State Planning CommiSSion · 2 State Planning Commission Tamil Nadu State Planning Commission The...

State Planning CommiSSion07th February 2014

Workshop Series : 1 / HSW / 2014

11State Planning Commission

Workshop Series : 1 / HSW / 2014

State Planning Commission07th February 2014

Health Insurance Schemes for Senior Citizens

2 State Planning Commission

Tamil Nadu State Planning Commission The State Planning Commission was constituted in Tamil Nadu as an Advisory body on 25th May 1971 under the Chairmanship of the Hon’ble Chief Minister to make recommendations to the Government on various matters pertaining to the development of the State. The Chairman of the Commission is assisted by Vice Chairman, Full Time Member & Part Time Members who are experts in various fields. The Principal Secretary to Government, Planning, Development and Special Initiatives and the Principal Secretary to Government, Finance Department are the ex-officio members. The Member Secretary is responsible for administration in the Commission.

The Commission has the following technical divisions:1. Agricultural Policy and Planning2. Industries, Power and Transport3. Land Use4. Education and Employment5. Health and Social Welfare6. District Planning and Rural Development7. Plan Co-ordination.

Main activities of SPC:1. Preparation of Five Year and Annual Plans based on the policies and priorities of the Government.2. Undertake Mid Term review of the Five Year Plan, other special reviews on the Economy and

advise the Government on appropriate modification and restructuring of the schemes.3. Monitor development indicators that influence the Human Development Index, Gender

Development Index, etc., at a disaggregated level and suggest correctional measures.4. Undertakes special studies as required for formulation and implementation of plan projects

and programmes. The State Planning Commission also organizes seminars/workshops.5. Tamil Nadu State Land Use Research Board (TNSLURB) is functioning under the chairmanship

of Vice Chairman, State Planning Commission as a permanent body in the State Planning Commission. This Board is intended to promote interaction and study the vital areas of Land Use. The State Planning Commission organizes seminars/workshops and undertakes studies on Land Use.

6. Human Development Reports (HDRs) were prepared for Dindigul, Sivagangai, Tiruvannamalai, Cuddalore, Nagapattinam, the Nilgiris, Kanyakumari and Dharmapuri districts. The concept of Human Development has been disseminated to all districts through workshops organized in the concerned districts. Preparation of District Human Development Reports (DHDR) for the remaining districts is under process.

7. State Balanced Growth Fund (SBGF) is operated to bridge the regional imbalances among the districts.


CONTENTS

Page No

Workshop Team 4

Executive Summary 6

Introduction 7

Health Insurance Policy 7

Health Insurance Industry in India 8

Features of Health Insurance Schemes 10

Health Insurance Policies for Senior Citizens 11

Chief Minister’s Comprehensive Health Insurance Scheme 12

New Health Insurance Scheme - 2012 13

Comparison of Senior Citizens Mediclaim Policies in India 13

Best Health Insurance Plans as reported by HelpAge India 15

Remarks / Suggestions of the Participants 16

Recommendations made by the State Planning Commission 21

List of Participants 22


WORKSHOP TEAM

State Planning Commission

Tmt. Santha Sheela Nair, I.A.S. (Retd.)Vice Chairman

Dr. V. Shantha Member (Health)

Dr. K. SridharMember (Health)

Tmt. S.R. NavaneethamHead of Division - Health and Social Welfare Division

Tmt. S. RajalakshmiPlanning Officer - Health and Social Welfare Division

Th. S. Boopathy MohanSystem Analyst

Tmt. K.S. JayanthiTechnical Assistant - Health and Social Welfare Division

Tmt. S. VijayalakshmiTypist - Health and Social Welfare Division


WORKSHOP TEAM

Presentations by

Dr. V. Sathish Raghavan Deputy Director Tamil Nadu Health System Project

Th. V. KumaraveluRegional ManagerUnited India Insurance Company Ltd.

Th. H. SrinivasanAssistant Vice-PresidentStar Health and Allied Insurance Company Ltd.

Th. R. MuthukrishnanSenior Manager HelpAge India


Executive Summary ......................................................................................................

an option of affordable premium instead of bearing high medical care costs, health insurance makes the medical care journey simple.

There are Insurance Companies who provide such Health Policies for Senior Citizens and to know and understand the details of the benefits extended under these policies, a workshop was organized in the State Planning Commission under the Chairmanship of the Vice-Chairman. Resource persons working in the domain of Insurance sector and representatives of organizations working for the welfare of Senior Citizens contributed vital inputs for improving the services.

Health an asset for all irrespective of age, becomes a major concern once age advances and there arises a need for adequate health cover. When a person crosses retirement age, steady income stops and any expense due to health problems eats into the savings. The increased healthcare cost stands as a huge impediment and it hinders the path of the elderly in taking good care of personal health. This is where a Health Insurance Policy comes into assistance by extending reimbursement of hospitalisation costs incurred due to an unfortunate health problem, subject to terms and conditions. People in general consider investment in health insurance as an additional expenditure. But, it is something that can bring best healthcare well in reach of all. Giving


Health insurance is defined as coverage that provides for the payments of benefits as a result of sickness or injury. It provides protection against financial losses resulting from injury, illness and disability.

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organisation such as a government agency, private business or not-for-profit entity.

Health Insurance Policy

The term ‘Health Insurance’ relates to a type of insurance that essentially covers the medical expenses. A health insurance policy like other policies is a contract between an insurance provider (e.g. an insurance company or a government) and an individual / group or his/her sponsor (e.g. an employer or a community organization) in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy. The premium is the amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.

The Contract / policy is generally renewable on yearly basis by payment of annual premium. The renewals are guaranteed lifelong by the insurance companies unless there is an element of fraud / non disclosure of material facts by the insured. In the case of National plans by the Governments or organized by the Government, generally the cover is available for life long. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance or in a national health policy for public insurance.

Introduction .....................................................................................................................


Health Insurance Industry in India

In India, the Insurance Industry can be broadly classified as Life Insurance and General / Non-Life Insurance. Under General Insurance, there are various types of Insurance, among which Health Insurance, which was once given least importance, is nowadays being given prime importance because of the high incidence of diseases and the huge costs involved in treatments.

The uninsured population is very high in India. However, Health insurance has become one of the fastest growing segments of India's economy. Launched in 1986, the health insurance industry has grown significantly, mainly due to liberalisation of economy and general awareness. The first health policies in India were Mediclaim Policies. In the year 2000, the Government of India liberalised insurance and allowed private players into the insurance sector. By 2010, more than 25% of India’s population had access to some form of health insurance.


The reports on the Health Insurance indicate that, the total Health Premium which was Rs.2,222/- crore in 2005-06 has increased to Rs.17,620/- crore in 2013-14. The Share of Health Insurance premium has improved from 11% in 2005-06 to 23% in 2013-14.

There are standalone health insurers along with Government sponsored health insurance providers. The following are the 26 General Insurance Companies including 5 stand alone health insurance companies.

1. United India Insurance Co. Ltd

2. The New India Assurance Co. Ltd.

3. The Oriental Insurance Co. Ltd

4. National Insurance Co.Ltd.

5. Bajaj Allianz General Insurance Co. Ltd.

6. ICICI Lombard general Insurance Co. Ltd.

7. IFFCO Tokio General Insurance Co. Ltd.

8. Reliance General Insurance Co. Ltd

9. Royal Sundaram Alliance Insurance Co. Ltd

10. Tata AIG General Insurance Co. Ltd.

11. Cholamandalam MS General Insurance Co. Ltd.

12. HDFC-ERGO General Insurance Co. Ltd.

13. L&T General Insurance Company Ltd.

14. Religare Health Insurance Company Ltd.

15. Magma HDI General Insurance Company Ltd.

16. Liberty Videocon General Insurance Company Ltd.

17. Star Health and Allied Insurance Company Ltd.

18. Apollo Munich Health Insurance Company Ltd.

19. Future General India Insurance Company Ltd.

20. Universal Sompo General Insurance Co. Ltd.

21. Shriram General Insurance Company Ltd.

22. Bharti AXA General Insurance Company Ltd.

23. Raheja QBE General Insurance Company Ltd.

24. SBI General Insurance Company Ltd.

25. Max Bupa Health Insurance Company Ltd.

26. Cigna TTK Health Insurance Company Ltd.


The public sectors have in the past introduced a number of innovative products even before entry of private insurers like Floater family mediclaim policy, Industrial All risk policy, Top up and Super Top up Health policy etc. To improve the awareness and reduce the procrastination in taking cover under health insurance policies, the General Insurance Corporation of India and the Insurance Regulatory and Development Authority (IRDA) are conducting awareness campaigns for all segments of the population. The IRDA serves both as Licensing authority and Grievance redressal cell.

Features of Health Insurance Schemes

The key aspects of health insurance schemes are the claim payment options. In the Direct Payment or Cashless Facility, the person does not need to pay the hospital as the insurer pays directly to the hospital. The policyholder and all those who are mentioned in the policy can take treatment from those hospitals approved by the insurer. Under the

Reimbursement facility, after completing the treatment, the patient pays the money to the hospital at the time of discharge and the patient can take a reimbursement from the insurer for the treatment that is covered under the policy.

The schemes mainly cover the Hospitalisation expenses (incurred as inpatient) of treating the Disease, Sickness, Injury etc. In most of the Health Insurance Policies, the hospitalization expenses such as Room rent, Nursing care, ICU expenses, Medical Practitioners fees, Operation Theatre expenses, Surgical appliances, Medicines & drugs, Dialysis, Chemotherapy, Radiotherapy etc. are covered. Under the United India Insurance Health Policies, AYUSH (Ayurvedha, Yoga, Unani, Siddha, Homoeopathy treatments are also covered. Certain exclusions like Pre-existing diseases, Pregnancy/ Childbirth, dental treatment, Psychiatric treatments and non-medical expenses like Registration charges are not covered.


The insurance companies offer health insurance from a sum insured of Rs. 5000/- for micro-insurance policies to a higher sum insured of Rs. 50 lakh and above. The common health insurance policies are usually available in the range of Rs.1-5 lakh. The health insurance policies offered by non-Life insurance companies usually last for a period of one year and the Life insurance companies offer policies for a period of several years. Under section 80D of Income Tax Act, the insured person who takes out the policy can claim for tax deductions.

Health Insurance Policies for Senior Citizens

The various types of policies available for elderly in the age group of the 61-80 years are Individual Health, Group Health, Tailor Made, Family Medicare, Trauma care/ Critical care Illness etc. About 14 insurance companies are offering specific Products for Senior Citizens or Products with entry age above 65 years. It is

reported that among the age group of 50-60 years, the claim ratio is more whereas above 65/ 70 years, the claim is very less.

The Health Insurance Policies exclusively offered for Senior Citizens by various companies are listed below :

1. The New India Assurance Company Ltd.

Senior Citizens Mediclaim Policy

2. National Insurance Co. Ltd.

VARISTHA Mediclaim for Senior Citizens

3. United India Insurance Company Ltd.

Senior Citizens Health Insurance Policy

4. Apollo Munich Health Insurance Company Ltd.

Optima Senior

5. Bajaj Allianz General Insurance Company Ltd.

Silver Health

Plan

6. Star Health Insurance Company Ltd.

Senior Citizens Red Carpet


Chief Minister’s Comprehensive Health Insurance Scheme

To achieve the objective of Universal Health care to the people of Tamil Nadu, the Government is implementing the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) through United India Insurance Company for the past two years. The basic eligibility criteria for the claim is annual income should be below Rs. 72,000/- per annum and in respect of disabled, there is no income limit. The sum assured is Rs. 1.00 lakh per year per family along with a provision to pay upto Rs. 1.5 lakh per year per family for certain specified procedures. The scheme provides coverage for meeting all the expenses relating to hospitalisation of the beneficiary. The scheme covers 1016 life saving procedures including 23 diagnostic services and follow up procedures. For certain procedures like Kidney, Liver, Stem Cell, Bone marrow transplants, Cochlear implant which cost much higher than the ceiling of Rs. 1.50 lakh stipulated under the CMCHIS, a corpus fund has been created to bear the additional expenditure. So far, 1.30 crore Smart Cards have been distributed. currently, 769 Hospitals have been empanelled to provide treatments including all the medical college hospitals.

Old Age Pensioners are also included in the scheme, the cover being given by United India Insurance Company. The specialities covered for elders are listed below :

Cardiology Nephrology

Cardiothoracic Surgeries Neurology

Chest Surgery Neurosurgery

Dermatology Ophthalmology Surgeries

Diagnostics Orthopedic Trauma

Endocrinology Plastic Surgery

ENT Poly Trauma

Follow Up Procedures Pulmonology

Gastroenterology Radiation Oncology

General Medicine Replacement

General Surgery Rheumatology

Genitourinary Surgery

Surgical Gastro Enterology

Gynaecology & Obstetric Surgery Surgical Oncology

Hepatology Transplantation

Interventional Radiology Vascular Surgeries

Medical Oncology


The age group-wise distribution of the beneficiaries of CMCHIS is given below :

New Health Insurance Scheme - 2012

The New Health Insurance Scheme provides cashless health insurance coverage to the families of all the Employees of the State Government, State Public Sector Undertakings, Local Bodies in Tamil Nadu, State Government Universities and Statutory Boards under the control of the Government of Tamil Nadu. The United India Insurance Company Ltd. has been appointed as the insurance company for the above scheme. This Scheme is also extended to Pensioners of the State Government, PSU etc. from July 2014.

The Scheme provides coverage for the eligible expenses incurred by the Employee on behalf of himself or any member of his or her family for the treatments and surgeries. The coverage includes the cost of medicines, laproscopic or open surgeries, doctor and

attendant fees, room charges, diagnostic charges, dietary charges availed in the approved hospitals. A total of 144 medical procedures and 599 surgical procedures are covered in the scheme. The coverage shall also include pre-existing illnesses which have been included but the transport charges will be excluded. The Scheme provides coverage for the treatments upto a maximum of Rupees Four lakh per Family of the Employee for a block of four years. The benefit will be on floater basis i.e. the total coverage up to Rupees Four lakh can be availed of individually or collectively by members of the Family during the block of four years with no restriction on the number of times the benefit is availed.

Comparison of Senior Citizens Mediclaim Policies in India


Best Health Insurance Plans as reported by HelpAge India

HelpAge India set up in 1978 is a secular, not-for-profit organisation whose mission is to work for the cause and care of disadvantaged Older Persons in order to improve the quality of their lives. It serves to protect the rights of 100 million grey population (India’s elderly) and provide relief to them through various interventions and help them live with dignity, independence & self-fulfilment.

Some of the best Health Insurance Plans for Senior Citizens as reported by HelpAge India are furnished below :

after 4 years


antsThe Vice-Chairman, State Planning Commission observed an increase in the population of totally abandoned, homeless older people in the State and suggested to take necessary steps for their betterment in life by establishing an exclusive service home in each village for older people who are totally helpless. She observed that beggars have increased manifold because sickness/ disability is an incentive for begging and pave way for easy income. She also stated that women begging is more rampant nowadays and needs to be addressed.

She enquired about the claims of elderly women under Insurance schemes and it was replied that approximately 40% of women make claims. She was distressed when it was informed about the non-coverage of the non-communicable diseases and also about the most life-threatening communicable disease - HIV under the Health Insurance schemes and insisted to take initiatives for covering these diseases under insurance scheme. In this regard, Thiru Srinivasan, Assistant Vice-President, Star Health Insurance Company replied that, normal HIV +ve persons are insured under a group policy called Star net plus. Further, HIV persons with a CD count of more than 350 are also covered under the health insurance policy available in retail group policies in India.

She stated that as ageing process is not uniform and differs from individual to individual

Remarks / Suggestions of the Participants .......................................................

and also the risk involved due to ageing is high, non-coverage of Geriatric medicine is illogical. Also, when she enquired as to what happens to cases of medical negligence and whether any coverage is provided in such cases, Thiru. Srinivasan from Star Health Insurance Company replied that, in such cases of negligence by the Doctor, the doctor will become liable for payment of compensation to the patient. Generally, the doctors and the hospitals protect themselves against such contingency by taking cover under professional indemnity insurance policy.

Finally, she suggested the following:

• Geriatrictreatmentshouldbecoveredin the Policies for senior citizens.

• Inbuilt incentives should be madethrough the insurance companies to take care of senior citizens.

• Insurance Companies shouldannounce / provide attractive schemes for senior citizens so as to cover 80-90% of them under the health policies.

• There should also be insurancecoverage for psychiatric treatments.

• Rashtriya Swasthya Bima Yojana -RSBY (National Health Insurance


programme) may be linked with the State scheme in Tamil Nadu.

• NGOs like HelpAge may be used toenroll Senior Citizens for the Health Insurance Schemes.

• Physiotherapymaybe coveredunderInsurance.

• Youngsters should be encouragedby providing additional incentives towards working on senior citizens so that the insurance company could extend their best service to senior citizens.

• Premiumforageabove65yearsshouldbe brought down since empirical data shows that claims are less when age is above 70 years.

• The insurance companies shouldcarry over the prevailing good health insurance model of Karnataka and universalize to Tamil Nadu.

• Concept papers from insurancecompanies are invited and a unique policy which should be set as a model for the rest of the country should be developed.

Th. Ashish kumar, I.A.S., Deputy Secretary to Government, SW & NMP Dept. mentioned that the Government Social Welfare and Nutritious Meal Programme Department is planning to frame a State Policy for Senior citizens with a holistic view.

Dr. K. Sridhar, Member (Health), SPC remarked that most of the insurance schemes do not provide coverage for the expenses incurred on post-hospitalisation treatment. He suggested the insurance companies to provide coverage atleast for elders for post-cancer pain treatment, since nowadays “Cancer”, one of the life threatening diseases is wide spreading in the State in a rapid manner.

He remarked that while the people with annual income of less than Rs.72000/- are covered in the CM’s Health Insurance Scheme, the people with annual income above Rs.72,000/- are left in lurch and so the Government should moot out a proposal for people who cannot avail private insurance. He suggested to go for a scheme that covers even the Above Poverty Line with some contribution by the policy holder.

He also suggested that usage of the term plastic surgery should be removed and renamed as aesthetic surgery or cosmetic surgery since it is reconstructive in nature.


He insisted that the insurance companies must work on public senior citizen health insurance schemes and atleast some company should give a comprehensive insurance scheme covering all exclusions. When he asked about the portability of the insurance schemes, it was replied that policy portability is allowed.

He further stated that in the case of old age people, the definition of illness itself would be different from normal persons and hence, it should be studied and worked out properly before framing the insurance policy and the monthly geriatric health check up should also be covered in the policy.

He informed that for the past 30 years, he is paying Health Insurance premium and as of now he is paying high premium. He suggested that the premium for Senior Citizens may be brought down and if the claim is less after the age of 65 years, the company could further decrease the rate of premium.

Dr. V.Sathish Raghavan, Deputy Director, Tamil Nadu Health System Project made a detailed presentation on the Chief Minister’s Comprehensive Health Insurance Scheme. He informed that out of the total claims of 5,56,096 upto Jan’ 2014, 71,408 are elders. As such, 13% of the beneficiaries of CMCHIS are elders and the amount spent for them is around Rs.138.58 crore.

He stated that ailments such as Depression, Dementia, Cataract which are common in elders and Certain types of Cancer have not been covered under the Insurance schemes, which should be included. He further stated that personal insurance for elderly is very costly and concluded that State sponsored insurance is the solution for increased cost for elderly care.

Thiru. H. Srinivasan, Assistant Vice - President, Star Health Insurance Company stated that there is a general grievance that most of the insurance companies cover only upto the age of 65 years, but the fact is that only entry into the scheme is restricted and renewal beyond the age of 65 years is allowed. He stated that generally only Hospitalisation is covered under insurance and not Out-patient care, but however outpatient radiotherapy is covered in Star Health Insurance under day care procedures including many other diseases like Cataract etc. He further stated that the “Health gain policy” in Star Health covers out-patient expenses with a flat premium recovered from the policy holders and this policy offers Income tax rebate benefits for the full premium like other medical insurance policies.

He also informed that the company has a unique programme called ‘Field visit’ programme and the concerned Doctor is assigned the responsibility of visiting field and approve the genuineness of the policy claim


before sanctioning. Claim to be intimated within 1 day and a doctor will visit within 3 hours and enquires with the hospital about the patient’s health. This fool proof method will avoid fraudulent claims.

He stated that, generally 2% of the sum assured is fixed for room rent. If we occupy room with higher charges, the other hospital charges claim will be cut down proportionately. He also informed that each policy has sub-limits according to the nature / severity of the illness/ diseases (eg: Stroke – Rs. 2.5 lakhs, Cataract – Rs.30,000/- etc.). He mentioned about the points to be taken care of while taking a Health Insurance Policy like sublimits of Pre-hospitalisation, Post-hospitalisation, number of network hospitals, whether services through TPA or directly, sublimits for room rents, list of day care procedures, coverage of non-allopathic treatment etc. He also detailed about the coverage for Non-allopathic treatment, Pre-Medical Examination, Pre-existing diseases (PED) and also about the exclusions, list of network hospitals etc.

He further informed the following:

• Next to motor Insurance, healthinsurance is largely covered under General Insurance Schemes. However, only 15% of the Indian population is covered under Health Insurance.

• In certain Health insurance schemes,non-allopathic treatments are also covered.

• In the Group Mediclaim Policy, thegroup as a whole is covered under the policy without restriction on age. The Group policy could buy back all waiting period, exclusions etc.

• About 15-20% of the senior citizensavail health insurance. Though Medical examination for enrolling is done by Star Health for the people aged above 50 years, no medical examination is done for senior citizens.

• If more population are enrolled thenpremium will come down.

• TheRoom rentduringhospitalisationis restricted to eligibility of the policy and other costs are also proportional.

• If customer information is properlygiven in the proposals, then the claim will be hassle free. Nowadays photo copy of the proposal form is given with the policy document for reference of the policy holder.

He also recommended that the premium paid by youngsters for covering senior citizens (covering parents and grand parents) may be given higher Income Tax benefits.


He concluded that people should look at Health Insurance as an investment and that a standard National Policy should be devised with standard exclusions and coverage.

Th. V. Kumaravelu, Regional Manager,

United India Insurance Company detailed about the various types of health policies, specific policies for Senior Citizens, general coverage – optional covers, benefits and exclusions. He informed that UIIC offers entry for Senior citizens upto the age of 80 years and various products are offered for them like Individual health, Family Medicare, Tailormade, Trauma care, Cradle care, Workmen medicare, JAB, UHIS, Cancer illness etc. He further detailed about the features of the health policies of UIIC as follows :

• Coverageisofferedonlyifhospitalized.However, there are more than 30 procedures/ surgeries/ diseases for which 24 hours hospitalization is not required.

• Nomedicalhealthcheckupisinsistedupon for persons upto 60 years of age.

• Health check-up offered as bonusafter 3 claim free periods.

• Ayurvedic treatment allowed inGovernment recognised/ approved/NABH/QCI.

• Ambulancechargescovered.• Uni-criticarepolicy-pays lumpsumas

soon as the contract of major illness.

He also informed about RSBY, the Universal Health Insurance Scheme (Government sponsored socially oriented insurance schemes) which covers even personal accidents. He proudly mentioned that UIIC is the first insurer to introduce Topup and Super Topup policy with a highlighting feature of higher sum insured with lower premium.

Th. R. Muthukrishan, Help Age India informed that the HelpAge India organized a Seminar on Health Insurance on 21.02.2012. He putforth the following grievances of Senior Citizens with regard to the practical discomforts/ difficulties in availing / processing of health insurance policies of various insurance companies :

• MostoftheSeniorCitizenssufferfromage related ailments and they must take medicines till their life time. But, geriatric medicines are not included in the insurance policies, which should be covered in the policies.

• The present format of the proposalform for taking up a policy is available only in the language of English. But, majority of the Senior Citizens in Tamil Nadu prefer the form to be in the State language of Tamil. Hence, the policy form may be printed in local language.

• ThefontsizeoftheTerms&Conditionsgiven in the form is very small and not legible and hence the font size to be increased.


• In the cases of Claim settlementby third party administrator, the minimum duration for clearance of the claim of TPS (Third party claim) is 3-4 months, which could be shortened by rapid processing of claims.

• Theaddressandthecontactnumbersof the O/o of the Ombudsman, Chennai which is available in the Policy form should also be made available in the proposal form.

• Thedestituteoldagepeople,OldAgehome inmates do not hold ration cards and so they are not covered under CM’s Health Insurance scheme. Hence,

alternative arrangements should be made for them to get enrolled in the above scheme.

• ThepremiumforSeniorCitizensHealthInsurance is high, especially for the age group of above 80 years, the premium is very high. Hence, the prevailing system of high premium rate relative to increase in age should be reduced.

• Reduction of paper works in theinsurance policy procedures should be encouraged.

• Special coverage for differently abledpersons is required.


• Geriatrictreatmentshouldbecoveredin the Policies for Senior Citizens.

• Inbuilt incentives should be madethrough the insurance companies to take care of Senior Citizens.

• Insurance Companies shouldannounce / provide attractive schemes for Senior Citizens so as to cover 80-90% of them under the health policies.

• There should also be insurancecoverage for Non-communicable diseases, monthly Geriatric checkup, Psychiatric and Physiotherapy treatments.

• Rashtriya Swasthya Bima Yojana -RSBY (National Health Insurance programme) may be linked with the State scheme in Tamil Nadu.

• NGOs like HelpAge may be used toenroll Senior Citizens for the Health Insurance Schemes.

• Youngsters should be encouragedby providing additional incentives towards working on senior citizens so that the insurance company could extend their best service to Senior Citizens.

• Premiumforageabove65yearsshouldbe brought down since empirical data shows that claims are less when age is above 70 years.

• The insurance companies shouldcarry over the prevailing good health insurance model of Karnataka and universalize to Tamil Nadu.

• The insurance companies mustwork on public senior citizen health insurance schemes and shall give a comprehensive insurance scheme covering all exclusions.

• Government may moot out a HealthInsurance proposal for Above Poverty Line people who cannot avail private insurance, with some contribution by the policy holder.

• Insurance companies should providecoverage atleast for elders for post-cancer pain treatment.

• Concept papers from insurancecompanies are invited and a unique policy which should be set as a model for the rest of the country should be developed.

Recommendations of the State Planning Commission ...............................


Tmt. Santha Sheela Nair, IAS. (Retd)Vice Chairperson, State Planning Commission.

Dr. K. SridharMember (Health),State Planning Commission.

Th. Ashish kumar, I.A.S.,Deputy Secretary,Social Welfare and Nutritious Meal Programme Department,Secretariat, Chennai.

Th. V. Chellasamy,Deputy Director,Directorate of Pension, Chennai.

Dr. V. Sathish Raghavan, Deputy Director, Tamil Nadu Health System Project, Chennai.

Th. V. Kumaravelu,Regional Manager, United India Insurance, Chennai.

Th. H. Srinivasan,Assistant Vice-President,Star Health Insurance, Chennai.

Th. R. Muthukrishnan,Senior Manager,HelpAge India, Chennai.

Th. Muruganandam,(Retd. U.S.- Health Department)President, TN Secretariat Pensioners Association, Chennai.

Th. M. Loganathan,Regional Manager,United India Insurance Company Ltd., Chennai.

Tmt. S. Jayasri,A.O., Regional Office,United India Insurance Company Ltd., Chennai.

List of Participants .............................................................................................

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