Nepal tries to ensure Covid-19 insurance

Since insurance companies in Nepal announced Covid-19 schemes in April, more than 1.4 million applied, but many patients are having payment disputes and few have collected their dues, thus jeopardising the public’s trust in the entire insurance sector.

As the spread of the pandemic across Nepal shows no sign of abating, insurance companies themselves may need Covid-19 insurance because of over-exposure to claims. 

When coronavirus insurance schemes were introduced in April, Nepal had very few cases and it looked like the country was not going to be severely affected. Insurance companies launched their schemes, and the overwhelming response has now come back to haunt them as the total number of cases crosses 105,000. 

The Insurance Board approved the coronavirus scheme because the public needed to be reassured, and it looked like a good business proposition as private companies partnered with e-pay services to process applications.

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Private companies issued 145,570 Covid-19 insurance policies from 22 April to 30 September. Collectively and individually, nearly 1.4 million Nepali individuals have coronavirus insurance for which the 20 companies have collected Rs796.1 million in premiums.

Of those insured, 5,316 have sought insurance claims, but so far only 827 have received payments totalling Rs76.6 million – a small percentage of the Rs518.8 million in claims for Covid-19 medical treatment. Insurance companies have been reluctant to pay this amount, citing lack of required documents and other reasons. 

As the number of cases kept piling up and hospitals started getting full, insurance companies got the government o bear part of the responsibility for repayment, and even change the guidelines for Covid-19 insurance. 

This resulted in a dramatic drop in coronavirus insurance in Nepal, even as the pandemic spread. Dip Prakash Pandey, CEO of Shikhar Insurance and chair of the Nepal Insurers Organisation admits the numbers have gone down even though the government has guaranteed payments.

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The government pays the premium for Covid-19 insurance of its civil servants, and has said it will bear 50% of the amount for the private and institutional group insurance. However, private companies are no longer promoting their insurance packages due to the sharp rise in the infection rate, increased risks and costlier claims. 

Whichever insurance company an individual buys a policy from, the premiums all go into an Insurance Pool and all private companies bear responsibility for repayment. However, private companies are said to be turning away people eager to buy insurance.

Pandey of Shikhar Insurance denies this: “We sell insurance only to those who come after completing the entire process. Those who do not do that and come without the required documents cannot be paid later even if they are insured.”

He says the real reason why the number of new insurances has dropped is because of the new requirement that local governments need to give their consent, and individual policies are not allowed any more, only companies and family groups. Besides, most families who wanted to be insured had already done so.

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With 20 non-life insurance companies on board, Covid-19 insurance companies offered two packages: normal and premium. The first could claim payments of up to Rs50,000 while the premium package would get Rs100,000. And since the scheme had government backing, the state would pay 50% of the premium package. 

When the scheme was introduced there was an arrangement for the insured to get the full amount immediately after being diagnosed positive, however, this arrangement failed miserably. After that, the companies changed the criteria of Covid-19 insurance so that the infected person would get only Rs25,000, and the remaining amount would be provided on the basis of the hospital treatment bill.

Until August, e-pay services and insurance companies were promoting their insurance products, but with the new government guideline they have deleted Covid-19 insurance even from their website under ‘New Products’, and prospective customers are finding it difficult to get information. 

Dilli Aryal, CEO of Rastriya Bima says the government company is issuing 50 to 60 Covid insurance policies daily. He says, “The reason the government stopped individual insurance was because of the hassles of presenting necessary documents. It is easier when done with companies or family groups.”

The Covid-19 Insurance Guideline 2020 of the Insurance Regulatory Board of Nepal has stipulated that all claims must be paid out in full within one year of being made. Because of the rising number of coronavirus patients needing hospitalisation, the claim amount has soared.  

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Pandey says, “The challenge is to ensure that Nepalis are not deprived of treatment because of cost, however there is a process of validating claims with official proof of infection, hospital bills and other documents. There may be delays, but all genuine policies will be honoured.”

Although applying for a policy can be done online, he said, there was a requirement to have physical proof to claim insurance payments. However, many policy-holders say private companies have been deliberately delaying payments under one pretext or another and claims have started piling up at the insurance pool as the pandemic spreads.

Asked about this, Insurance Board spokesperson Rajuraman Poudel said: “There may be delays, but the insurance companies will pay the claim within a year as per rules.”

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The insurance pool has been given the responsibility by the government to process all claims, and it is being administered by Shikhar Insurance. However, the public’s trust in insurance is being seriously undermined by these excuses – after all only 0.38% of those who insured themselves against Covid-19 are claiming payment.

Negative publicity about Covid-19 insurance has begun to undermine the public’s trust in not just pandemic insurance but cause heavy collateral damage on the overall insurance sector.  

The insurance companies have now fully understood the repercussions of the pandemic, and they claim that they took the risk as a public service in April. The industry is ready to face the worst, they say, and even if it takes big losses in Covid-19 payouts, it is well positioned to survive because of back stop from the government, Nepal Reinsurance Company, the Insurance Board and other insurance companies.  

The formula has apportioned risk so that the first 10,000 claims will be borne by the insurance companies themselves, the risk for the second 10,000 will be borne by the Nepal Reinsurance Company, an additional 5,000 will be paid out by the disaster contingency fund of insurance companies, and the final next 10,000 will be borne by the Insurance Committee. The government will bear the risk of 35,000 Covi-19 insurers. 

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