An Appeal To IRDA For Justifiable Medical Insurance Premium

The Chairman,
IRDAI,
HYDERABAD

Sir,

Respectfully, may we invite your kind attention to a Mediclaim Insurance Policy structured by UIIC for Bank Retirees, of course in consultation with Indian Banks' Association, Mumbai. In this regard we have to make following submissions:

1. That, the policy was introduced in 2015. Nov15- Oct 2016  Premium was Rs.5620/- for Rs.300,000 cover.

2. That, on renewal for Nov 2016- Oct 17,  Nov 2017 Oct 2018, Nov 2018- Oct 2019 the premiums were raised to Rs.12020, Rs.12333 & Rs. Rs.21595/- respectively.

3. That, now for renewal in Oct.2019- Nov 2020 the premium is further raised to Rs.24897/- for same coverage. Just by 5th year it witnesses an increase of about 5 fold over base premium of Rs.5620/-. It's plundering.

4. That, the scheme was to cover domestic treatment, but the same was later denied in breach of trust.

5. That, it is cashless scheme operationalized through chain hospitals & TPAs.

6. That, the UIIC or TPAs have no such expertise as to superwise or monitor over the treatment and charges that chain Hospitals bills.

7. That, in view of situation as stated in para 6 above, hospitals endeavors have been so far to siphone maximum amount of Insured sum by fair & foul modus operandi. It's the basic reason that caused such spurt in claim ratio in such unprecedented manner.

8. That, there is a powerful nexus, read as racket, between chain hospitals & TPAs. TPAs bills are cleared in hour, but in case of treatment at self cost by retiree, in other hospital, his claims are subjected to rigorous scrutiny, queries, delay for month(s), rejection etc., since in such bills TPAs find no hidden benefits. TPAs efforts use to force people to take treatment in chain hospitals only.

9. That, there is no such third authority to examine & watch over the behavior of chain hospitals. Hospitals are fearless and so far we have no reference of any blacklist or penalized hospitals for unfair treatment & billings.

10. That, it's Cashless Facility, but the amount rejected by TPAs are being recovered by hospitals from patient. This is very obnoxious situation. Hospitals are not bound by any liability, but approved by TPAs. It's happening in 100% cases. TPAs just reject some amounts to prove their loyalty to UIIC. It's really shocking situation, leave aside how unethical behaviors persist on the part of UIIC and all. It's Cashless Scheme and A is just a patient, whose treatment is adjudged and provided by hospital, then why should A should bear any cost is stark question to which nobody answer.

11. That, all chain hospitals, irrespective of status of city have identical room rents, ICU, ventilator, test charges. They have modelled their treatment and services keeping in view the Policy terms & conditions. These terms & conditions are self determined and there is no such regulatory guidelines or authority to rule over them.

12. That, in CGHS, in case of hospitalization in referred hospitals, there is proper mechanism to monitor the treatment and billing. Here, neither UIIC nor TPAs have any such arrangement.

13. That, despite chain hospital status, hospitals dont relieve patients till payment is not cleared by TPAs. It is always delayed by a day and patient held up, awaiting bill clearance from RPAs.

14. That, New India Assurance Co. has offered same policy on 30/31% less premium, which is being ignored, presumably on extraneous considerations offered by UIIC. NIA & UIIC are PS Insurers. NIA lower quote itself prove as to how UIIC could succeed to sell its policy by 30/31% more premium.

15. That, there are scandals that need thorough investigation and probe. Mediclaim Insurance product is based on organized loots. Looking to social economic condition, more and more people are trying to secure their health through mediclaim insurance Policy. Therefore, it needs necessary mechanism to save people from such scandalous and organized loots.

Prayer:

1. That, we have a reason to believe, being Regulator, you are competent Authority to examine into such apathies that too by a Public Sector insurer.

2. That, you are the competent Authority to look into breach of policy terms. If domicile treatment was covered, how UIIC can back out from it? Ask them to refund premium charged for with penalty for unfair practices,  breach of trust.

3. That, you are the competent Authority to look into nexus/ racket formed in this regard. It's totally based on corruption, a systemic corruption. It works as sleeper cell.

4. That, you are the competent Authority to look into causes and genuinness of such steep rise of premiums. There is 5 fold rise in 5th premium. We have been given to understand that Insurers can't increase base premium at least for 3/4 years as per IRDAI rules. Some writ is heard by Hon'ble Supreme Court and an order has been passed to approach you.

5. That, looking to whole issue, including NIA offering same product and services on 30/31% less than UIIC, first UIIC policy in question may please be abandoned, and secondly, the whole matter may please be referred to CVC for further investigation, as in this affair apart from UIIC, Bankers body Indian Banks' Association, TPAs & Chain Hospitals are involved.

We are confident of your Authority and endevours to part with justice to odd 4.5 lakh Bank Retirees, victim of apathies of such scandalous nexus based on vested interest.

With Regards,



( J. N. Shukla)
National Convenor,
FORUM OF BANK PENSIONER ACTIVISTS,
Prayagraj ( U. P.)

8.10.2019

Copies to:

1. Hon'ble Prime Minister, New Delhi
2. Hon.Finance Minister, New Delhi
3. CVC, New Delhi
4. Chairman, IBA, Mumbai
5. Chairman, UIIC, Chennai

- for their kind information & necessary action.