Health Insurance
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Health insurance provides coverage for medical expenses and loss of earnings due to illness or injury. It depends on the conditions, benefits, and treatment options covered by the policy. Premiums are paid in advance for future health coverage. There are different types of health insurance plans such as group, individual, and family floater plans. While perceptions of health insurance in India are mixed, it has become necessary due to rising medical costs, the need to share health risks, and securing one's family's health. Government initiatives aim to increase health insurance penetration and affordability, but challenges remain around healthcare delivery and costs, consumer awareness, and claim ratios.
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- 2. What is HealthInsurance?Health Insurance provides cover against loss from illness or bodily injury. It can pay for medicine, visits to the doctor, hospital stays, other medical expenses and loss of earnings. It depends on the conditions covered and the benefits and choices of treatment available on the policy. A fee called premium is paid for advance health coverage.Buying a PromiseTypes of Health Insurance Plans:Group Insurance Plan for groups like employees of a company, members of an association or a co-operative society and so on.
- 4. Floater Insurance Plan - can be availed individually or by all the members of the family. It provides single premium for the entire family.
- 5. Unit Linked Health Plan - such plans combine health insurance with investment and pay back an amount at the end of the insurance term. The returns of course are dependent on market performance.HealthInsurance further categorizedPrivateRisk rated & offered by commercial organizationSocialNon risk rated & initiated by Govt.Community Based/ NGOsLeading health care insurance companies are constantly coming out with new plans to meet the requirements of their customers.
- 6. The State of HealthCare in India:Indias healthcare infrastructure has seen steady improvement in the recent past, but much remains to be accomplished.Government spending is less than 25% against the average spending of 30 -40% in other neighboring countries.Healthcare providers have expanded their operations considerably and stand-alone health insurance products are now sold by general insurers and life insurers, as well as by new specialist health insurers. The third party administrator (TPA) landscape has also undergone noteworthy changes in the past few years.Healthcare costs in India account for 5% of GDP, 80% of this is private out-of-pocket spend. With hospitalised Indians spending almost 60% of their annual expenditure on healthcare, the need for good quality, affordable health insurance is already high.
- 7. HealthInsurance Market size and Growth Rate
- 9. Getting claims is difficult and important ailments not covered
- 10. Meant for the rich, educated or those in business
- 12. Benefits hospitals more than holders
- 13. Money goes waste when young
- 15. Good mix of return and security
- 17. A way to take care of responsibilities and be self reliant Negative Perception Positive Perception
- 18. What you spend on your health:Indirect costs such as travel, lodging etc add to financial burden and most often these expenses are overlooked while planning for medical expenses.
- 19. Why do we need HealthInsurance?Having Health Insurance has become the need of the hour for several reasons: Change in lifestyle and attitude have made Indians more prone to health issuesRising medical costs
- 21. Sharing the burden of health related risk
- 22. Securing the health of your family
- 23. Securing the health of senior citizens
- 24. Tax benefit under section 80D
- 25. Helps preserve savings/investment for life
- 26. Prevents indirect costs and extra expenses
- 27. Increases productivity of workforce
- 28. Helps represent a healthier state and country
- 29. Keeping pace with customer needs while achieving profitability.
- 30. HealthInsurance: Challenges Limited Influence over healthcare delivery mechanism Limited bargaining power
- 31. High claim ratio - Insufficient data on consumers & disease patterns, absence of standardization of healthcare costs & significant levels of frauds leading to under-pricing of insurance products and higher value of claims Low level of consumer awareness
- 32. TPAs facing funding support resulting in delays and impacting the claims disbursement time.` Low health insurance penetration and lack of affordability for low income consumers
- 33. Government Initiatives CGHS Schemes for Government Employees
- 34. ESIS Schemes
- 35. Recent Initiative - covering mass populace PAN India
- 36. RSBY
- 37. With participation of health insurer
- 38. Implemented in 11 states
- 39. Extended to other section of populace other than BPL
- 40. State Government have also initiated several schemes where there is participation of Insurers to run the Scheme
- 41. HealthInsurance Focus Creating awareness on Rights & Responsibilities
- 42. Data Pool Regulator as a repository
- 44. TPAs
- 45. Health Providers
- 47. Removal of Service Tax
- 48. Standardization of definition a right step ahead
- 49. Standard Pre-Existing exclusion defined w.e.f. 01/06/08
- 50. Gradation of Health service providers
- 51. Pool for Senior Citizen
- 53. Compulsory Health Benefits for organized sector
- 54. Government role on mass healthcare initiativesHealthInsurance way to go