Insure And Be Insecure

Selling The Policy		Buying The Policy

Insurer		Customer
Largest-selling product (mediclaim) but design fundamentally faulty—doesn’t ensure adequate coverage for policyholders and doesn’t mitigate risk for insurers Mass selling of policies, little product innovation, background checks inadequate Given limited base of potential customers, insurers chase the same target group Fine print hides more than it reveals; sub limits based on room rent and other costs— not on the cost of procedures Lower or no incentives to sell to people above the age of 60, disabled people		Does not read the fineprint of the policy, usually tardy about preserving documents Not aware of risks, rights, responsibilities in buying a proper policy Not upfront on pre-existing health conditions; creates issues with future claims Many know they will incur healthcare expenses in the future; exploit the policy Tendency to scrimp and buy low-cost policies despite being made aware of risks involved

Renewing The Policy

Insurer

Product premiums do not rise in line with galloping medical inflation, lacks depth of coverage
High claims from the 50+ age bracket. Not enough younger healthy people in the pool; insurers penalise older people by jacking up premiums.
Customer penalised for using the policy; premiums hiked after claims made in the previous year
Enthusiasm in selling the policy not always evident in renewing it
Product premiums do not rise in line with galloping medical inflation, lacks depth of coverage
High claims from the 50+ age bracket. Not enough younger healthy people in the pool; insurers penalise older people by jacking up premiums.
Customer penalised for using the policy; premiums hiked after claims made in the previous year
Enthusiasm in selling the policy not always evident in renewing it

Third-Party Administrator

Beholden to business from the insurance companies for their livelihood, TPAs work to their own advantage
Act as middlemen often to the detriment of customers; deny claims on their own
Some low-quality set-ups not sufficiently trained to handle vast amount of claims
Poor after-sales service, especially with low-value clients

IRDA, Regulator

No control over hospitals or healthcare service providers; health is a state subject
Not eager to play a proactive role even when customers are at the receiving end
No serious push to reform the segment

Hospitalisation, Claims

Insurers

Hospitals

Lack of standard rates and treatment procedures across hospitals, across cities
Hugely varying rate cards for insured and uninsured patients
Inflated rates vary vastly between hospitals in the same city and in rest of India
Uneasy relationship with insurance firms, no onus of responsibility on charging patients indiscriminately

Customers

Customers want quality healthcare but not willing to bear any burden of the cost
Shock over rejection of claim or underpayment; have to often fight for claims

How medical insurance is flawed, from beginning to end