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Changes In Health Insurance Policies – Part 2

Posted on: October 2nd, 2020 by hema kashyap No Comments

The IRDAI has modified guidelines on proportionate deductions under health insurance policies that will take effect from October with the goal to reduce out-of-pocket expenses for policyholders.

According to the IRDAI, as a part of product design, insurers are to propose proportionate deductions of the associated medical expenses when a policyholder chooses a higher hospital room category than the category that is eligible as per terms and conditions of the policy.

The following expenses will not be part of the ‘associate medical expenses’:

• Cost of pharmaceuticals
• Cost of implants and medical devices
• Cost of diagnostics

The insurers will have to ensure that proportionate deductions are not applied in respect of the hospitals which do not follow differential billing by room category nor for those expenses in respect of which
differential billing is not adopted based on room category.

In addition, insurers are not permitted to apply proportionate deductions to ‘ICU charges’ because there
are no different categories of ICU.

The insurance regulator has also asked the insurer to standardise exclusions — listing diseases or medical
conditions that are not covered under a policy.

The new conditions have to be incorporated in the new policies filed by insurers on or after 1 October and
for existing products which are due for renewal from 1 April 2021.


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Changes In Health Insurance Policies

Posted on: September 25th, 2020 by hema kashyap No Comments

From October health insurance policies in India will change in accordance with the guidelines and specifications issued by IRDAI. The changes will be applicable on all existing and new health insurance policies. Here is the list of expected changes:

COVER FOR NEW AILMENTS

Now the health insurance policies will cover:

• Illnesses contracted due to hazardous activity.
• Treatment of mental illness, behaviour and neurodevelopment disorders
• Age-related degeneration and internal congenital diseases
• Artificial life maintenance
• Puberty and menopause-related disorder.

NO REJECTION OF CLAIM AFTER 8 YEARS

If a health insurance policy has completed eight years, i.e., the policyholder has renewed the policy for eight years continuously, a claim cannot be rejected except for proven fraud and permanent exclusions.

NEW DEFINITION OF PRE EXISTING DISEASE (PED)

  1. Any disease/s or ailment/s that has been diagnosed by a physician 48 months before issuance of the
    health cover will be classified under PED.
  2. Any disease/s or ailment/s for which any type of medical advice or treatment was recommended by a
    qualified doctor 48 months before issuance of the policy will be qualified under PED.
  3. Any condition whose symptoms or signs have resulted within three months of the issuance of the policy
    will also be classified under
  4. Pre-existing Diseases.

All health conditions and illnesses suffered after the issuance of policy will be covered under health insurance. Some of the major diseases include Alzheimer, Parkinson, AIDS/HIV and morbid obesity.

PAYING HEALTH INSURANCE PREMIUMS IN EMIS

The regulator has allowed the payment of health insurance premiums in instalments.
The premium mode (frequency) can bemonthly, quarterly or half-yearly.


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IRDAI panel proposes pandemic risk pool with $10bn government guarantee

Posted on: September 19th, 2020 by hema kashyap No Comments

A working group set up by IRDAI has recommended to set up a pandemic risk pool for India.

The report submitted by the group to IRDAI said that the actual pool size will depend on the risks covered and the estimated potential losses. However, in the initial stages, it should have $10bn of hedge as guarantee from the government.

The recommended ‘Indian Pandemic Risk Pool’ will be used to address losses caused to low-income sectors of society and will serve as a medium of providing relief to these sectors by the government in case of any future pandemic events.

The working group also proposed that in the first phase of this pandemic pool implementation business interruption impacting the wages of the MSME sector and migrant workers should be given preference.The total pay-out is expected to be around $10.51bn with the estimate of 40m employees and workers getting benefits and pay-outs limited to a maximum of three months.The report also suggested that in subsequent phases, pandemic coverage will be extended to other lines of business. Consequently the exposure will increase and the government backstop requirement will increase to $17bn .

IRDAI executive director and chairman of the working group Suresh Mathur said the pool would require around 20 to 25 years to grow before it becomes self-sufficient.

According to the report, the government backstop will be utilised only when a pandemic trigger strikes and the pool pay-out is higher than the premiums collected, capacity offered by (re)insurers, capacity offered by other bonds and surplus of the prior years.

The working group suggested that Indian Reinsurer GIC Re which has experience in managing the Indian market terrorism risk pool and the nuclear risk insurance pool in India, would be an apt administrator for the proposed pandemic pool.

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Quick Guide To Basis Of Sum Insured And Claim Settlement

Posted on: August 29th, 2020 by hema kashyap No Comments

Cambridge Dictionary defines Sum Insured as “a maximum amount that an insurance company will pay to someone who makes a claim”.
This definition is at the heart of many on-going conflicts and debates in the Insurance world. As simple as it sounds from an Insurer’s perspective, it is an enigma for most buyers of insurance products. Buyers’ confusion is often compounded by ‘newer bitter discoveries’ at the point of truth; Claims. The objective of this primer is to be a simple ready reckoner of popular insurance policies for both, insurance professionals selling commercial lines products and buyers.

Some commonly used terms in context of sum insured are:

Market Value / Depreciated Value: Market value is the value of an asset as currently priced in the marketplace i.e. at which it can be sold or bought on ‘as it is’ basis. It would closely represent the present-day new cost of similar item / structure less the depreciation due to age / usage. This is, in most cases, different from the accounting Book value or the Original Purchase price.

Reinstatement Value: It represents the current ‘new for old’ replacement value of the asset. It represents the price of a new same or similar asset. Often it is included by incorporating “Reinstatement Value Clause” in the policy.

Average Clause / Under-Insurance: if the sum insured of a property at the time of loss or damage is less than its Market Value or Reinstatement Value (as per the policy conditions ), claim payment by the insurance company will be reduced in the same proportion.

POLICY TYPE BASIS OF SUM INSURED BASIS OF CLAIM SETTLEMENT
 

1. Standard Fire & Special Perils (SFSP)

 

2. Burglary & Theft

 

Option I

Reinstatement Value (RV) for all fixed assets and Market value (MV) for stocks. Reinstatement Value clause to be specifically mentioned.

Option II

Market value for all fixed assets and stocks. In the absence of Reinstatement Value specifically, policy is default treated as on Market value.

Option I

Claim settlement on RV basis for all fixed assets after actual reinstatement of assets and MV for stocks. Insured can opt to take MV settlement for fixed assets with no reinstatement.

Option II

Claim settlement on Market Value for all fixed assets and stocks.

 

3. Industrial All Risk / Asset All Risk / Property All Risk

 

Reinstatement Value (RV) for all fixed assets and Market value (MV) for stocks. (Some Insurers may agree for MV only for very old fixed assets, in which case, the claim settlement will also be on MV basis). Claim settlement on RV basis for all fixed assets after actual reinstatement of assets within 12 months (or an extended period, if allowed by the Insurer) and MV for stocks. Insured’s option to seek MV settlement for fixed assets with no reinstatement.
For all policies above, average clause applies in all claim situations. Upto 15% Under-Insurance relaxation, under material damage section, can be mutually agreed in IAR / AAR / PAR policies.
 

4. Marine Cargo / Transit

 

Predetermined valuation arrived at and hence these policies are on ‘Agreed Value’ basis between the Insurer and Insured. Claim settlement on Agreed
 

5. Boiler and Pressure Plant CPM Electronic Equipment Machinery Insurance

 

Reinstatement Value (RV) for all such equipment. (Some Insurers may agree for MV only for very old fixed assets / 2nd hand machines, in which case, the claim settlement will also be on MV basis). Partial loss settlement on RV basis with no depreciation except limited life items. Total loss settlement on MV basis. Partial loss MV settlement with no reinstatement exists. Average clause applicable.
 

6. Project Insurance

 

Completely erected value of the project including design fees, supplies, erection costs, freight, all taxes and duties. Any used equipment / machinery can be covered on MV basis or Refurbishment valuation report basis. Loss settlement on Reinstatement Value basis. For Used equipment / machinery on MV or Agreed Value Average clause is applicable.
 

7. Business Interruption (Fire / Machinery)

 

Advance Loss of Profit –

Annual Gross Profit and multiple of the same if the Indemnity period is more than 12 months. For Gross Profit, please refer to the specific definitions under the policy wording. Limited Premium refund provision exists. Loss settlement on reduction in Gross Profit during the interruption period corresponding to the Indemnity period. Average clause is applicable. As the sum insured is adjustable based on actual, a buffer is always advisable.
 

8. Liability Policies

 

(CGL, D & O, PI, Cyber, Crime etc.)

Limit of liability (LOL) to be selected by Insured basis of their own exposure analysis / specific contract values. Any One Accident (AOA) & Any One Year (AOY) basis loss settlement
 

9. Employee (WC) compensation policy

 

Sum Insured based Earnings of the covered employees which include wages, salaries, over time, board / lodging, any other perquisites Claim settlement basis the award of judicial authority / body created for labour claims adjudication. Some Insurers’ may apply under insurance on claims if Earnings are understated.

 

Understanding the average clause/ under-insurance clause:

  • A new machine was purchased in 2010 for INR 10 lakhs. This is the Original Purchase Cost
  • A used 2010 model can be bought for INR 6 lakhs in 2020. This is the Market Value of the machine
  • The same new machine costs INR 20 lakhs in 2020. This then is the Reinstatement Value
  • The machine has been depreciated @ 5% per annum, using Straight Line Depreciation method, in the books of the owner. Thus, the Book Value of the machine is INR 5 lakhs.
  • If the Sum Insured of INR 5 lakhs is taken under the Fire Insurance policy, on Reinstatement Value basis, the insurer will apply 75% under-insurance and pay only 25% of each claim (INR 5 lakhs / INR 20 lakhs)
  • If the Reinstatement Value Clause is not attached to the policy, the claim will be assessed with 16.66% under-insurance (INR 5 lakhs / INR 6 lakhs) after application of depreciation.

This Primer provides advice on broad principles only and is not intended to be an exhaustive review of your potential loss exposures. There may be many areas where further specialist advice is required. In such cases, please feel free to contact us.


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Sunshine is the best medicine

Posted on: August 20th, 2020 by hema kashyap No Comments

The lockdown and WFH has forced us to stay inside our houses for the last 3 months. This has drastically reduced our exposure to sunlight. Ancient Indian texts, Ayurveda and now growing modern research on sunlight suggests that moderate exposure to sunlight is beneficial to both body and mind. It is a known fact that exposure to morning sunlight promotes Vitamin D production in the skin round the year.

Soaking in the sun can have several health benefits and here is why you should spend at least 10 minutes in sunlight every day:

  1. Elevates the mood: Brain releases a hormone called “Serotonin” which helps a person feel calm and focused. Moderate exposure to sunlight boosts the serotonin level which in turn improves the mood.
  2. Increases Vitamin D production: Vitamin D is essential for calcium absorption and bone growth. It is sunlight that activates Vitamin D production in the body.
  3. Improves sleep: “Melatonin” also known as sleep hormone helps in improving sleep, synchronizes body clock and lowers stress and it is sunlight that impacts the production of melatonin.
  4. Heals skin disorders: Sunlight helps in the healing of skin disorders such as acne, psoriasis, eczema, and other fungal skin infections.
  5. Boosts growth in children: Many cultures recognize this that moderate sunlight exposure increase the growth and height of children, especially babies. Studies have shown that sun exposure in first few months has an effect on how tall the person grows.

According to WHO, getting anywhere from 5 to 15 minutes of sunlight on your arms, hands, and face 2-3 times a week is enough to enjoy the vitamin D-boosting benefits of the sun.

But if you’re going to be outside for more than 15 minutes, protect you skin by applying sunscreen and covering yourself.

 


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Quakes arouses interest in insurance

Posted on: August 12th, 2020 by hema kashyap No Comments

Frequent low-intensity earthquakes are prompting people living in the National Capital Region (NCR) to look for home insurance, according to a survey. According to a report by the National Disaster Management Authority, 59% of India is vulnerable to moderate-to-major earthquakes.

More than 11,000 home owners were surveyed to gain an understanding of people’s attitude towards home insurance. Five out of 10 respondents in Delhi said that earthquakes have made them anxious enough to think about buying home insurance while 35% of the respondents in NCR have home insurance.

Survey findings show however that home insurance is not the first insurance product on most people’s “To Buy” list as 73% of the respondents across India and 57% in Delhi-NCR said that they have so far not considered buying home insurance.

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Seasonal monsoon floods inflict US$20bn economic toll in Asia

Posted on: August 8th, 2020 by hema kashyap No Comments

An active monsoon season prompted more than $20bn in flood-related damage in parts of China, Japan, India and Bangladesh during the month alone. Much of the physical damage to property, infrastructure and agriculture was anticipated to be uninsured – only reinforcing the importance of finding ways to help lower the protection gap across the region.

Furthermore, persistent seasonal rainfall worsened the flood situation across China’s Yangtze River Basin during the month, with the death toll since 1 June rising to at least 175, as extensive flooding affected the hardest-hit provinces of Anhui, Hubei and Chongqing municipality.

The Ministry of Emergency Management (MEM) noted that nearly 500,000 homes had been damaged or destroyed and 5.2m ha of cropland affected. Direct seasonal economic losses were estimated at CNY150bn ($22bn), of which nearly $16bn occurred in July. Most of the losses were anticipated to be uninsured.

Other natural hazard events that occurred in Asia Pacific in July include:

  • Record-breaking rainfall triggered widespread flash flooding and landslides across southern Japan from 3-10 July, killing at least 82 people and injuring 114 others. Flood damage was most severe on Kyushu Island as dozens of prefectures reported varying levels of physical damage impacts to homes, businesses, infrastructure and agriculture. The event prompted a nearly $4bn recovery effort by the federal government.
  • Record-breaking rains, described as a 1-in-500-year event by the Meteorological Service of New Zealand, triggered flash flooding and landslides in northern and western New Zealand on 17-18 July. Thousands of homes and a vast area of agricultural land in Northland were inundated. Local authorities of New Zealand expected a multi-million-dollar level of direct damage and economic loss.

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Youngsters rushing for short-term health cover

Posted on: July 31st, 2020 by hema kashyap No Comments

Based on early data from insurers, 43% of the buyers of the standard short duration COVID-19 policy sold by all general and health insurers in India are in the age group of 20-30 years.The policy offers a policy period from three-and-a-half months to nine-and-a-half months.

There are several factors that could explain the popularity of Corona cover.

People seem to be expecting the pandemic to go on for a while more, as suggested by the greater demand for policies ranging from six-and-a-half months to nine-and-a-half months – the upper limit of the available policy period.

The pricing of the policy, which is deemed affordable by most young urban working people, and the ease of buying it online, are other factors contributing to its popularity.

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Indian State Owned Insurers Get Fund Injection

Posted on: July 18th, 2020 by hema kashyap No Comments

The Indian government has decided to inject $2.3 bn into three state owned general insurers. National Insurance, Oriental Insurance and United India Insurance. The insurers’ capital has been significantly depleted by several loss-making underwriting years. After the capital injection, the insurers are expected to renew focus on risk management and profitability. They are expected to enhance their risk-based pricing and underwriting discipline to ensure organic capital growth and attract foreign reinsurance coverage.

The government’s goal of listing the companies on the stock market will become feasible only after this. The Cabinet also halted a planned merger of these insurers.

Additionally, given these state-owned insurers’ dominant position in India and ability to undercut other companies’ pricing, improved pricing discipline will benefit the wider market’s underwriting performance.

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Circadian Rhythm – The body’s clock

Posted on: July 15th, 2020 by hema kashyap No Comments

Just like the sun’s 24-hour movement around the earth our body also has a 24-hour cycle called as Circadian Rhythm. Circadian rhythm is the body’s “internal clock” that tells us when to eat, sleep and wake up.
A part of brain’s hypothalamus controls our circadian rhythm which in turn is guided by factors such as sunlight and temperature. When it’s dark at night our eyes send a signal to the hypothalamus that it’s time to feel tired. Our brain then sends a signals the body to release melatonin, which makes us sleepy and the opposite occurs during the day when light signals suppress melatonin production.

Circadian rhythm guides our body to let it know when to sleep and when to be awake. If the same is not functioning properly it can affect sleep, body temperature, hormones, appetite, and other body functions.

When circadian rhythm is not functioning optimally it may lead to obesity, diabetes, depression, bipolar disorder, seasonal affective disorder, and sleep disorders such as insomnia.

Tips to reset the body clock to rest:

  • Expose yourself to sunlight first thing in the morning after waking up for at least 15 minutes
  • Regulate you meal times. Never miss your breakfast and try having an early dinner.
  • Exercise daily preferable at the same time. Not only it is good for health but it also helps in sleeping better at night.
  • Limit use of electronics before bed. Start dimming lights about two hours before bedtime and resist scrolling through social media in bed.
  • Develop a regular sleep-wake cycles. Going to bed and waking up at the same time each day will help keep your body’s internal clock in check.

 


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