STATEMENT REFERRED TO IN REPLY TO PART (a) to (e) OF RAJYA SABHA STARRED QUESTION NO. *199 FOR 17TH MARCH, 2015 REGARDING “NATIONAL MEDICLAIM PLUS POLICY” TABLED BY SHRI VIVEK GUPTA , M.P.
(a): “National Mediclaim Plus” Policy is a new Health product of National Insurance Co. Ltd. launched on 15th August, 2014 as per the File and Use guidelines of Insurance Regulatory and Development Authority of India (IRDAI). This is not pre-existing product and thus the question of increase in premium does not arise. Under the approved product there are 13 covers, Medical Second Opinion and 2 optional covers, namely Critical illnesses (8 Nos.) and Outpatient Treatment. The Sum Insured under the product varies from Rs.2 Lakh to Rs.50 Lakh. The premium amount chargeable under the policy would depend on the options chosen. Premium rates are fixed based on the loss ratio and various other factors and are filed with the Authority as part of the File and Use procedure. The National Insurance Co. Ltd.’s other products like National Mediclaim Policy, Parivar Mediclaim for Family, Varistha Mediclaim for Senior citizens, Baroda Health Policy, BOI National Swasthya Bima Policy and Universal Health Insurance Scheme address the requirements of all strata of society. The Insurer has not replaced the “National Mediclaim Policy” with this policy. They are still selling, the “National Mediclaim Policy”. Thus the “National Mediclaim Plus Policy” is a completely different and new product with altogether new features, options etc.
(b): “National Mediclaim plus Policy” is a recently approved one and the review of premium rates is envisaged to be done by the Appointed Actuary of the National Insurance Co. Ltd. as deemed necessary as per Regulation No.7, related to Principles of Pricing of Health Insurance Products under the IRDA (Health Insurance) Regulations, 2013.
(c ):There are several other health Insurance products of this Company as well as other Insurance Companies to meet the needs of different sections of people at appropriate premium rates. The Policyholders may also migrate to other policies of the same Company or other Company’s under portability enabled by IRDAI regulations without losing the accrued benefits in terms of waiting period for the purpose of pre exiting disease. There are several products meant for poor people, where the Sum Insured and the premium are lower; i.e., Micro Insurance Products, Universal Health Insurance Policy etc. Further, Rashtriya Swasthya Bima Yojana (RSBY) is a Government run scheme which provides health insurance to unorganized Workers belonging to BPL category and their families. During the course of its implementation, apart from BPL families, RSBY coverage has been extended to other categories of Unorganized workers viz. Building & Other Construction Workers, Licensed Railway Porters, Street Vendors, MGNREGA workers (who have worked for more than fifteen days during preceding financial year), Beedi workers, Domestic workers, Sanitation Workers, Mine Workers, Rickshaw pullers, Rag pickers and Auto/Taxi drivers. Under the scheme, the eligible families in the unorganized sector are provided smart card based cashless health insurance cover of Rs.30,000/- per annum.
(d): Any product sold in the market has to be filed with the IRDAI by the Insurance Company under File & Use Procedures complying with the Health Insurance Regulations 2013. As far as the premium is concerned, the Insurer takes various factors such as loss ratio, claims experience, inflation rate, further assumptions and other actuarial parameters into account while finalizing the premium rates. It is required that the Appointed Actuary of the Company examines and certifies the premium rates. Further, the pricing is also examined by the Actuarial Department of IRDAI and on confirmation by the Actuarial Department the final premium is approved by IRDAI.
(e):The question of increase or revisions in the rates of National Mediclaim Plus Policy at the moment does not arise because it is a new product. However, the review of the product “National Mediclaim Plus Policy” may be done in the future as per the relevant provision of the Health Insurance Regulations 2013 by the Appointed Actuary keeping in view financial sustainability and viability of the product with respect to the premium rates. Changes in rates, if any, are applicable from the date of approval by the IRDAI and are applied prospectively.
The above statement was submitted in reply of undermentioned Rajya Sabha Question:-
GOVERNMENT OF INDIA
MINISTRY OF FINANCE
QUESTION NO 199
ANSWERED ON 17.03.2015
National Mediclaim Plus Policy
199 Shri Vivek Gupta
Will the Minister of FINANCE be pleased to satate :-
(a) whether Government is aware that the increase in premium payable in the National Mediclaim Plus Policy is very high and causing distress to the many, especially, for lower income groups, economically weaker sections and to the senior citizens alike;
(b) if so, whether Government proposes to review the recently revised premium;
(c) if not, the manner in which Government plans on providing similar medical facilities and insurance cover to these sections of the society;
(d) whether there is an existing mechanism that caps the amount increased in the premium; and
(e) the rationale behind such an increment in the revised rates of the Mediclaim Plus Policy?
THE FINANCE MINISTER
(SHRI ARUN JAITLEY)
(a) to (e): A Statement is laid on the Table of the House.
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