Speaking at a Moneylife Foundation seminar, IRDA chairman J Hari Narayan said that the need for various implants is real and it has to be addressed as disability can happen due to accidents, medical condition or at birth
In most cases, medical treatment under insurance does not cover prosthetics/artificial limb, when in fact, this is absolutely essential for an amputee to live a normal life. Col (retd) Satish Mallik, a Kargil war veteran and amputee himself, brought this to the attention of the insurance regulator at a special meeting organised by Moneylife Foundation on 16th May. Col Mallik and Lt Col Prakash represented The Challenging Ones, a not-for-profit organisation that encourages and helps amputees not only to lead a normal life, but look beyond and participate in sports and other activities.
Col Mallik said, "There is need to cover repair and replacement of a prosthesis, if this is deemed appropriate by the insured's treating physician/prosthetist". He said that at present, only few mediclaim policies cover prosthetics and out of them only Max Bupa covers up to the sum insured. While the Employee State Insurance Corporation (ESIC) does give limited facility for fresh amputees, some group plans cover prosthetics for even existing amputees. "Individual mediclaim should cover fresh amputee and possibly existing amputees too", he requested.
Insurance Regulatory and Development Authority (IRDA) chairman J Hari Narayan immediately acknowledged the need for mediclaim to cover prosthesis. He said, "The need for various implants is real and it has to be addressed. Some mediclaim policies cover prosthesis and there is need for others to cover. We will advice companies about it. There is increasing need for various types of implants. Disability can happen due to accidents, medical condition or at birth. Prosthesis is essential part of the treatment for loss of limb. However, certain embellishments may be viewed as cosmetics and may not be covered and we too will not support it."
The Challenging Ones NGO gave a memorandum to the IRDA chairman requesting him to ensure that all insurance providers be mandated by regulations to offer mediclaim and accident cover policies to cover the cost of provision of prosthesis/ artificial limbs to the insured person, up to the sum insured and without any artificial cap.
The memorandum states that "The exclusions like war and war-like situations, natural calamity, act of terrorism may also be waived off to cover the provisions of Prosthetics under all medical/accidental insurance policies. This waiver may be given to the insurer on an enhanced/additional premium. Worldwide, in countries which have a market economy, insurance companies are mandated by regulations to provide prosthetic coverage under Medical/Accident insurance policies".
The Challenging Ones is a platform for the challengers (people call them physically challenged). It is a peer support group to hold hands of new amputees. It promotes sports for amputees.
Here is the memorandum written by Maj D P Singh and submitted by Col (retd) Satish Mallik and Lt Col Prakash of The Challenging Ones to the IRDA chairman:
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right hand does not know left hand.
what is necessary for army ,is a;sp necessary for all insured.
the mediclaim / mediclaim like policy even excludes walker,crutches,belt ,walking stick in case of disabled & diapers in senior citizen with neuro, ortho, other disease challenged.
The culprit 'file & use' product sell ,WITHOUT BEING CHECKED,CROSSCHECKED, SCRUTINIZED BY regulator.
even when good corporate hospital levies a registration ch, service charge,management charge (which is paid by the insured) are disallowed.
some policies are on sale where certain definition .of disease are in too technical terms.
another example is use of conjunctions (and) or disjunctions- (OR) deliberate used for confusion . English language grammar knowledge deficient tpa administrator staff ,punish poor insured.
it is a common knowledge that regulator has framed rules in such a way that TPA (health product policy) can have only one doctor to look after entire country spread claims ( highly improbable task for any most brilliant medical doctor (the doctor in rules is not defined). the deciding doctor fails to understand standard medical history taking.