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June 1, 2002 | 1315 IST
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Medical insurance benefits may be curtailed


The four state-owned general insurance companies are planning to reduce benefits available to medical insurance policyholders as part of a strategy to reduce claims.

Senior executives told Business Standard that a proposal to link benefits like hospital room tariff would be linked to the size of the policy.

For instance, an insured person with a Rs 100,000 Mediclaim policy would be entitled to a hospital room with a tariff of Rs 2,000 a day, while someone who had bought a Rs 300,000 cover would be entitled to a much higher tariff of Rs 5,000 a day, they explained.

The development assumes significance as only in February this year, medical insurance premiums had been enhanced in a graded manner by 15-25 per cent and a new slab of 35-45 years was introduced. Sources said though some misuse of the policy had been checked, there still was scope for further rationalisation.

Prior to the premium rationalisation, the state-owned general insurers had claims ratio (claims as a percentage of premiums) ranging between 80 per cent and over 100 per cent. National Insurance accounted for the highest ratio.

"The details are being finalised as we also need to ensure that the honest policyholders are not punished," a senior executive with a general insurance company said.

The proposal is to be shortly taken up by General Insurance (Public Sector) Association or Gipsa, the coordinating body for the four public sector general insurance companies - Oriental, National, United India Insurance and New India Assurance.

Executives said the claims had come down marginally but it was necessary to restrict benefits as the ratio would go up in the coming years.

Such checks on misuse were earlier part of the policy but over the years they were removed as companies tried to encourage more and more people to buy Mediclaim.

General insurers have also decided to adopt a more cautious approach, while underwriting group medical insurance policies.

Executives said that Delhi-headquartered Oriental Insurance, for instance, has decided that the family floater to provide benefits to family members of policyholders covered by the group policy would require the concurrence of the head office.

This has been done as tariffs on family floater have not been rationalised significantly and a very low premium is paid for purchasing an additional cover to include family members.

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