Published On: Sat, Mar 28th, 2015

Medical Insurance: A life saver?

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More and more Mauritians are adhering for medical insurance policy. Because of unforeseen health coverage turns out to be a necessity. Prevention is better than cure. It is in this light that they are more than one to opt for medical insurance. Insurers have achieved over 10% growth in the number of members with medical insurance plans in recent years.

Many people subscribe to a medical cover in order to access the services of a private clinic. Why is this case? It is for the care of the patient, the quality of care provided there, and access to advanced technologies. Rishi Sookdawoor, president and CEO of BAI Co. Ltd, said that before bringing his choice on a medical insurance policy, it is important to determine current and future needs. Afterwards, do not hesitate to compare different offers. It is wise not to compare prices only. These criteria are also important: the technical aspects of the proposed insurance, service quality and monitoring, repayment rates and speed, ease of access and to contact their insurer.”The technical characteristics of our products and the quality of the service we offer our customers both on track and on the reimbursement of medical differentiate us from our competitors,” he says. For him, a good medical insurance is important in case of illness or hospitalization, as it provides access to medical care that we could not fulfill by other means.

For its part, Devesh Biltoo, Manager – Underwriting Department at the Mauritius Union explains that in case of illness requiring treatment abroad, repatriation solutions and legal assistance, also draws. In the case of certain interventions, the waiting list is very long. It is these elements that convince and more and more people to turn to the private sector where they enjoy a personalized service where the emphasis is on comfort.

How much does that cost?

Premiums vary from the ceilings of the profits. Nevertheless, one can take out medical insurance coverage from Rs 250 rupees per month (or Rs 3000 per year).

Questionnaire

How is a subscription to a medical insurance? Insurance companies require persons wishing to join medical insurance to complete a questionnaire before signing a contract. This questionnaire is to identify the person’s health, but also his medical history and lifestyle: smoking, alcohol, stress, among others. On the other hand, the objective of this questionnaire for the insurer, is to assess the risk-taking after acceptance of a health insurance claim. It should be noted that insurers ensure on measuring risk-taking, to assess the amount of contributions paid by the insured. A health questionnaire is submitted, priority to people aged over 50 years.

Cover

It is good to know that medical insurance can cover totally or partially the cost of medical consultations, the cost of drugs or treatment and hospital-related costs as well as optical and dental care. However, some medical benefits for so-called chronic diseases such as diabetes and hypertension, are not reimbursed by medical insurance. Most of the proposed plans do not cover preventive care, mental disorders, musculoskeletal diseases, some vaccines and drugs.

Exclusion clauses

Insurance companies are far to highlight the exclusion clauses fonts and consumers feel it is an abuse of them. The exclusion clauses in health insurance policies are common practice.

If a client consults at least three times in a year for the same illness, the insurance company can simply exclude the disease, and even the speciality concerned (gastroenterology, gynecology, urology, or, for example) of the insurance policy upon renewal of the contract. The argument of a large insurance company to many of these customers is that insurance covers what might happen, not what will happen.

For Pramode Jaddoo is a scam. “I think it is a scam, because insurance companies are supposed to Cover the customer who pays the premiums. “We do not intentionally fall ill,” said the economist at the Institute for Consumer Protection (ICP). He wonders why the insurance does not cover chronic diseases, because the client passes medical examinations at the time of subscribing to a policy. The amount of the premium is calculated on the results of this review. On the other side, Kris Lutchmeenaraidoo, president of the association of insurers, explains the rationale for the exclusion clauses in health insurance policies. He noted that the law requires insurance companies to be clear with their client on all the clauses contained in the insurance contracts.

Some figures

According to the Financial Services Commission statistics, in 2011 the insurance companies in Mauritius have paid Rs 1 billion in compensation to their customers, as part of health insurance policies against Rs 724.77 million in 2010, an increase of 27.71%. The number of relevant insurance policies has increased by 10, from 7,818 in 2010 to 78,925 in 2011.

 

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