THE AVERAGE middle class person is ‘speechless’ today on whether a mediclaim policy is a bane or boon for him. In India, it is only corporates and government; employees who avail such a kind of facility. General insurance; companies must be limited to purely non-life insurance and leave medi-claim or health issues with the government.

General insurers have already had their hands full with fire insurance, marine insurance, crop insurance, household insurance, travel insurance, and re-insurance. Any change looks terrible at first sight.

Consumers have lost faith in mediclaim policies as General Insurance companies are neither transparent nor accountable. Firstly, there is always a denial of claims by such companies contending that such claims are due to some pre-existing disease (or complication arising from such pre-existing disease and hence not valid. Secondly, there is a major burden of renewal premiums and denial of bonus. Thirdly, the insured who had claimed earlier are being refused to renew their policies the following year by some insurers, without giving reasons for the same.

Regular and immediate health concerns of an individual’s life are excluded from some policy. They are  as vaccination, dental treatment, cataract and age-related eye ailment, diabetes, hypertension, skin disorder, cost of spectacles and contact lenses, hearing aids, regular health checkups, pre-hospitalisation charges, post-hospitalisation charges, ambulance charges, coma, infertility, sterility, ambulatory dialysis, oxygen concentrator for asthmatic conditions different nature of treatment such as ayurvedic, naturopathy, homeopathy, etc. For Maternity expenses benefit is availed after payment of  an additional 20 per cent of the total basic premium. Claim is given in respect of delivery for only first two children and for operation associated therewith.

Health policies, exclusively for Senior Citizens, issued up to 60 years of age is either denied to people above 55 years or issued at steep premiums. According to reports, the highest losses are incurred on health policies.

To make matters worse, many private hospitals charge an exorbitant amount when they come to know that the patient has a mediclaim policy. On the other hand, many individuals file fraudulent claims by providing claims from their relatives, friends, among others, by writing their names which makes the health insurance company more vulnerable.

The biggest problem in India is that people in an emergency situation are unable to reach hospitals quickly. Most of them use private or public transport because they don’t have money. Only few use ambulances.

Under ULIP plans which covers health and life cover, the premiums are high and no loans are allowed for the same.

A provision for quality health facilities is the right of every citizen of India. Due to the pathetic state of public health care services diseases such as diabetes, malaria, typhoid, tuberculosis, hypertension, cholera, diarrhoea, dengue, hepatitis A, B, C are on the rise. Medi-claim insurers give insurance only upto 5 lakh.