As­sign­ing the Weights

Consumer Voice - - Bfsi -

Pre­mium (20 points)

This in­di­cates the pay­ing ca­pac­ity of a se­nior cit­i­zen. With only life­time sav­ings as a cor­pus fund and the reg­u­lar pen­sion amount for ful­fill­ing their daily needs, this age group would look for the cheap­est pol­icy with max­i­mum ben­e­fits. For weightage, max­i­mum points are awarded for the cheap­est pre­mium, while least points have been as­signed for the high­est pre­mium.

Co-pay­ment (20 points)

Max­i­mum weightage has been as­signed for least co-pay­ment, and vice versa.

Pre-ex­ist­ing dis­ease (15 points)

This is a con­tro­ver­sial clause – one that has been de­bated even in the ju­di­cial pro­nounce­ments. This

clause is in­ter­preted dif­fer­ently for dif­fer­ent dis­eases. We have given prime im­por­tance to this clause and as­signed max­i­mum points for min­i­mum wait­ing pe­riod, while as­sign­ing lesser points for in­creased wait­ing pe­riod.

No-claim bonus (10 points)

When an in­sured does not in­voke the health pol­icy through­out any year, they are en­ti­tled to ei­ther a dis­count on the pre­mium payable dur­ing the suc­ceed­ing year or a hike in sum in­sured (sub­ject to ceil­ing). We have as­signed max­i­mum points for higher bonus and nil points for no cover.

Day-care cover (10 points)

This is im­por­tant for the con­sumer as it re­duces their cost or cov­ers additional med­i­cal ex­penses, though it is not go­ing to al­ter their op­tions in a ma­jor way while choos­ing a pol­icy. Hence, we have as­signed max­i­mum points for full cov­er­age of ben­e­fit and nil points for no cover.

Domi­cil­iary treat­ment (5 points)

These are the ex­penses in­curred in case the pa­tient is be­ing treated at home due to non-avail­abil­ity of beds in hospi­tal or due to their not be­ing in a med­i­cal con­di­tion to be moved to a hospi­tal. For as­sign­ing weights, we have taken into ac­count cov­er­age avail­able (max­i­mum points) and no cover ex­tended (nil point).

Or­gan donor ex­penses (5 points)

In case of an or­gan trans­plant, cost of hos­pi­tal­iza­tion of the donor and the cost of trans­plant are pro­vided by the in­sur­ance cover ex­cept for the cost of or­gan. Max­i­mum weights have been as­signed for avail­abil­ity of cover and nil point for no cover.

Pre-hos­pi­tal­iza­tion (5 points)

The ex­penses in­curred for a limited pe­riod be­fore the date of hos­pi­tal­iza­tion of the in­sured (for lab tests, con­sul­ta­tion, etc.) are cov­ered. Max­i­mum points have been as­signed for max­i­mum pe­riod cov­ered and nil points for no cover.

Post-hos­pi­tal­iza­tion (5 points)

The ex­penses in­curred for a limited pe­riod af­ter hos­pi­tal­iza­tion (for lab tests, con­sul­ta­tion, etc.) are cov­ered. Max­i­mum weights have been as­signed for max­i­mum pe­riod cov­ered and least points for lesser pe­riod cov­ered.

En­try age (5 Points)

The age fac­tor is con­sid­ered but it is not of prime im­por­tance. Hence max­i­mum points have been as­signed for any en­try age and least points for ceil­ing on en­try age.

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