Dear Mr Soumitra Mukherjee,
I have seen your mail dated 11.10.2022.
Your second mail has an attachment letter from KMD. In the 2nd page of KMD's letter it is indicated as:
Other Hospital Expenses:
"Proportionate deduction applicable for higher room rent on all hospitalization expenses expect Medicines & Investigations in case of higher room rent is opted"
But in the Q & A Sl.1., they have very ingeniously created an impression that the Proportionate charges are not applicable. The Q & A portion is reproduced:
"Srl No. QUERIES & CONCERNS RAISED BY AICBRF, CHENNAI
RESPONSE RECEIVED FROM M/s KMDRBPL
01
Whether concept of “Proportionate deduction” of other
expenses applied, if the retiree opts for a room of higher
Bed Charges
even where the Hospital does not charge extra on the basis of higher room rent?ANS:
No. If it is cashless then the TPA will have the
rate list to ascertain. However in cases of
Reimbursement, the hospital has to certify
along with the rate list
."
The question is based on a premise "where the Hospital does not charge extra on the basis of higher room rent?". It is rare that we will find a hospital which does not charge extra on the basis of higher room rent. In today's Corporate world, they suck the blood of the patient . The onus is on the claimant to prove. So, in all cases where room rent is higher than the accepted amount under the policy, the Proportionate clause will kick in.
The question in Q & A has been framed in such a way that a cursory reader will fall prey to the gimmicks played by them. I know their answer will be : No compulsion on any one. One can decide about joining this policy. But poor retirees are taken for a ride by word jugglery.
To substantiate let the persons who have claimed some amount from the insurer should come out with the facts regarding charging of Proportionate amount.
By paying a lesser premium of around Rs.10,000/- or Rs.15,000/- we end up with a lesser claim settlement amount which will be akin to 15 to 20% co-pay.
Nothing comes cheaper in this world. There are hidden agenda everywhere and let the retirees understand this and take a considered view.
Because of the very high premium, I am trying to wriggle out of the IBA Policy. But the reality is, being aged we are in the totally neglected sector. The IBA policy holders are in Catch 22 position. Being aged our mind is also not co-operating to analyse the alternatives. One has to make a decision, as his wisdom says.
Regards,
S Rajamani.