On a family holiday in Switzerland in May, a father's worst nightmare came true.
On a Friday afternoon my son had acute pain in his abdomen, the general practitioner whom we consulted advised us to rush to a hospital. At the hospital he was advised to undergo an emergency appendicitis removal operation. We were apprehensive as we were in a strange country and even communication with some of the doctors was a little challenging as some of them could not speak English fluently. In the late evening after considering the risks of not operating we gave our consent for the operation.
We could afford to pay for the operation on our own but at the back of my mind was a question whether the insurance company (my travel insurance policy was taken from a public sector insurance company) would actually pay up. The policy was part of a package taken through the tour operator who had made the travel arrangements for us. He in turn had used the services of an insurance broker to buy the package policy.
Here is my experience described in greater detail:
Friday, May 23: My son got operated at around 10 pm. He was admitted and operated without us having to fill in an admission form or making any deposit. They did not even know whether we had insurance to cover the costs.
Late at night I sent an email to the international TPA, the Indian TPA and the Indian insurance broker informing them of our impending claim.
Saturday, May 24: My son was fine and so started to try and call for activating the claim process. The initial call to the Paris toll-free number was not very fruitful with the male consultant on the other end of the line not giving any satisfactory response. But when I checked my email I had received a response from them indicating a file number for my claim and laying down the documents needed to process the claim.
I also reached a very helpful gentleman called Prakash who was the claims executive with the insurance broker in India. He made several calls to me and also spoke to the TPA in Paris and generally guided me. The hospital was also helpful and provided the necessary facility for faxing the papers to the Paris TPA. However a confirmation from the TPA to the hospital got stuck because they wanted a medical report from the hospital before providing a coverage confirmation (which would have enabled me to avail of cashless facility from the hospital).
The hospital informed me that this was not a usual request and it took a couple of hours before I could get the report and fax it to the Paris TPA. Meanwhile since it was a Saturday I was forced to make a deposit (around Rs. 125,000) to the hospital by using my credit card. While we received no final confirmation from the Paris TPA the Indian TPA had not responded at all.
Sunday, May 25: My son was discharged from the hospital.
The hospital said the deposit was enough to cover the bill and they would refund the balance in due course by crediting the balance to my credit card account. No final confirmations from the Paris TPA, though I must say that by then a very competent lady from the Paris TPA kept calling me to update me on what was happening. She also informed me that she had sent a confirmatory fax to the hospital (this was after the discharge) and as the hospital office was closed we could not confirm the receipt of the fax by them.
Monday, May 26: The hospital confirmed that they had received the fax confirmation from the Paris TPA and would refund the entire deposit amount to my credit card in a few days time after they actually receive the payment from the insurance company. Prakash had been in touch with me through out.
Tuesday, May 27: We return to India.
First week of June: Submitted a claim for expenses paid for the general practitioner in Switzerland, the ambulance charges, and the medicines purchased amounting to about Rs 25,000. This was submitted to the Indian TPA through Prakash.
Second week of June: Got the Switzerland hospital deposit amount refunded in my credit card account. Was shocked to discover that even though in Swiss franc terms I had received the full refund, there was a difference of around Rs. 13,000 in the rupee amount that I had paid and the rupee amount credited to my credit card account. On closer inspection it proved to be because of the huge 3.5 per cent each way commission that the credit card company charges (making it 7 per cent in all) as well as the significant differential in the buying and selling rate of the foreign exchange.
Meanwhile Prakash informed me that my other claim had been approved on June 13 and I could expect the payment cheque in 15 days time.
July 2008: No cheque despite vigorous follow up. Finally in the last week of July sent an e-mail notice to the insurance company that I would complain to the Insurance Ombudsman if I did not receive the payment.
August 4, 2008: Finally I receive the cheque by courier.
My learnings from the whole episode:
1. Never pay by credit card overseas. Only the card issuer goes laughing all the way to the bank.
2. The Indian insurance companies have specific requirements that make the process of pre-approval that much more difficult overseas as it is not in line with local practices.
3. The moment you submit claims to the Indian TPA brace yourself for delays.
4. Use the two magic words 'Insurance Ombudsman' in your letters and e-mails. That's the one thing that makes the wheels move.
5. The insurance broker is worth his weight in gold if they have people like Prakash working for them.
6. While the delays were annoying and the amount retained by the credit card company was scandalous, I don't think I will ever venture outside Indian shores without a proper travel insurance policy.
7. If you have to fall ill do so in a country like Switzerland, where even the general ward is better than the luxury suites of Indian hospitals. The nursing staff actually helped us in booking a hotel for the night and summoned a taxi for us. A level of service that I cannot even imagine in India.
Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium. An insurer is a company selling the insurance. The insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
Some Insurance Types
Different types of Insurance plans are offered based on your needs. Some of them are
• Life Insurance
• Health Insurance
• Dental Insurance
• Automobile insurance
• Property insurance
Life Insurance
Life insurance or life assurance is a contract between the policy owner and the insurer, where the insurer agrees to pay a sum of money upon the occurrence of the insured individual’s or individuals’ death or other event, such as terminal illness or critical illness. In return, the policy owner (or policy payer) agrees to pay a stipulated amount called a premium at regular intervals or in lump sums.
Health Insurance
The term health insurance is generally used to describe a form of insurance that pays for medical expenses. Basically, the client pays a sum of money called the Premium and in turn the Insurance firm would commit to pay a predetermined sum of money to meet the customer’s claims. Health insurance plans are offered in two categories. They are individual and group insurance policy. The individual plans covers health costs for a single person whereas the group health insurance plan covers medical coverage for the entire family.
Dental Insurance
Dental insurance covers dental costs for an individual or group. The costs include normal dental care cost as well as damage to teeth in an accident. Dental insurance protects people from financial hardship caused by unexpected dental expenses.
Automobile insurance
Auto insurance protects the policy owner against financial loss if he has an accident. It is a contract between policy owner and the insurance company. The policy owner agrees to pay the premium and the insurance company agrees to pay the losses as defined in your policy.
Property insurance
Property insurance gives protection against your property. This includes specialized forms of insurance like fire insurance, flood insurance, earthquake insurance, home insurance etc.
Life insurance is an important aspect of everyone’s lives and is something which everyone will have to face at some point in time throughout their lives. This point may come sooner rather than later for some individuals because of the job they perform on a daily basis.
While some individuals start everyday by putting on their suits and racing to get to the coffee shop for their morning coffee, others are strapping on their work boots and preparing themselves for a day of excruciatingly hard labor. As scary as it may sound, there are many individuals who are willing to put their lives in danger every single day when they get up and go to work.
The following is a list of the top 5 jobs which are considered to be the most dangerous jobs in the world. Individuals who perform these jobs are highly recommended to have a life insurance plan incase (god forbid) anything goes wrong on any given day. These are the 5 occupations which made the list:
1.Police/Detectives - Police Officers face life threatening situations almost everyday. They are highly trained to defend themselves and are equipped with protective equipment at all times. Life insurance and disability insurance are crucial for individuals working in the field of policing.
2. Airplane Pilots - Believe it or not, airplane pilots require life insurance because they are dealing with such powerful machines which have been known to have mechanical glitches. Airplane pilots are also highly trained in their field to make sure they do their best to fly safely.
3. Construction Workers - Construction workers are somewhat unappreciated for the amount of hard work they do everyday. They not only put their lives in danger from all the machinery they are expected to operate, but they also face many factors which will affect their health in the long run. Overexposure to sun, heat and excessive lifting are just a few of these factors.
4. Farm Workers - Much like construction workers, farm workers are at high risk of injury or death due to the fact that they are constantly operating heavy machinery. There are hundreds of farm work related deaths a years and thousands of injuries for individuals working in farm fields. Life insurance and disability insurance are important for individuals in this occupation.
5. Fire Fighters - It is a known fact that fire fighters put their lives on the line everyday to save the lives of others. Knowing the potential consequences and performing the job anyways indicates that these workers deserve the highest level of respect from others. Individuals who have chosen careers in firefighting are also likely to have a life insurance policy.
Is your job dangerous? Is your life on the line everyday? Maybe not, but there are many other factors other than your occupation which may indicate you need life insurance. Life insurance is a plan which will ensure your loved ones are taken care of incase anything happens to you. Wouldn’t you like to know your family would be looked after should this type of situation occur?
The growing number of consumers taking up health insurance plans has led to the mushrooming of scam health insurance providers. These providers often target new retirees and the elderly individuals and small-business owners, who can’t negotiate better rates with legitimate insurers. Be very cautious before you invest in any health policy. Read on to get an idea about 3 ways in which your health insurance company can scam you.
1. Failure to pay claims: Usually fraud health insurance agents sign up a huge number of people quickly by offering them lucrative deals. These insurance providers keep paying small premium amounts and medical claims, but if there is a substantial claim amount or regulators catch them, these illegal companies vanish as if they never existed.
So, just beware if you are getting delayed payments or your service provider is offering fake excuses for the failure to make the payments. If you have signed up for these illegal plans, you may be liable for the medical bills of your employees as well.
2. Non-licensed health plans: If the company from which you have bought your health care policy is not licensed by State Insurance Commissioner, you can be in trouble. If all the protections of insurance regulation do not apply on your service provider, then the company may be phony. In this case your service provider is scamming you by selling non-licensed health plans.
Insurance agents are not allowed to sell any legitimate ERISA or union plan as federal law governs them. So, if your insurance agent tries to dupe you by selling an “ERISA” or “union” plan, report them to your state insurance department.
3. Unusual coverage offered at lower rates: If you are offered an unusual coverage irrespective of your health condition and that too at lower rate and much more benefits in comparison to other insurers, its time for you too hit the panic button. Do not get fooled by the lucrative offer, else you can be taken for a ride. The ‘scamsters’ aim to collect huge amounts as early as possible so, they try to sell maximum number of policies at attractive prices.
Life insurance is the building block of any good financial plan. It can protects your family against the loss of income caused by a premature death. Some life insurance policies are permanent, while others only last a specific amount of time and are commonly referred to as term life insurance. Whether you think you need term life insurance or a permanent life insurance plan, you should always get the policy that is right for you.
Disability insurance can protect against the agony of income loss caused by an injury or sickness outside of the workplace.
Group Health Insurance can help employees pay for some of the costs of medical services including yearly physicals, blood testing, and surgeries. Most group health insurance plans require a co-pay for covered doctor visits and prescription drugs.
Travel insurance is a type of insurance that can help indemnify you against a trip cancellation or evacuation. A travel insurance policy comes with specific definitions regarding to what it considers an emergency evacuation or travel related sickness or accident. You can find insurance coverage for terrorism, hazardous sports and activities, annual travel insurance (Holiday Insurance policy), and much more.
Travel Health Insurance is a health insurance coverage for those that do not reside in their native country. Many American's health insurance plans do not offer medical protection outside of the United States. If you are a college student abroad, missionary, or expatriate in need of a doctor or hospital in another country, you might need to purchase a travel health insurance policy; otherwise the school or organization has it available for you. Travel Health Insurance is also known as international or global medical health insurance.