
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State Planning Commission
He stated that ailments such as
Depression, Dementia, Cataract which are
common in elders and Certain types of Cancer
have not been covered under the Insurance
schemes, which should be included. He further
stated that personal insurance for elderly is
very costly and concluded that State sponsored
insurance is the solution for increased cost for
elderly care.
Thiru. H. Srinivasan, Assistant
Vice - President, Star Health Insurance
Company stated that there is a general
grievance that most of the insurance companies
cover only upto the age of 65 years, but the fact is
that only entry into the scheme is restricted and
renewal beyond the age of 65 years is allowed.
He stated that generally only Hospitalisation is
covered under insurance and not Out-patient
care, but however outpatient radiotherapy is
covered in Star Health Insurance under day care
procedures including many other diseases like
Cataract etc. He further stated that the “Health
gain policy” in Star Health covers out-patient
expenses with a flat premium recovered from
the policy holders and this policy offers Income
tax rebate benefits for the full premium like
other medical insurance policies.
He also informed that the company
has a unique programme called ‘Field visit’
programme and the concerned Doctor is
assigned the responsibility of visiting field and
approve the genuineness of the policy claim
before sanctioning. Claim to be intimated
within 1 day and a doctor will visit within 3
hours and enquires with the hospital about the
patient’s health. This fool proof method will
avoid fraudulent claims.
He stated that, generally 2% of the sum
assured is fixed for room rent. If we occupy
room with higher charges, the other hospital
charges claim will be cut down proportionately.
He also informed that each policy has sublimits according to the nature / severity of
the illness/ diseases (eg: Stroke – Rs. 2.5 lakhs,
Cataract – Rs.30,000/- etc.). He mentioned
about the points to be taken care of while
taking a Health Insurance Policy like sublimits
of Pre-hospitalisation, Post-hospitalisation,
number of network hospitals, whether services
through TPA or directly, sublimits for room
rents, list of day care procedures, coverage
of non-allopathic treatment etc. He also
detailed about the coverage for Non-allopathic
treatment, Pre-Medical Examination, Preexisting diseases (PED) and also about the
exclusions, list of network hospitals etc.
He further informed the following:
•
Next to motor Insurance, health
insurance is largely covered under
General Insurance Schemes. However,
only 15% of the Indian population is
covered under Health Insurance.
•
In certain Health insurance schemes,
non-allopathic treatments are also
covered.
•
In the Group Mediclaim Policy, the
group as a whole is covered under
the policy without restriction on age.
The Group policy could buy back all
waiting period, exclusions etc.
•
About 15-20 % of the senior citizens
avail health insurance. Though Medical
examination for enrolling is done by
Star Health for the people aged above
50 years, no medical examination is
done for senior citizens.
•
If more population are enrolled then
premium will come down.
•
The Room rent during hospitalisation
is restricted to eligibility of the policy
and other costs are also proportional.
•
If customer information is properly
given in the proposals, then the claim
will be hassle free. Nowadays photo
copy of the proposal form is given with
the policy document for reference of
the policy holder.
He also recommended that the premium
paid by youngsters for covering senior citizens
(covering parents and grand parents) may be
given higher Income Tax benefits.
State Planning Commission
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He concluded that people should look
at Health Insurance as an investment and that
a standard National Policy should be devised
with standard exclusions and coverage.
Th. V. Kumaravelu, Regional Manager,
United India Insurance Company detailed
about the various types of health policies,
specific policies for Senior Citizens, general
coverage – optional covers, benefits and
exclusions. He informed that UIIC offers entry
for Senior citizens upto the age of 80 years
and various products are offered for them like
Individual health, Family Medicare, Tailormade,
Trauma care, Cradle care, Workmen medicare,
JAB, UHIS, Cancer illness etc. He further detailed
about the features of the health policies of UIIC
as follows :
•
•
•
•
•
•
20
Coverage is offered only if hospitalized. However, there are more than 30
procedures/ surgeries/ diseases for
which 24 hours hospitalization is not
required.
No medical health checkup is insisted
upon for persons upto 60 years of age.
Health check-up offered as bonus
after 3 claim free periods.
Ayurvedic treatment allowed in
Government recognised/ approved/
NABH/QCI.
Ambulance charges covered.
Uni-criticare policy-pays lumpsum as
soon as the contract of major illness.
State Planning Commission
He also informed about RSBY, the
Universal
Health
Insurance
Scheme
(Government sponsored socially oriented
insurance schemes) which covers even
personal accidents. He proudly mentioned that
UIIC is the first insurer to introduce Topup and
Super Topup policy with a highlighting feature
of higher sum insured with lower premium.
Th. R. Muthukrishan, Help Age India
informed that the HelpAge India organized a
Seminar on Health Insurance on 21.02.2012.
He putforth the following grievances of
Senior Citizens with regard to the practical
discomforts/ difficulties in availing / processing
of health insurance policies of various insurance
companies :
•
Most of the Senior Citizens suffer from
age related ailments and they must
take medicines till their life time. But,
geriatric medicines are not included in
the insurance policies, which should
be covered in the policies.
•
The present format of the proposal
form for taking up a policy is available
only in the language of English. But,
majority of the Senior Citizens in Tamil
Nadu prefer the form to be in the State
language of Tamil. Hence, the policy
form may be printed in local language.
•
The font size of the Terms & Conditions
given in the form is very small and not
legible and hence the font size to be
increased.
•
•
•
In the cases of Claim settlement
by third party administrator, the
minimum duration for clearance of the
claim of TPS (Third party claim) is 3-4
months, which could be shortened by
rapid processing of claims.
The address and the contact numbers
of the O/o of the Ombudsman, Chennai
which is available in the Policy form
should also be made available in the
proposal form.
The destitute old age people, Old Age
home inmates do not hold ration cards
and so they are not covered under
CM’s Health Insurance scheme. Hence,
alternative arrangements should be
made for them to get enrolled in the
above scheme.
•
The premium for Senior Citizens Health
Insurance is high, especially for the age
group of above 80 years, the premium
is very high. Hence, the prevailing
system of high premium rate relative
to increase in age should be reduced.
•
Reduction of paper works in the
insurance policy procedures should be
encouraged.
•
Special coverage for differently abled
persons is required.
State Planning Commission
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Recommendations of the State Planning Commission................................
•
Geriatric treatment should be covered
in the Policies for Senior Citizens.
•
•
•
•
Inbuilt incentives should be made
through the insurance companies to
take care of Senior Citizens.
Premium for age above 65 years should
be brought down since empirical data
shows that claims are less when age is
above 70 years.
•
Insurance
Companies
should
announce / provide attractive schemes
for Senior Citizens so as to cover 8090% of them under the health policies.
The insurance companies should
carry over the prevailing good health
insurance model of Karnataka and
universalize to Tamil Nadu.
•
There should also be insurance
coverage for Non-communicable
diseases, monthly Geriatric checkup,
Psychiatric
and
Physiotherapy
treatments.
The insurance companies must
work on public senior citizen health
insurance schemes and shall give a
comprehensive insurance scheme
covering all exclusions.
•
Government may moot out a Health
Insurance proposal for Above Poverty
Line people who cannot avail private
insurance, with some contribution by
the policy holder.
•
Insurance companies should provide
coverage atleast for elders for postcancer pain treatment.
•
Concept papers from insurance
companies are invited and a unique
policy which should be set as a model
for the rest of the country should be
developed.
•
Rashtriya Swasthya Bima Yojana RSBY (National Health Insurance
programme) may be linked with the
State scheme in Tamil Nadu.
•
NGOs like HelpAge may be used to
enroll Senior Citizens for the Health
Insurance Schemes.
•
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Youngsters should be encouraged
by providing additional incentives
towards working on senior citizens
so that the insurance company could
extend their best service to Senior
Citizens.
State Planning Commission
List of Participants..............................................................................................
Tmt. Santha Sheela Nair, IAS. (Retd)
Vice Chairperson,
State Planning Commission.
Dr. K. Sridhar
Member (Health),
State Planning Commission.
Th. Ashish kumar, I.A.S.,
Deputy Secretary,
Social Welfare and Nutritious Meal Programme Department,
Secretariat, Chennai.
Th. V. Chellasamy,
Deputy Director,
Directorate of Pension, Chennai.
Dr. V. Sathish Raghavan,
Deputy Director,
Tamil Nadu Health System Project, Chennai.
Th. V. Kumaravelu,
Regional Manager,
United India Insurance, Chennai.
Th. H. Srinivasan,
Assistant Vice-President,
Star Health Insurance, Chennai.
Th. R. Muthukrishnan,
Senior Manager,
HelpAge India, Chennai.
Th. Muruganandam,
(Retd. U.S.- Health Department)
President, TN Secretariat Pensioners Association, Chennai.
Th. M. Loganathan,
Regional Manager,
United India Insurance Company Ltd., Chennai.
Tmt. S. Jayasri,
A.O., Regional Office,
United India Insurance Company Ltd., Chennai.
State Planning Commission
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State Planning Commission