Page 15 - Insurance Times April 2024

management indicated that medical such health plans that cover senior citi-
inflation remained high. zens do not come cheap. Premiums Health cover for Ayush
The company is likely to effect a price have risen sharply, in tandem with the treatments opens up
alarming increase in healthcare infla-
increase for some of the products in the opportunities, chal-
next few months. "We periodically re- tion. Under the circumstances, can a
view product pricing subject to various family floater health plan provide a lenges
market conditions," the company told. breather? Extension of health insurance to
A family floater plan, as the name sug- treatments under Ayurveda, Yoga,
Meanwhile, the Chennai head quar-
gests, covers all family members depen- and Naturopathy, Unani, Siddha
tered Star Health has become the first
standalone health insurance company dent on the policyholder. Typically, the and Homoeopathy (AYUSH) at par
to achieve the milestone of settling policy allows the policyholder, or the with other treatments not only
more than 1 crore claims since its in- proposer, to add their spouse and chil- opens up new opportunities but
ception in 2006. During this period, dren. Most policies don't allow children also brings in a new set of chal-
the company has disbursed more than above 25 years to be part of this plan. lenges for industry, according to
Rs. 44,000 crore in claim payments. Unlike an individual plan where the experts.
The company has a claim settlement sum insured can be claimed by only the In the new guidelines issued, the
team of over 580 medical experts from policyholder, the sum insured of a fam- Insurance Regulatory and Develop-
across specialisations. ily floater is a single pool from which ment Authority of India (IRDAI)
all participants can claim. Naveen directed the general and health
"The journey from an unknown startup
insurance company to becoming the Fernandes, an insurance adviser and insurers to put systems in place to
largest standalone health insurer has chairman of BASL, says that buying a offer cover for AYUSH treatments
been exhilarating. This landmark ac- family floater could help save costs by removing existing limitations, if
complishment underscores our com- since rarely does everyone in a family any, from April 1, 2024.
mitment towards our valued custom- needs hospitalization at the same time. "This initiative ensures that AYUSH
ers and bolsters our position as their But a few insurance advisers are of the treatments are at par with conven-
preferred health insurance partner," opinion that the decision to choose tional medical options, catering to
said Anand Roy, MD and CEO of Star between an individual or a family the changing preferences of indi-
Health Insurance. floater plan might be a tricky one. viduals seeking holistic healthcare
In the total claims settled over these Samarth Puja, an insurance adviser solutions,'' Tapan Singhel, MD &
years, 14 per cent of the claims were with Ditto, said the premium of the CEO, Bajaj Allianz General Insur-
paid to senior citizens, 61 per cent to family floater is calculated based on the ance told.
other adults, and 25 per cent of the health condition of the eldest member. IRDAI has specified criteria for
total claims outgo were towards chil- Hence, the insurance premium might AYUSH hospitals which will deter-
dren. Fever and infectious diseases not be as cheap as expected. mine claim eligibility. Admissibility
were the most prominent reasons for Another issue is that most plans don't criteria may include the severity of
claims, amounting to 20 per cent of allow more than two adults to be the condition, treatment details,
the total number of claims paid. and the potential need for
added in a family floater. Those who
Claims arising for general medicine, hospitalisation, he said, adding:
are above 60 years are also excluded
gastroenterology, and orthopaedics ``However, the intricacies of the
from most plans. Thus, senior citizens
were also sizeable, said the company. integration will be worked out
are not eligible to participate in most
family floaters. more molecularly,'' Singhel added.
Why family floater health
Nisha Sanghavi, founder of Promore `` This directive opens up new op-
plans aren't for the elderly Fintech, said only a few policies like the portunities for policyholders to ac-
Health insurance needs to be a critical ICICI Lombard Health Advantedge cess a wider range of healthcare
component in your financial plans. That Apex Plus Plan and ICICI Lombard thereby allowing policyholders to
helps you meet any exigency, say finan- Health Elite Plus allow parents above adopt a treatment of their
cial advisers. It becomes even more the age of 60 to be added in a family choice,'' Ashish Yadav, Head of
important if there are elderly depen- floater but their high premiums might Products, Manipal Cigna Health
dents in your family. At the same time, make them unattractive. said.

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