Presentation onMedical Insurance In India

ICICIHealth InsuranceHero.mp4

WHAT IS MEDICAL INSURANCE

System of assurance to make contingencies of health care expenses.

To provide protection against financial loss by unforeseen sickness.

To meet cost of good medical care.

Relieves anxiety and tension.

WHY MEDICAL INSURANCE REQUIRED

Medical expenses have increased. Common man has to stretch to uncomfortable financial limits to get proper treatment for himself and his family.

Covers the individual and family against any financial constraints arising from medical emergencies. In case of sudden hospitalization , illness or accident, health insurance takes care of the expenses on medicines, oxygen, ambulance, blood, hospital room, various medical tests and almost all other costs involved

Emergence of Medical Insurance Sectors

The importance of Health Insurance, popularly known as Mediclaim has considerably increased in India in the recent years.

Awareness and importance of health and health related issues has encouraged this growth. Also, now a days people are financially smart and pay more attention to their financial planning. They know that health would always not remain the same and therefore it is wiser to invest in a comprehensive medical policy.

cont.

Emergence of Medical Insurance Sectors

On the other hand, the insurance companies were fast to react to this situation. They saw a market and hence, got out of their shell and evolved. They knew that they had to provide smart medical insurance plans to tap the market.

All these factors have lead to the changing face of the health insurance sector in India. Apart from this, steps taken by the government and the endeavors of the insurance companies are the prime factors inducing this growth.

HEALTH INSURANCE

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of  health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity

Cover Required And Medical Tests

• Cover Required If you earn more than 5 lakhs per year,

get a cover of at least 5 lakhs. Anything below that, take a cover equal to your annual income.

Medical Test• Typically, below 45 years of age does

not require medical tests. A few plans for senior citizens don't require tests as well.

TYPES OF HEALTH INSURANCE

INDIVIDUAL MEDICALIM

FAMILY FLOATER POLICY

UNIT LINK HEALTH PLANS

Benefits Of Health Insurance

Family Floater PoliciesFree Health check upsBonus Benefit/ No claim BonusTax BenefitCashless ClaimsPre Hospitalization and Post

hospitalization BenefitsCover for pre- existing diseasesHospitalization cash benefitsAmbulance charges

What does health insurance cover

Basic Coverage 

A health insurance plan should

provide cover for hospital rooms,

doctor or surgeon fees, medical tests,

medicines and related expenses. It

provides you with essential protection

plus a range of optional extensions

that can be selected to suit your

specific insurance requirements. 

cont.

Health Insurance Cover

Specific Health Plans 

It provides covers for critical illnesses

or diseases such as heart attack,

kidney failure, etc; most insurers offer

critical illness plans. Another set of

specific insurance plans target

ailments such as diabetes and cancer.

These plans offer cash on

hospitalization, reimbursement for

expenses incurred on surgical

treatments, and such like. 

cont.

Health Insurance Cover

• Critical Illness Plan  To provide financial assistance in the

form of a lump sum, tax-free payout to help you overcome the financial stress and difficulties associated with diagnosis of a serious illness.

Critical illness insurance plans supplements mediclaim , which reimburses the hospitalization and medical expenses. Critical illness insurance plans are benefit plans that pay the amount equal to sum assured, if the critical illness strikes, irrespective of expenses incurred on treatment.

“Doctor, do you think I need an MRI?”

Contribution of government in shaping health insurance

sectorThe government has interfered

whenever the cost of the medical care

has become unreasonable. Such

government intervention is required

to make the process of medical

insurance cost-effective and

achievable especially for those who

are financial deprived.

 The government introduced

innovative healthcare products to the

medical market . cont.

Contribution of government in shaping health insurance

sector The government established

appropriate health infrastructure to

support the Mediclaim conveniences

that are offered in the market.

The government has also taken

various proposals to support the

growth of the insurance sector such

as Tax benefit offered under Sec 80 D

of the Income Tax Act.

Role of the Private Sector Companies in promoting the

Health Insurance PoliciesThe private players in the

health insurance sector have

supported their customers by

providing them affordable,

inexpensive and easily accessible

insurance

The insurance companies have given a

lot of importance to convenience of

the customer. Buying the e-policy

online has become a much convenient

alternative with the facility to renew it

anytime, anywhere.

cont.

Role of the Private Sector Companies in promoting the

Health Insurance PoliciesThe insurance companies have developed precocious Mediclaim insurance policies that not only provide comprehensive coverage but also induce various other benefits.

Another major step in the health insurance sector is the floater concept, where they cover the entire family in one policy.

Private companies are constantly improving their products to meet the needs of the people as much as possible. Such steps include various plans that cover critical illnesses, outpatient expenses and others.

Health Insurance Claim Settlement Process

Cashless

Reimbursement

Health Insurance Companies In India

In India, there are companies both in public as well as private sector providing health insurance solutions to individuals and to groups. Some of the health insurance companies in India are:

1) Life Insurance of India 2) New India Assurance 3) Royal Sundaram Insurance 4) ICICI Lombard 5) Star Allied Health Insurance and

many more. 6) Tata AIG 7) Bajaj Allianz Apollo

Apollo Health Insurance.mp4

Health Care Financing In India

The share of public financing in total health care is just about 1% of GDP compared to 2.8% in other developing countries.

Beneficiaries are both poor as well as well-fed section of society.

Over 80% of the total health financing is private financing , much of which is out-of-pocket payments (i.e. User charges) and not any prepayment schemes.

Finally,………Need of Medical Insurance Arises

Third Party Administration And Its Role

TPA stands for Third Party Administrator.

TPA is a middlemen between Insurer and the Customer . Customer can directly deal with TPA at the time of claim and TPA will help with all the process of claim settlement . A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement.

cont.

Third Party Administration And Its Role

• The concept of TPA has been introduced by the IRDA (Insurance Regulatory and Development Authority of India) for the benefit of both the insured and the insurer.

• The insured is benefited by quicker & better health service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA and a TPA can serve more than one insurance company.

cont.

Third Party Administration And Its Role

Some of the services TPA provides areMaintain database of policyholdersIssue of identity card to all

policyholdersProvide ambulance serviceProvide information to policyholders

about hospitals.Check various investigationsProvide Cashless serviceProcess claims

Tips to choose the right insurance plan

1. Adequate Coverage Amount2. Cost Benefit Ground3. Age Factor4. Age until Renewals Allowed5. Co-pay and sub Limits6. Temporary and permanent exclusions7. Covered by employer or not

Health insurance typically helps a patient manage health care costs

beyond a threshold amount through pooling

As a contingent

claim instrument,

health insurance is an efficient way to help individuals

prepare for health care

Insurer payment

(from premium

pool)Individual

paymentDeducti

bleCo-insured Health care expenditure

(INR)

Patient expenditure (INR)

Stop-loss level

ConclusionHealth insurance is an emerging

important financial tool in meeting health care needs of the people of INDIA. CBHI is to be further explored so that the disadvantaged section get maximum benefit.

In India at present no Pan-India Model of HI.

All different forms need to be explored.

Presented By: Ankita Malik Majibul Rehman Nishant Mittal Rishab Jain Vinod Seth Aman Rishi