“What the hell”, Rita shrieked as she looked at the hospital bill. Sinking into the sofa in the Hospital lobby, a stream of thoughts ran through her mind – Why on Earth didn’t she listen to Sejal, she should have opted for the twin room, covered in her mediclaim policy; the smug look on her brothers face when he would exclaim “मैंने नहीं कहा था, ६ महीने मे वापस आ जाना हैं इस्ने, अरे independence अपनी जगह है, inflation अपनी जगह”; God, why me!!!
As if reading her state of mind, Sejal gave her an assuring look – I will loan you the money.
Strike a chord, did we there? How on earth could the bill amount exceed Rita’s mental calculations by one lakh, especially when the difference in rent between the twin room and deluxe was just about ₹2500 a day?
Here’s how – Room Rent forms the basic unit for calculation of a hospital bill; every subsequent charge, from nursing to medical supplies to doctor visits, are factored in as a multiple of the room rent and not individually i.e. the nursing charges aren’t an objective ₹ 300 a day, but ₹300 a day for the General Ward, ₹300*2 for a twin sharing room, ₹300*4 for a deluxe one; the calculations therefore go exponential.
Mind you, this is one of the elementary complexities of Group Health Insurance. There are dozens of such complexities that can turn you dizzy.
Why not Keep It Simple Stupid, you ask?
Well, for one, Hospitals aren’t regulated in our country. Insurers do try to rein them in, but in the absence of an appropriate regulatory authority, Hospitals do end up misusing a lot of the power they are bestowed with.
Insurers aren’t completely blameless in this jamboree either. Commercialization of insurance rests on information asymmetry, as a foundational stone – let us (Insured & Insurer) each share all of the information we have about each other, with each other, but only on a need-to-know basis.
Insurers are concerned about the premiums, spirit of the contract be damned, the Insured on the other hand has heard so many horror stories about claim settlement that she does not see the point in “utmost good faith”.
“What then” you ask “is the solution to all this mess? Please don’t tell me it’s education, aren’t there Agents who are paid by the Insurers to educate the Insured?”
Precisely the point, paid by Insurers. We aren’t tainting the entire lot, but as Sinclair said “It is difficult to get a man to understand something, when his salary depends on him not understanding it”. The bigger incentives for the Agents are stacked in policies that generate higher commissions for themselves as against better policies for the Insured.
Is the industry doomed then? Isn’t there anyone who could address the Insured’s plight?
ढैन-टेणां – बजी सीटी, Broker ने मारी entry!!!
Fun fact, well for the Insured at least – Brokers are liable to settle a Client’s claim if the Client can prove that the claim was rejected on the grounds of wrong advice from the Broker. This essentially means sourcing a policy through a Broker is insuring the risk of the risk itself.
Brokers, in turn, address this concern by insuring themselves with a professional indemnity policy, which can cover them for such acts of Errors & Omissions, if and when they arise.
Still not sold? Well, here’s other five reasons why sourcing your Group Health Insurance through a Broker could yield significant dividends
- The Broker understands the technicalities of a policy and translates them for you in simple English. In 2022, it remains a sad reality that the policy wordings in use are the same antiquated ones that were used a thousand years ago. The Broker acts as the interface who translates this complexity into simplicity.
- Having worked with Clients across Industries, a Broker is not only aware of the Insurance best practices but also best practices across other Industries. The Broker can help buy and subsequently fine tune any gaps that you may face with its implementation; this short term investment can thus translate into a significant long term gain of time and energy.
- An Insurance Broker is responsible for balancing TPAs’ and Insurers’ promises and delivering standardized experiences. The Broker can be your single point of contact. She knows who to contact for what, and more importantly when to escalate and to whom for quick resolution.
- Health is undoubtedly one of the most technical verticals amongst all of the Insurance Lines of Businesses; its complexity can be gauged from the fact that the frequency of circulars and clarifications on IRDAs website are the most for this vertical. Miss one circular and not only might it cost your Employee a good 30-40 thousand, but it could set ablaze a fire that could burn careers. The Broker ensures this doesn’t happen.
- The Insurance Broker adds significant value to the whole experience and administration of group insurance. The Broker doesn’t sit on the sidelines watching you go through a horrible claim experience. The industry experience she has gathered over the years translates into actionable items that ensure you have an “aha” experience, every single time.
“Okay, sourcing through a Broker might be beneficial, but how does one evaluate the Broker?”, you ask?
इस मर्ज़ की दवा भी हम हिं दिये देते हैं हुज़ूर. “
Here are some pointers on how to choose the right broker:
- Ask for references from Clients who have left them. The more recent the severance of the relationship, the more accurate the Client’s assessment of the Broker.
- Pose as an Employee (from the Broker’s current Clientele) seeking assistance in claim settlement. Assess the quality of service delivery.
- Ask for signing a Service Level Agreement, defining the broad contours of delivery. Insert a clause that allows you to fine tune the agreement (if need be) as you go.
- Get a long pending claim assessed for settlement from the Broker.
And if that doesn’t work either, we are just a call away!!!
Author – Susheel Agarwal, he is the CEO of Ethika Insurance Broking which is a new kind of insurance broker that combines technology and innovation to make employee health insurance simple, humane and proactive. In other words, employee health insurance covers not only sickness but employee wellbeing and happiness too. We provide tailor-made risk management solutions to our customers thereby decreasing their risk in their organizations.
(Above mentioned article is Brand Desk Content, This article is a sponsored publication and does not have journalistic/editorial involvement of IDPL)
