This phase of the generation could be the tipping point for the upcoming times. Every day, there is a campaign about one thing or another. It could be about changing the societal stigmas, digitization, redefining ancient beliefs, cure for chronic diseases, education, etc,. While doing so, the unawareness of a common man in India about modernization of the society that we live in has remained a missing gap. It could be about the opening your home for travelers or other essential need like owning a health insurance policy
Unfortunately, having a health insurance policy is not yet legalized in India unlike a motor insurance. In general, we all have been a part of conversation on Investments, LIC, SIP, Loans, but rarely a health insurance. And even the fraction of those who have one, do so to save taxes or was by default it is provided by the employer.
Here are a few hard facts about Health insurance –
- It definitely does not cover for a risk prevention or avoidance. Eg: vaccination.
- It does not cover for cosmetic surgeries and maternity termination unless advised by the doctor.
- It does not cover the regular dental expenses neither the pharmaceutical expenses for Cold, Fever, Jaundice, Typhoid unless hospitalized.
The uprise of Health insurance
Every country addresses the health related concerns of the citizens differently. The hospitalization expenses and the probability of an individual falling sick is only uprising, majorly due to lifestyle changes. There are also countries like Srilanka, Seychelles, Morocco, Canada, Bhutan where the health related expenses of the citizen is funded by the government. In US, it is mandate to have a health insurance. In Bhutan due to lack of sophisticated equipments, the chronic treatments are referred to other neighboring countries and the expense is funded by the government.
Lately, IRDA (Insurance Regulatory and Development Authority) has made a certain amendments in regulations to promote awareness of health insurance. New campaigns and innovative policy benefits are launched by the Insurers. Awareness of “Health insurance” is the large gap in India. A vast majority of Indians have a health insurance to save taxes or have witnessed/experienced a friend or a relative hospitalized.
“Awareness precedes choice and choice precedes results.” There are around 20+ Insurers having a policy in each category (Maternity, Senior citizen, Cardiac, Blood pressure, Diabetes, etc). The category of policies and the respective special benefits are only getting better.
We have heard this popular line innumerable number of times, “Insurance is a subject matter of solicitation. Please read the offer documents carefully”. The truth is, it is not enough if you simply read. You need a context too. In fact, you might not even know if there is another policy better than this for the same Premium.
The good news is, all the Insurance policies abide by the regulations set by IRDA. There are a list of Basic terminologies, Benefits and Exclusions those are sacrosanct across all the policies. Example : Waiting period, Exclusions, Periodic exclusions, Copay, Cover, Premium, Deductible and many such. Also note, a few among these only have a thin line of difference, by definition but make a world of difference once you’ve made the claim. One such example is between a Copay and Deductible.
Copay : This is the sum amount of the total expense that you agree to share with the Insurer. This is a percentage of total claim and NOT an absolute value.
Deductible : This is the sum amount that you agree to pay for the medical expenses before the Insurer starts covering for your claims. This is an absolute value.
Where is the confusion here?
The conundrum towards insurance usually happens after the user has raised a claim. As said in the earlier post, an agent will not be transparent in revealing the limitations and conditions of a policy that he is selling. It can so happen that, when the policy holder raises a claim for his illness, he realizes this sickness is not covered by the insurer. Your claim can be rejected if,
- The waiting period is not yet completed. Also note, waiting is different from periodic exclusions although both refer to the wait for a specified period.
- That particular illness could be a permanent exclusion (will never be covered)
Sometimes, even when covered there could be under-writings for which the claim can be subject to. And these under-writings are not always published in the policy.
Can an encyclopedia be made to look like a Brochure ?
It had been realized people hardly read a policy for the complexity and unawareness about the subject terminologies. There is a plethora of information the user needs to know about the policy but how much of it is essential ? The website definitely cannot be overwhelmed with extensive information. And, the user cannot be navigated to a new page multiple times. This leads to multiple layer of links and gets tedious to map the website on the user’s mind. The vital information can be revealed on-the-go. The user can however download the policy terms, brochure and prospectus to chew the cud*.
I would put it this way. Consider these 3 Cs (Content, Context and Comparison) those need to be addressed by an aggregator / broker while making a pitch. This will help the user connect the broken dots and help him make a decision. Now, let’s consider a pricey metric called “Waiting period”
Content : The period up to which you have to wait, to be able to raise a claim for a pre-existing disease.
Context : If the waiting period = 3 years, you might not know how to comprehend that. For a few it could be a long time while it could be the vice – versa for others. This might need a (Policies Vs Waiting period) graph to provide context to a user for a waiting period of 3 years. Eg: Dave and Ned are 2 different kind of users.
Dave : “Oh! Just 3 years? Sounds good”
Ned : “OMG! Can’t I raise a claim for 3 long years?”
Comparison : So which other Insurer has a lesser waiting period ? And if there is, do they provide the same or more benefits like Daycare, Outpatient, Maternity, Cataract, etc ?
Sigh! So just reading the policy wordings is not sufficient to be able to purchase. It only helps you be aware once you have chosen the policy.
- Would you be retired in next 5 years ?
- You want to be on a safer side and just own a health insurance
- You need one for tax saving purpose ?
- You are planning to be a parent soon ?
- You need cover for an existing illness like Diabetes, Blood pressure, Anaemia, Cardiac, etc,.
Honestly, this list is huge. With the innumerable number of parameters, the decision making factors can be shrunk to a concise list like Waiting period, Premium, Cover, Benefits, Exclusions, Copay, Deductible and Age limit.
There is this theory on “Memorability” that cites, humans on large cannot remember more than 3 things, at max 4. And if these metrics match your need, you’re sorted, ensuring there will be no limit on room rent, no Copay and no Deductible in the policy.
- Waiting period – Lower the better.
- Premium – How much I can afford ?
- Cover – How much might I need ?
- Benefits – The primary benefits like Maternity, cover for your pre-existing disease, if any should be covered.
- On large, all other benefits like Daycare, OPD, Organ donor, cover for Ayurveda, Domiciliary, etc,. can be treated secondary. Overall, the subject of health insurance is a complicated matrix based on relative theories.
And as per the well known “Occam’s razor theory”, “Design is not complete when there’s nothing more to add but when there’s nothing more to remove.”