Health Insurance for Senior Citizens: M.V.Ruparelia.
National Policy of Older Persons, 1999 lays down very clear lines of action by Governments at Centre & State/UT level in respect of Health Care of Senior Citizens in paras 33 to 47 with detailed directives to make out action plans in para 93. Ministry of Health & Family Welfare took no action in 11 years, as no funds were provided in 9th & 10th Plan Period (Ministry’s letter no. F.No.T-21014/02/2008-NCD dt 3-3-08). In 11th Plan, Rs 400 crores are provided but Ministry is doing nothing even now for Health Insurance for all segments of Senior Citizens, as provided in para 36, which reads as under:
36. The development of health insurance will be given high priority to cater to the needs of different income segments of the population and have provision for varying contributions and benefits. Packages catering to the lower income groups will be entitled to state subsidy. Various reliefs and concessions will be given to health insurance to enlarge the base of coverage and make them affordable.
As per Media Reports (DNA-3-7-10), Minister of State for Health & Health Secretary are busy fighting over sanction for Portal & Health Minister is out of Country! See the Education Minister; every day, he is in News; he has brought RTE Act in a short time and here is a Ministry & Ministers, who do not bother about their Elders, even when they are told that not taking required action on provisions of NPOP for 11 years is nothing but deplorable Elder Abuse!! There does not appear to be any sincerity of purpose or seriousness or sanctity of their responsibility towards their elders!!
With advancing age, old persons have to cope with health and associated problems some of
which may be chronic, of a multiple nature, require constant attention and carry the risk of
disability and consequent loss of autonomy. Some health problems, especially when accompanied
by impaired functional capacity, require long term management of illness at time, and of nursing
care. Health Care for all by 2000 was a slogan of Government but even after 10 years, still majority of Senior Citizens face the same difficulties of unaffordable Health Care. Ageing makes most of Senior Citizens sick without their fault and are required to be cared for by Society & Government. The major portion of present generation of Senior Citizens has fought for Independence and after achieving it in 1947 and suffering scarcity period for a considerable portion of their life brought the Country to the present prosperity and a proud place in Global Economy. With advancement in Medical Science and economic prosperity of the Country, life expectancy has almost reached to 80 and expected to touch 100 soon! With more than 9 crores, Country is already classified as ``Ageing`` and is having second largest population of elders in the World. Number of Senior Citizens is increasing at double the rate of younger generation and time shall come soon, when elders shall be in majority. If proper attention is not paid to such a large number of experienced Senior Citizens and their health immediately, the Society & the Government shall face a serious insurmountable problem!! Next to financial security comes the health care. In absence of good affordable health care services, Senior Citizens are at the mercy of God and many do not dare to go to doctors for treatment and just prefer to suffer and tolerate! Only about 2% are covered by some sort of Health Insurance; 5% are looked after by previous employers and 3% are sufficiently rich to afford all types of treatment. 90% are just not able to afford present costly medical treatment and can not think of getting health insurance by paying present exorbitant premium increasing every year, as they age.
Health Insurance also known as Mediclaim in India provides the cover against the medical care costs arising from disease or accidental injuries. Health insurance is a crucial financial product that every individual must have irrespective of their age. It allows to focus on getting the best treatment without bothering about the financial costs of the same. It covers all or part of the medical costs of treating the disease or injury including doctor's consultation charges, medicine and nursing costs. Treatment can be sought in any recognized nursing home or hospital across India. Insurance policy generally does not cover routine medical expenses like outpatient care, and daily medicines. Health insurance in India can be bought both as an individual or a family and as a group. Group Health Insurance is bought by either an employer or an association for its members.
Medical insurance is provided through several private insurance companies and four public sector general insurance companies. These are:
National Insurance Company
Oriental Insurance Company
New India Assurance Company
United India Insurance Company.
There is large number of schemes for Senior Citizens which are with exorbitant premiums and most of Insurance Companies are discouraging Senior Citizens to take up the policies, as these are considered unprofitable. They have stopped giving commission to their agents for Policies of Senior Citizens. Moreover, Doctors, Hospitals & insurers are taking undue disadvantage of these Medi-Claim Insurance policies many a times by getting unnecessary Tests/Investigations/Operations etc. There is a need to legislate & provide a Regulatory Body like IRDA for entire business of providing Health Care including manufacturers of medicines & chemists. The entire business of Health Care including Health Insurance should be handed over to Charitable Trusts or such organizations, who are willing to provide these humane services on no-profit basis. Insurance Scheme should be simple & user friendly with modest premium within reach of upper middle class paying income tax; lower middle class and poor elders by providing subsidies, as provided in para 36 of NPOP before 11 years, when economy was not so much developed. Comparative premiums charged by various companies and restriction on entry age are shown below. These premiums are increased considerably as an insured Senior Citizen ages. Premium should not be increased after entry and present premiums should be reduced considerably for Senior Citizens by providing Insurance Fund out of atleast 50% of Service Tax on premiums, as recommended by IRDA on 21-1-2009 (pending acceptance for 1 ½ years!) as per Sastry Committee Report. With a view to reduce premium, Insurance Companies should tie up with various hospitals, accredited by National HealthCare Quality Assurance Agency-NABH in different areas and enter in to agreements for giving regular clientele and reasonable fixed charges for various operations and medical procedures, as fixed by Armed Forces Medical College, Pune in collaboration with Ministry of Health & Family Welfare. Insurance companies must be made to realize, if necessary by legislation that health insurance is a human-centric and a social obligation to provide insurance to Senior Citizens at a reasonable cost with no entry & exit age bar, covering all existing diseases and providing out-patient treatments (OPD) also. Insurance should be for longer periods and not for one year only. If the Yasaswini health insurance scheme, pioneered by Narayan Hrudayalaya in Bangalore, can provide complete health cover (from common cold to brain surgery to 1.7mn farmers at a cost of Rs.5/month), why Senior Citizens of the Country can not be provided. Proper Insurance at reasonable cost, which will keep this community of Think-Tank healthy for the Country.
Cholamandalam Basic cover Rs. 50000 Rs.1985
National Mediclaim Rs. 50,000 Rs. 2,158
Cholamandalam Basic cover + Extra Cover Rs. 50,000 Rs. 2,261
Oriental Individual Mediclaim Policy Rs. 50,000 Rs. 2,688
STAR Health Medi Classic Rs. 1,00,000 Rs. 3,000
National Mediclaim Rs. 75,000 Rs. 3,125
Cholamandalam Basic cover Rs. 1,00,000 Rs. 3,226
Cholamandalam Basic cover + Extra Cover Rs. 1,00,000 Rs. 3,497
Oriental Individual Mediclaim Policy Rs. 75,000 Rs. 3,886
STAR Health STAR Medi premier Rs. 1,00,000 Rs. 4,104
National Mediclaim Rs. 1,00,000 Rs. 4,180
New India Mediclaim policy Rs. 1,00,000 Rs. 4,560
Bajaj Allianz Silver Health Rs. 50,000 Rs. 4,780
STAR Health Red Carpet Rs. 1,00,000 Rs. 5,000
Oriental Individual Mediclaim Policy Rs. 1,00,000 Rs. 5,196
General Insurance Companies Maximum Entry Age (Yrs)
Oriental Insurance No Limit
New India Assurance 80
Reliance General Insurance 80
Star Health and Allied Insurance 80
IFFCO Tokio General Insurance 70
Cholamandalam General Insurance 65*
ICICI Lombard General Insurance
60
Tata AIG General Insurance 60
Apollo DKV 60
National Insurance 59
Bajaj Allianz General Insurance 55
HDFC Ergo General Insurance 55
Universal Sompo General Insurance 55
Royal Sundaram General Insurance 50*
United India Insurance 50
Government has provided Rashtriya Swasthya Bima Yojna for BPL (Below Poverty Line) workers in unorganized section (and not all BPL) with effect from 1-10-07 for implementation in five years by 2012-13. Progress of the scheme in various states is worth taking note of! Unless implementing authorities are taken up severely from time to time, no advantage will reach any elder! Health Insurance cover under this scheme is provided to BPL workers in unorganized sector and their families (up to 5 members) to the extant of Rs.30000 p.a. The beneficiary has to pay only Rs. 30 p.a. as registration fees. States have to approve Insurance Companies in each district and nominate proper Public/Private Hospitals having sufficient facilities as per guidelines. The insurance company shall enroll the beneficiaries. The scheme shall be financed by Central & State governments, as laid down. Smart cards shall be issued to each beneficiary house holds for cashless service in the nominated hospitals. The beneficiaries shall be eligible for coverage of financial costs of inpatient health care services as well as agreed day care procedures not requiring hospitalization, as decided by State Government with Insurance Company. Some basic exclusions are also kept. Limit of Rs 30000 for 5 members of family is a mockery of human being, seeing the economic progress of the Country and requires to be increased on par with Rajiv Aarogyasri Community Health Insurance Scheme for all BPL families and implementation ensured properly! This scheme should cover all Senior Citizens, whose annual income is less than Rs 30000-the per capita income of Indian Citizen and the concept of belonging to BPL family as per 13 parameters should not apply to Senior Citizens for this purpose.
Due to political will of the then Chief Minister, Government of Andhra Pradesh has introduced Rajiv Aarogyasri Community Health Insurance Scheme for all BPL families for providing quality medical care for identified diseases. Rajiv Aarogyasri Community Health Insurance Scheme is a unique Community Health Insurance Scheme implemented in Andhra Pradesh from 1st April, 2007. The scheme provides financial protection to families living below poverty line upto Rs. 2 lakhs in a year (Rs 1.50 lakhs in all cases with additional Rs 0.50 for severe cases) for the treatment of serious ailments requiring hospitalization and surgery. 330 procedures are covered under the scheme. The scheme is implemented through Insurance Company, selected through a competitive bidding process. The objective of the scheme is to improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through an identified network of health care providers. All the preexisting diseases are covered under the scheme. The beneficiaries of the scheme are the members of below poverty line (BPL) families as enumerated and photographed on the Rajiv Aarogyasri Health Card/ BPL Ration Card. The benefit on family is on floater basis i.e. the total reimbursement of Rs.1.50 lakhs can be availed of individually or collectively by members of the family. An additional sum of Rs 50,000 is provided as buffer to take care of expenses if it exceeds the original sums i.e. Rs 1.50 lakhs per Individual/family. Cost for cochlear Implant Surgery with Auditory Therapy is reimbursed by the Trust up to a maximum of Rs.6.50 lakhs for each case. The transaction is cashless for covered procedures. BPL beneficiary can go to hospital and come out without making any payment to the hospital for the procedures covered under the scheme. The same is the case for diagnostics if eventually the patient does not end up in doing the surgery or therapy. Hospitals have to conduct at least one free medical camp in a month, there by taking advanced evaluation to the doorstep of patient. All the Primary Health Centers (PHCs) which are the first contact point, Area/District Hospitals and Network Hospitals, are provided with Help Desks manned by AAROGYA MITHRAs to facilitate the illiterate patients. Government of Andhra Pradesh has introduced Rajiv Aarogyasri-I( Rajiv Aarogyasri Community Health Insurance Scheme) in phased manner starting from Phase-I on 01.10.07 to Phase-V on 17.07.08. The scheme is covering 6.55 Crore BPL population belonging to 1.83 lakh BPL families. Further the coverage under the scheme which started with 163 procedures in six systems was gradually extended to 330 procedures in 13 systems.
Government has to provide affordable Health Insurance Scheme for those above BPL category (APL, those having income above Rs 30000 to Rs 2 lakh by providing relief & concessions as per para 36 of NPOP. Centre can provide Rajiv Aarogyasri Community Health Insurance Scheme for this segment of Senior Citizens by charging affordable premium.
Next comes those whose income is more than Rs 2 lakhs and income tax payers, who have paid income tax during their working life of 30-40 years and thereafter continue to pay also. They deserve some consideration in absence of any Security Scheme in our Country, as sickness is due to ageing and not due to their fault and with decrease in interest rates on their savings and high cost of living & health care, it is difficult for them to pay present premiums for health insurance. Provisions of para 36 applies to them also. Base premium for them should be Rs 2000 as against Rs 3000 recommended by IRDA for sum insured of Rs 1 lakh ( para 12.2 of summary of recommendations).As per statistics of 2007-08, Insurance Companies paid claims to the extent of Rs.4137 crores against the receipt of premium of Rs. 5064 crores. It would be seen from this that there is enough scope to give relief to Senior Citizens in premium rates.
