Usually, when a well-heeled 32-year old woman expresses an intention to bucy a health insurance policy, insurers are only too anxious to make that sale. But in this particular case I am referring to no insurer has been willing to sell a policy. The reason— she has had a kidney transplant.
When M S Sharma's daughter underwent a surgery four years ago, at a premium private hospital in Delhi, it cost the family nearly R10 lakh. They not only had to pool in all their savings, but also borrow in order to make that payment. Subsequently, the father thought it prudent to get a health insurance cover for his daughter, who is single and earns well. However, no insurer is willing to sell her a policy.
Of course, this means that unless insurers change their methods, people like Sharma's daughter will continue to be denied insurance coverage for the rest of their lives. And given the steep cost of medical care these days, what happens to them if they fall sick?
To put it bluntly, the denial of insurance takes away their right to healthcare. And there is a large section of such people with medical conditions, including disability, who come under this category and there is an urgent need to ensure that they are all brought under the insurance net. They should not be denied their right to buy a policy. Will the insurance regulator please take note?
In fact, in response to the exposure draft on Health Regulations put out by the Insurance Regulatory and Development Authority (IRDA), organisations representing people with disabilities, had pointed out such discriminatory and biased policies in the insurance sector and said that their requests for coverage were being routinely turned down.
Interestingly, in the United States, it is such unfair practices in the insurance sector which eventually led to the Patient Protection and Affordable Care Act, under which, beginning 2014, insurers cannot deny coverage (or charge more) on the basis of a pre-existing condition, including disability. Until 2014, all such people, who are turned down by insurers can get health cover under the Pre-existing Condition Insurance Plan, run by the government. It's time we too took a good look at the health insurance sector and work out how best it can respond to the health needs of the community.
S.N.Shastri: When I bought my cell phone, I bought an insurance against theft of the phone. However, when I actually lost it, the insurance company told me that they could not pay because there were no signs of forcible entry into my car, from where it had been stolen. I was not told about this when I bought the insurance. Is there any way I can recover the cost of my phone from the insurance company?
The Insurance Regulatory and Development Authority's Regulation on the Protection of Policy Holders' interest, clearly mandates that the insurer or his intermediary inform the consumer about all the terms pertaining to the insurance product, particularly the exclusion clauses. Obviously, the insurer or his agent has not followed this regulation in this case.
The consumer courts have held that violation of the Regulation constitutes deficient service and anyone guilty of such deficiency is liable to face the consequences. So, lodge a complaint before the consumer court. Earlier, in certain cases, the apex consumer court has taken strong objection to the insurer, ignoring the IRDA Regulations on the protection of policy holders' interest and said it had to pay for its lapses and compensate the client.