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Dr KK Aggarwal |
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![]() Understanding Insurance Terms Deductibles In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. Deductibles are typically used to deter the large number of trivial claims that a consumer can be reasonably expected to bear the cost of. By restricting its coverage to events that are significant enough to incur large costs, the insurance firm expects to pay out slightly smaller amounts much less frequently, incurring much higher savings. As a result, insurance premiums are typically cheaper when they involve higher deductibles. Deductible is what makes insurance so profitable. Copay Copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maxima whereas coinsurance payments do. Though the copay is often a small portion of the actual cost of the medical service, it is meant to prevent people from seeking medical care that may not be necessary (e.g.: an infection by the common cold). The underlying philosophy is that with no copay, people will consume much more care than they otherwise would if they were paying for all or some of it. Co Insurance In health insurance, coinsurance is sometimes used synonymously with copayment, but is defined differently – a copay is typically fixed while the coinsurance is a percentage that the insurer pays after the insurance policy's deductible is exceeded up to the policy's stop loss. Out of pocket maximum The yearly out-of-pocket maximum is the highest or total amount your health insurance company requires you to pay towards the cost of your health care. The out-of-pocket maximum helps protect you from very high additional costs. In most cases, once you reach your health plan's out-of-pocket maximum, your insurance company will cover 100% of the costs they consider to be medically necessary. Loading in Health Insurance Loading, in terms of Mediclaim Insurance means the Insurer (Company) will charge more amount than the regular premium from the policy holder after a claim has been made. For example you pay Rs 6,000 annual premium, and now in 4th year you make a claim, then from the 5th year onwards, your premium will increases by a certain amount which can range from 5% to even 300%. The increase depends on the company terms and the rules. If the loading is 50%, your premium will increase by 50%. (9000/- in this case). Loading can apply with every claim you make. 1. ICICI Lombard mediclaim policy states different slabs for different amounts of claim made. 2. Star Health’s Red Carpet policy for Senior citizens: makes an option of Co-pay up to 30% but also has Loading as well. 3. United India (Gold and Platinum only) and Max Bupa has no loading clauses Loading challenged in consumer courts 1. Amina Sheikh, an octogenarian, was insured for Rs 1.5 lakh for a decade by the National Insurance Co. Ltd. under its Mediclaim Policy. When her policy was due for renewal in 2007, the company increased the premium from Rs 5,305 to Rs 32,787. This was done to make it financially unviable to continue with the policy. Her daughter protested, so the premium was brought down to Rs 23,845, which too was very high. She was forced to pay this premium and renew the policy to avoid a break in insurance. Her daughter wrote to the company demanding an explanation for the arbitrary increase. The divisional manager replied that the policy now stood cancelled as Amina did not seem happy with the firm. He also clarified that the premium doubles immediately when a person crosses 80 years of age and for her, the premium had been loaded by another 100% in anticipation of claims arising due to advanced age. CWA then filed a consumer complaint. Rendering the judgment on behalf of the bench, the forum president observed: “Managers of public sector undertakings are duty-bound to take decisions based on facts and not in an arbitrary and irresponsible manner based on their emotions.” Case Study 2: In Dr Rupali Shirke’s case, the insurance company loaded her premium by 50%, increasing it from Rs 7,727 to Rs 11,824 and decreased the sum insured from Rs 5 lakh to Rs 2.5 lakh. This was done because of two claims lodged by her, which were genuine and settled by the company. This was considered as an “adverse claims ratio” by the firm. When she protested, the insurance firm ignored it. Case Study 3: In the case of Hoshang Khan, after a claim was lodged, the insurance firm imposed a loading of 400%, increasing the premium from Rs 10,558 to Rs 55,952. Khan could not afford the high premium, so he sent the premium cheque without the loading, but the insurance company returned it. CWA filed a complaint against United India Insurance Co. Ltd. The Forum held that loading of premium was arbitrary and unjustified. It directed the company to accept the premium without loading. On receipt of the basic premium, the firm was directed renew the policy with retrospective effect from 2006 onwards to maintain the policy’s continuity. Co-Pay in Mediclaim Co-pay, as the name signifies is the payment made by two parties, even if that is not in equal proportions. Under this clause, the insured is also required to bear a certain percentage of expenses incurred on illness/disease while hospitalized, either conditionally or under certain conditions. In India Co-Pay only comes into picture after a certain age. Most of the companies levy this clause once the policyholder enters the Senior citizen category, that is after the age of 60. Mostly this percentage is mentioned as 20% pay – i.e., policyholder is required to pay 20% of the expenses out of his own pocket. For example a person is 65, and falls ill and gets admitted for which a bill comes of 70,000/-. His Mediclaim Policy mentions 20% co-pay, then he will have to pay 14000/- and the rest will be paid by the Mediclaim company. Some companies may charge this co-pay clause if the policyholder is taking treatment in out of network hospitals. Even if a company does not have co-pay and loading clauses today , it can include them at later stage . Every policy mentions that “all terms including premium are subject to change on renewal, based on claims or otherwise.” 1. Bajaj Allianz implemented a new loading clause in August 2010. 2. ICICI Lombard, has classified claims into Chronic and Non Chronic. Non-chronic claims like an accident or Malaria etc. would have a loading only above a certain threshold claim amount, which is not carried forward in the subsequent year. Whereas chronic ailments will have a loading of 75% and carried forward up to 200%. (Some of the inputs from Manish Chauhan, Jago Investor) ....Read More Things you should know about erectile dysfunction ED is often the result of diseases or conditions that become more common with age or a side effect of the medications used to treat them. Other causes include prostate surgery, stress, relationship problems, and depression. With age tissues also become less elastic and nerve communication slows. Cardiovascular disease is a common cause. Blocked arteries affect not only the coronary arteries but those throughout the body as well. Up to 30% of men who see their doctors for ED have underlying heart blockages. Intriguing findings from the Massachusetts Male Aging Study suggest there may be a natural ebb and flow to ED — that is, for some men, trouble with erections may occur, last for a significant amount of time, and then partly or fully disappear without treatment. For some men, simply losing weight may help. Others may need medications, and there are other options available as well. (Harvard Newsletter) ....Read More |
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Satsang is a common household word and is often held many residential colonies. Traditionally, Satsang meant the regular meeting of a group of elderly or women of an area with a common intention of attaining inner happiness or peace through Bhajans or devotional songs for a particular God or Gods. In Satsang, people realize that it is the Self, communing with Self. The Sanskrit word ‘Satsang’ literally means gathering together for guidance, mutual support or in search of truth. It may involve talking together, eating together, working together, listening together or praying together. Most scriptures describe Sat and asat. They discriminate that this world is maya (asat) and God is Divine. Furthermore, they state that maya is not yours; Divine is yours. Sang means to join, not just coming close, but to join. And how do you join? Only with love, which acts as glue. So Satsang is: Sat—Divine. Sang—loving association. In non-traditional Satsang, people verbally express themselves to others in an uninhibited way. Here, each participant talks free of judgment of others, and self. In this way, each person is able to see many viewpoints, which may serve to diminish the rigidity of their own. Satsang is one way of acquiring spiritual well being. Many scientific studies have shown that when mediation or chanting is done in groups it has more benefits than when done individually. Maharishi Mahesh Yogi once said that if 1% of the population meditates or chants together it will have a positive influence on the entire society. Satsang also helps in creating a network of people with different unique talents. Satsangi groups are often considered in a very deep-rooted friendship. Adi Shankaracharya in his book Bhaja Govindam also talks about satsang in combination with sewa and simran and says that together the three can make one acquire spiritual well- being. Nirankaris and Sikhs also give importance to satsang and in fact every true Sikh is supposed to participate in the Gurudwara on a regular basis. Chanting of mantra or listening to discourses in a satsang helps to understand spirituality through gyan marga. Group chanting continued on a regular basis is one of the ways of meditation mentioned in the shastras. It shifts consciousness from sympathetic to the parasympathetic mode. The medical educational programs of doctors of today can be called medical satsangs as whatever is discussed is for the welfare of the society. However terrorism meetings held to discuss implanting a blast couldn’t be called a satsang. Satsang also inculcates in us, one of the laws of Ganesha, the law of big ears, which teaches everyone to have the patience to listen to the others. In satsang, nobody is small or big, everybody has a right to discuss or give his or her views. Over a period of time, most people who regularly attend satsang, start working from the level of their spirit and not the ego. ....Read More |
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![]() Hiding their weaknesses and highlighting their strength
There was a King who had only one eye and one leg. He asked all the painters to draw a beautiful portrait of him.
But none of them could because how could they paint him beautifully with the defects in 1 eye and 1
leg. Eventually one of them agreed and drew a classic picture of the King.
It was a fantastic picture and surprised everyone. | |||||
News Around The Globe
Rabies News (Dr. A K Gupta) Can a rabies vaccine be given to a pregnant woman? Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice. |
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Valvular Heart Disease News
Clinical examination remains the first step in diagnosis of mitral valve prolapse. The non-ejection click is mobile, meaning that the timing varies with maneuvers that alter left ventricular volume. The mitral regurgitant murmur can be late systolic (early in the disease) or holosystolic (severe prolapse or flail). |
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![]() Diet for heart disease prevention with special reference to edible oils
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Paternal age and fertility |
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![]() HCFI Activities EBook CPR 10 Camp – E Book Sahodaya Sr Sec School, SDA, New Delhi Total CPR since 1st November 2012 – 57939 trained TV and Radio Coverage 30th July: Dr KK Aggarwal on India News Video Chats and uploads Dr KK Aggarwal on How to Stay Fit Advocacy through Print Media Media advocacy through Web Media Poly Diet and Poly Drugs 1st Aug | |||||
![]() When could Constipation be a Serious Problem? While most instances of constipation may not be serious, some cases of infrequent or difficult bowel movements need evaluation by a doctor said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela. |
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![]() ![]() Heart Care Foundation of India Organizes a CPR 10 Training camp at Balwant Rai Mehta School, Greater Kailash, Part 2, New Delhi on 2nd August 2013. |
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eMedi Quiz Read this…………………
A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in…..:
Yesterday’s Mind Teaser:Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? Answer for yesterday’s Mind Teaser: d. Foul-smelling discharge from the penis Correct answers received from: Dr.Praveen Jain, DR AVTAR KRISHAN, Dr.K.V.Sarma, daivadheenam, Dr.B.R.Bhatnagar, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr.K.Raju, Dr Jainendra Upadhyay, Dr B K Agarwal, Dr Valluri Ramarao, DR ABBAS VAKIL Answer for 3rd August Mind Teaser:a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually Correct answers received from: Dr. P. C. Das Send your answer to ijcp12@gmail.com ![]() ![]() ![]() eMedi Apps ![]() ![]() ![]() |
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A certain little girl, when asked her name, would reply, "I’m Mr. Sugarbrown’s daughter." |
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Situation: An asthmatic with respiratory rate of 37 developed respiratory arrest. |
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![]() When you are at a loss of what to do, do nothing. Doing nothing can be very wise. When you pause doing things, you become more aware of God’s presence, and often an unexpected solution to your question will arise. |
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Dr KK Aggarwal :Poor hygiene habits may lead to Typhoid fever http://bit.ly/1666DSO #Health |
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![]() Dear Sir, Thanks for the nice updates. Regards: Dr KM Sharma. |
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Forthcoming Events CPR CAMPS
29th September–Dil Ka Darbar at NDMC Convention Centre, CP New Delhi 20th Perfect Health Mela from 18th Oct to 22nd Oct at different locations 20th Perfect Health Mela from 23rd Oct to 27th Oct at Constitution Club of India |
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eMedinewS Special 1. IJCP’s ejournals (This may take a few minutes to open)
2. eMedinewS audio PPT (This may take a few minutes to download) 3. eMedinewS audio lectures (This may take a few minutes to open) |
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Our Contributors Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer |
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