A healthy spread ; Stand-alone health insurers are making a mark, writing novel policies that cover everything from joint families to a visit to the dentist.

In October 2007, Delhi-based businessman Chander Amla bought afamily floater health insurance policy from Royal Sundaram GeneralInsurance, which extended a combined cover of Rs 3 lakh to him, hiswife and daughter.

Two years later, he felt that the amount was not sufficient tocover the rising medical costs and asked the insurance company toraise the sum insured. He was particularly worried about the Rs1,500 per day room rent cover during hospitalisation.

"The average daily room rent in a reputed hospital is muchhigher. Also, the policy covered only illnesses that requirehospitalisation of more than 24 hours. There are so many day-careprocedures now that do not require hospitalisation for more than aday," says the 60-year-old Amla. After his several calls to thecompany went unheeded, an insurance broker advised him to buy MaxBupa's Heartbeat policy. It appeared to match his needs better, withan individual cover of Rs 3 lakh for him and his wife. "In the MaxBupa plan, there is no room rent cap. Moreover, the policy coversmedical expenses that do not require hospitalisation for more than24 hours," he says.

Indeed, stand-alone new private health insurance companies suchas Max Bupa, Apollo Munich Health Insurance and Star Health andAllied Insurance are making their presence felt by unveilingradically different products, for individuals and families alike,and in the process offering comprehensive cover across age groups.

"Today, we have products with a lifelong policy renewal feature -covering you from cradle to grave," says Antony Jacob, CEO, ApolloMunich, a 74:26 joint venture between the Apollo Hospitals Group andGermany-based Munich Re. The penetration of health insurance inIndia is abysmal - only about one per cent of the population iscovered under any form of health insurance according to the NationalCouncil of Applied Economic Research (NCAER). Contrast this with theUnited States where 85 per cent of the population is covered orChina at 77 per cent. This, say these private companies, is becauseproducts and services are not fully designed to meet the uniquerequirements of Indian families. "So far, the insurance products inthe market have ignored the needs of Indians. But now, the purehealth players are launching products keeping the customers inmind," says Jacob.

Max Bupa

What's new: Family First Only product with comprehensive coverageof joint or extended families

Insurance cover: Rs 1-5 lakh individual cover plus Rs 3-15 lakhfor the whole family

Benefits:

-- Unlike existing family fl oater policies, an individual cancover extended family as well (up to 13 members)

-- Includes maternity benefi ts and newborn baby care

-- No involvement of third-party administrators as companyexecutives personally manage the claims

Consider the example of Max Bupa, owned 74 per cent by Max Indiaand 26 per cent by Britainbased Bupa. It entered the market in April2010 and recently launched a plan, Family First, that covers anextended Indian family of up to 13 members, including parents,spouse, children, brothers, sisters, and even in-laws, grandparentsand grandchildren through one policy.

It offers individual insurance cover for each insured person -ranging from Rs 1 lakh to Rs 5 lakh - apart from a floatinginsurance cover that is available to all family members. This is abig departure from the industry norm where family floater productscover only nuclear families with a maximum of two adults and twochildren.

In addition, the maximum sum insured in usual floater policies isRs 10 lakh, whereas Max Bupa Family First gives coverage of up to Rs15 lakh.

"The product has been designed keeping in mind the needs of jointfamilies. It is the first time that individual cover and familyfloater cover have been combined in the same policy," says DamienMarmion, CEO of Max Bupa Health Insurance. The plan has other uniquefeatures. It offers maternity hospitalisation and newborn baby cover- features that were till recently available only under groupmediclaim Max Bupa, which is connected to over 600 hospitals acrossthe country, was also the first insurer to introduce "single-ageband pricing" products.

Here the company determines the premium solely on the basis ofthe individual's age. "So, it helps avoid a sudden spike in premiumwhen an individual crosses a particular age limit," says Marmion whothinks that although Max Bupa's policies are 15-20 per cent costlierthan somewhat similar products by its competitors, customers areready to pay.

Another fleet-footed entrant is Apollo Munich, which flagged offoperations in August 2007. Health insurance policies issued by non-life insurers typically do not offer cashless treatment at OPDs, oroutpatient departments, and health check-ups. Apollo Munich'sproduct Maxima has started offering, for the first time in India,cashless inpatient and outpatient treatments. The plan is availablefor both individuals and family, which can include two adults andtwo kids. While the sum insured on inpatient treatment is Rs 3 lakh,the limits on OPD expenses varies between Rs 5,000 and Rs 7,000 atany of the over 1,500-odd pharmacies, diagnostic centres andconsultants empanelled by Apollo Munich.

Apollo Munich

What's new: Maxima Only product that covers cashless OPDexpenses, health check-ups, eye and dental care

Insurance cover: Rs 3 lakh in the case of both individual andfamily fl oater

Benefits:

-- Medical expenses that require hospitalisation of less than 24hours are covered

-- Half the unused OPD entitlements can be carried forward to thenext year

-- No age limit for policy renewal"Forget the big diseases, weoffer insurance even for allergies, sore throat and cracked lips.The aim of this product is to shift the focus from curative topreventive coverage," says Jacob. Maxima was launched in August andthe company is expecting to sell over 5,000 policies by the end ofthe financial year. Star Health and Allied Insurance, which startedoperations in 2006, also has a first to its credit. It has launchedthe first health product for diabetics (Diabetes Safe) that coversthe cost of hospitalisation of up to Rs 5 lakh. Diabetes often leadsto trouble in the kidneys and the eyes, and can cause crippling footulcers. India has the world's largest population of diabetics: 51million and counting.

"Any person diagnosed with Type II Diabetes can take this policybetween 26 and 65 years of age and can get renewals till age 70,"says V. Jagannathan, Chairman and Managing Director of Star Healthand Allied Insurance, which also has a product for HIV positivepatients. Star Health, which is available at more than 4,600hospitals, also has top-up health policies that give extensivemedical coverage and are cheaper than the regular policies. Forinstance, a Star Super Surplus top-up of Rs 7 lakh costs around Rs7,500 per annum for an individual while a regular Oriental Insurancepolicy of Rs 3 lakh costs Rs 8,500 annually.

In India the public sector still accounts for 58 per cent of thehealth insurance market. But the private companies are makinginroads, and the stand-alone ones among them have taken 12 per centof the total market. Clearly, the growing competition will mean thatthe customer will truly be king in the future and is likely to bespoilt for choice.