RICBL launches medical insurance to address rising medical referrals

PEMA TSHOMO
Thimphu

The Royal Insurance Corporation of Bhutan Limited (RICBL) unveiled a new medical insurance scheme on 1st July offering a potential solution to the escalating medical referral expenses incurred by the government. The announcement comes amid growing concerns about the financial burden of overseas medical treatment for Bhutanese citizens.

Karma, the Chief Executive Officer (CEO) of RICBL, emphasized the significance of life and property insurance, stating, “The main objective, the essence of insurance, is to secure life and property. The most important thing is life; then comes property. These two are the most important. Today, RICB is making medical insurance available to all the people in the country.”

The program aims to empower Bhutanese citizens to manage their medical needs through private insurance options. “The essence of today’s program is to make sure there is a program where people can avail medical services,” Karma explained.

He elaborated on the impetus behind the new policy: “It has been over two years since we began this work. We started after COVID-19.”

“The time has come. The National Insurance Standard has come, and medical insurance has come. Because things have changed drastically, and it has shifted the Bhutanese economy,” he added.

Further, he said that, due to the issue of having a limited number of specialists, all the treatment needs are in India. So, with discussions related to treatment with comfort, ICICI Lombard General Insurance, the biggest treatment provider in India, was involved.

“We discussed two things with them: reinsurance. Some companies are doing 7 million, 10 million, and so on. RICBL can’t take the huge risk and keep it with RICBL. What we do is quota-sharing,” he added.

Additionally, Karma elaborated on the challenges of securing reinsurance and the efforts undertaken by RICBL. “I had been down there for discussions three times. The business isn’t big, but through the relations between the countries, this reinsurance has been carried out.”

He added, “The second aspect regarding medical insurance is that there are three basic things: the insurance giver, the hospital, and the third-party administrator. While we send people down there for treatment, they need a third party who can collect them from the airport and negotiate prices with the treatment services in India.”

He cautioned policyholders about potential wait times, stating, and “They have a waiting period of one month.”

Affordability was a key concern addressed during the launch. Everyone is concerned about the premium. These premiums will be based on the size of the population. As it’s a small population, the premium becomes lower as it divides. So, in the end of the conference they decided to keep the same rate as India.  

Recognizing the initial financial burden, RICBL is offering a discount to incentivize early enrollment. “When it comes to another thing, as a new scheme, they have offered a discount of 15 percent on the premium for a year, 2024. They have done as much as they can to reduce the premium and offer discounts,” Karma said.

As corporate citizens and a legal entity, they are wishing to do some charity work for the people as a profit-maximizing company. He even shared the details: “As corporate citizens, we need to serve the nation. These premiums have been reduced as much as possible from the RICB side, with discussions through email with India over the last six months.”

Karma added by outlining RICB’s aspirations for the future of insurance in the country related to crop insurance and livestock insurance.”

They are also looking forward to the new government being able to help in those areas too, unlike the earlier government, due to a lack of budgetary support. They even submitted the proposal several times.

Kuenzang Thinley, General Manager of General Insurance, presented a detailed breakdown of the medical insurance scheme’s features and benefits.

He highlighted the rising medical expenses borne by the government, stating, “In 2022-2023, the Royal Government of Bhutan (RGoB) has spent around 500 million on referral cases. In the past three years, on average, RGoB has spent 280 million.”

“So, the medical expenses will be higher if private treatment is included as well. The pressure on the health system is increasing with the increase in lifestyle expenses, NCDs, and high-paying professions,” he added.

The GM explained how the new health insurance scheme simplifies the referral process for patients. Patients needing specialized care will need approval from a committee, but the initial recommendation will come from their doctor. Importantly, this referral program is currently limited to treatment in India.

The good news is that the program is cashless, so patients won’t need to pay upfront for treatment. Additionally, there are partnerships in place with major hospitals in India to ensure patients receive proper care.

Finally, the program offers affordable premiums with flexible payment options, such as quarterly or yearly installments, making it accessible for many people.

 “There are two kinds of plans: individual and floater plans. An individual plan is meant for a single person. The floater plan is meant for the family,” GM said.

GM delved into the coverage details, stating, “The insured sum ranges from Nu 300,000 to Nu 1,000,000. Pre-existing diseases will be covered after two years, but with the condition that the medical practitioner uses a big justification.”

The new health plan offers some details specific to renal patients. Those with a history of kidney disease will have a two-year waiting period before certain treatments are covered.

Additionally, he said that individuals aged 46 and above may need a short medical report for referrals. To make this process easier, the plan has partnered with diagnostic centers that offer these reports and may even provide discounts.

He further clarified the scope of coverage, including hospitalization and outpatient procedures. “For inpatient cases, which take place over consecutive hours, the expenses will be covered. The next aspect is roommates; the cabin charges and nursing charges are covered. This is the most important part of the treatment.”

“For daycare procedures, the treatment that is less than 24 hours, for instance, which does not require hospitalization, like cash rate, national sinuses, chemo therapy, dialysis, and ECG. So, there are 115 procedures on their list that will be treated, and the expenses will be covered by RICB,” he added.

Particularly, the insurance plan goes beyond just covering hospital stays. It also covers medical expenses for 30 days before the treatment starts and 60 days after they leave the hospital. This includes any medications that the patient needs to buy, including refills. Even if a doctor refers them to an AIIMS hospital, the plan will still cover their treatment.

An intriguing feature of the plan is the free health check-up benefit, once every two years as per the policy. “With a maximum of up to 10 percent of the annual sum insured, we are going to cover the expenses of Nu 100,000 after two years,” Kuenzang Thinley highlighted.

Thinley explained the exclusions. The plan won’t cover non-emergency situations or pre-existing conditions unless a doctor declares them resolved after two years. Expenses related to obesity, cosmetic surgery, pregnancy, plastic surgery, comfort items, childbirth-related illnesses, hygiene products, and substance abuse are not covered.

Health Minister Tandin Wangchuk, provided insights into the current state of Bhutan’s healthcare system and how the new scheme complements it. He said, “Bhutan is the only country that provides free services both inside and outside the country. It has become an exemplary case in the world.”

The health minister added, “All people who cannot be treated here will not be sent out. It has been done with limited numbers, with genuine cases following referral guidelines. Especially for kidney patients, it has a good collaboration between RICB and the health ministry.”

According to him, the Government spends a significant amount on referrals every year. He said, “The new scheme will help alleviate this pressure. Bhutanese people will be sharing the medical expenses. Whereas the government is providing Nu 28 million per year. This will benefit from cost-sharing.”

As detailed by Kuenzang Thinley, the factors influencing premium costs depend on age. The higher the age, the more premiums will be charged. He said, “This is because as people get older, their age group tends to have better jobs and is more secure financially. For those with lower salaries, they are placed in a lower premium bracket.”

Further, the installations can be divided into whatever an individual prefers, quarterly or half-yearly.

There is an age limit for coverage. Before, it was limited to 65 years. But again, it was revised to 70. However, he said that an insurance regulatory body in India has removed the age of 70. So, he is hoping to improve more than that as things go well.

The launch of the RICBL’s new medical insurance scheme marks a significant development in Bhutan’s healthcare landscape.

With its focus on affordability, accessibility, and comprehensive coverage, the scheme has the potential to alleviate the financial burden on the government and empower Bhutanese citizens to manage their medical needs effectively.

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