For insurers providing group health insurance coverage, parents of employees are becoming more expensive to handle than the employees themselves. Most health insurers are now putting restrictions on claims arising out of parents of employees, who are covered under group health insurance, provided by their employers.
Of the total claims from group health insurance policies, at least 60 per cent are from parents of employees, according to most health insurers. "Since the claims from parents are becoming high and unsustainable, many insurance companies are asking parents to be covered separately within the group insurance scheme or we ask employees to share a part of the claim costs," says Segar Sampath, deputy general manager, New India Assurance.
Most companies these days, provide health insurance coverage for employees and up to three of their dependents through group health insurance schemes. With larger number of claims coming from dependent parents than employees due to age-related ailments, insurance companies have been finding it difficult to service the claim.
Unlike regular health insurance schemes, where there is a pre-existing ailments clause and waiting period for coverage to begin, in group health insurance schemes, ailments and treatments of dependents are covered from day one of an employee joining an organisation, leading to higher number of claims.
"We see in many cases that parents get admitted, that too, in high-end hospitals even for the smallest of ailments only because it can be covered through the group health scheme provided by the office. It becomes unsustainable for companies," says KG Krishnamurthy Rao, managing director and chief executive officer, Future Generali India Insurance.
Many health insurers are now reworking the terms of insurance coverage with the employers whenever group policies come up for renewal. Insurers are taking measures, such as fixing a limited sum insured, asking the employees to share the bill, having a cap on procedures, excluding hospitalisation coverage for non-critical conditions or allowing only a one-time claim per dependent.
While insurers blame employees for high claims coming from parents, several industry members blame themselves for the mess. "When insurers make a quote for group health insurance, they know that it is a mixed basket. With age, ailments and costs also go up naturally. Insurers should factor in all these aspects, fix the proper actuarial costs for young employees, older parents and then make a quote. But competition in the industry is forcing insurers to undercut costs and everyone suffers in the end," says V Jagannathan, managing director, Star Health and Allied Insurance.
Source : www.mydigitalfc.com
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