Surgery-only cover launched
17 Apr, 2014 12:12 PM
An analysis of health insurance claims has shown that a big chunk - nearly 46% - is on account of non-surgical treatments. With increasing awareness of mediclaim benefits, policyholders are going for hospitalization even in cases like diarrhea and fever which were hitherto treated at home.

"According to our study, only 54% of claims comprise of surgical cases. In most non-surgical cases, it is possible to avail treatment at home. We therefore found there is a demand for a product where the benefit is specific to surgical treatments," said Tapan Singhel, MD & CEO, Bajaj Allianz General Insurance. The company has received approval from the Insurance Regulatory and Development Authority for a 'surgical protection plan' where the premium is 40-50% cheaper than a regular mediclaim policy.

Insurers said that there is an increasing incidence of hospitalization for treatment of infections and this could partly be because of increased awareness of benefits under mediclaim policies. "A large chunk of our claims is on account of gastroenteritis. We have observed that hospital admission for gastro cases is higher where there is a health policy," said an official with a private general insurer.

According to data compiled by the Insurance Information Bureau, which is promoted by the insurance regulator, the top six categories of claims paid are from disease groups infectious, clinical findings, urology, digestive, pregnancy and injury, in that order. These account for 64% in number and 53% in claims paid amount.

Under Bajaj Allianz's surgical protection plan, a 30-year-old could get a cover of up to Rs 10 lakh for a premium of Rs 5,639, which is nearly 30-50% cheaper than a conventional mediclaim, depending on the proposer's age group. The policy names 600 surgeries that are categorized into five grades depending on the severity of the surgery. For instance, a heart bypass or a knee replacement would come under a grade one surgery against which half the sum insured is paid out immediately. A grade III surgery like an appendectomy will entitle the insured to a fixed benefit of Rs 1,70,000 on a Rs 10-lakh sum insured.

"An appendectomy can be conducted through a number of procedures - open surgery, laparoscopy or by use of laser knife. The policyholder can choose any method as the benefit is fixed," said Renuka Randive, assistant vice-president, health, Bajaj Allianz.
Source : The Times Of India

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