Page 13 - Insurance Times September 2021
P. 13

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
   8   9   10   11   12   13   14   15   16   17   18