Page 13 - Insurance Times September 2021

healthcare centres. With privatisation Lombard General Insurance in an ana- verge of a debt trap as insurers are not
of the healthcare system, the patients lyst call said that the second wave im- processing health insurance claims.
are getting fleeced by the private hos- pacted the affluent class having better According to a report, 330,000 claims
pitals and clinics as there is no enforce- insurance. "Covid claims are signifi-
ment of the Clinical Establishment Act cantly higher and the reporting tail is worth Rs 10,603 crore are still out-
of 2010 and the relevant Rules framed longer. Even as the number of cases standing with insurers as they are yet
in 2012. came down, moderate and critical to take a call on whether to process
settlements based on their investiga-
Parikh said the Union government, in cases had substantially increased," he tions. In FY22, 49,452 Covid-19 claims
consultation with states, is yet to said. ICICI Lombard has increased worth Rs 389 crore have been rejected
frame and notify "conditions for regis- prices for group health insurance fol- on various grounds.
trations: minimum standards of facili- lowing higher claims.
ties and services; minimum require- Insurers are contractually obligated to
"As an industry, we had 10 lakh claims
ment of personnel; provisions of main- settle only those diseases included in
in the first quarter of this year, which
tenance of records and reporting; fixa- the scope of coverage and Covid-19 is
is the same as the number of claims for
tion of rates for each type of procedure the whole of last year. The claims are absent from most such lists. Survivors
and services within the range of rates close to the provisions that we had of those with fixed-benefit health poli-
determined by the central government cies covering critical illness typically
made last year," said Ritesh Kumar,
issued from time to time." bought before 2020 have been jolted
MD & CEO, HDFC Ergo General Insur-
He said in the absence of framing and ance. He added that if his company's by the development.
notifying the minimum standards, the experience was anything to go by, 25% Many of these policies were sold by
clinical establishments in 17 states and
of the claims were yet to come in. bank agents as bundled riders to mort-
UTs are operating on the basis of pro- gage loans - in the event of death due
visional registration. According to PolicyBazaar health insur-
ance head Amit Chhabra, in the first to disease or accident the debt is
The PIL, filed through advocate Srishti wave of the pandemic, claims for Covid waived. However, denial by insurers
Agnihotri, sought a direction to the treatment were a third of total health mean families get caught in a debt
Centre to "operationalise all the pro- claims. This dropped to 31% as the first trap.
visions of the 2010 Act and 2012 Rules,
and among others, direct that the con- wave ebbed in the December quarter The private insurer HDFC Ergo said this
ditions for registration which include even as the share of private treatment in a letter to the family of a mortgage
increased. Before the second wave hit,
the observance of minimum standards, insurance policyholder who died of
display and observance of determined there was a sharp drop in Covid Covid-19 during the second wave of the
hospitalisation cases and a rise in elec-
rates for procedures and services." pandemic: "As the said ailment (Covid-
tive procedures, which resulted in the
19 sepsis) is not covered under critical
Covid claims to exceed share of Covid dropping to 14%. illness enlisted under the terms of the
In the first quarter of the current fis- policy, hence this claim is being repu-
other claims in Q1
cal, Covid claims are expected to be diated in the light of the above."
Even as the second wave of Covid ebbs, more than 50%. Even now claims are
claims continue to pour in for health coming in for reimbursement for HDFC Ergo lists nine diseases as being
insurance companies. As a result, pay- hospitalisation and domiciliary treat- liable for claims under critical illness -
out due to Covid claims is likely to ex- ment. Another reason for the increase cancer, renal failure, major organ
ceed the insurance claims of other ail- transplant, sclerosis, stroke, heart
in Covid claims during the first quarter
ments in the first quarter of the cur- is the drop in other ailments due to the valve replacement and paralysis,
rent fiscal. among others.
lockdown.
Insurance companies have already "A critical illness policy linked with
settled claims of more than Rs 16,000 Families of Covid victims home loans only covers the critical ill-
crore due to Covid and the numbers nesses listed in the policy. Hence, it
are still rising, according to industry in debt trap does not trigger or pay for claims be-
executives. Families of many Covid-19 victims, who yond the purview of the policy," an
Bhargav Dasgupta, MD & CEO, ICICI succumbed to the disease, are on the HDFC Ergo spokesperson said. T

The Insurance Times, September 2021 13