OIC redesigns mediclaim policy

Huge losses in health portfolio has forced Oriental Insurance Company to restructure mediclaim policy by raising premiums, putting cap on room rent and making compulsory medical check up for people aged above 45, reports Economic Times.

For every Rs 100 premium on an average, the company pays Rs 120 by way of claims, which amounts to incurred claim ratio of 120%, an OIC official told the media.

Faced with stiff challenges to sustain the health business, the company has completely restructured the product from September. For example, the premium for a person aged 25 is Rs 1,100 for a policy of Rs 1 lakh compared to Rs 1050 earlier, an increase of 5%.

But, for a person aged 48, the premium is Rs 3,500 as against the earlier rate of Rs 2,600-Rs 2,700, an increase of 30%.

One of the reason for high claims is the fact that most people visit specialised hospitals and stay at single occupancy room even for a minor health problem and a major portion, at times above 50% of the total claims, goes toward room rent.

"Now, the room charge has been restricted to one per cent of the sum insured or subject to a limit fixed by OIC," he said. Similarly, many times disputes arise in claim settlement due to hiding of facts like pre-existing diseases.

So, OIC has made it mandatory for a person aged above 45 to undergo a compulsory medical test at centres identified by the insurer and half of the expenses will be borne it.