Date post: | 20-Mar-2017 |
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HISTORY OF HEALTH INSURANCE
Hamurabi Managed Care Circa 1700 BC
Health Insurance rules carved on a stone Codex Hammurabi Rates set for general surgery Fees set on ability to pay Owners to pay for slaves Consumers & Patient’s rights to be advertised
Modern Health Insurance
Blue Shield & Blue Cross (1st half 20th century )
Medicare (1960)
Medicaid (1960)
NHS (1946)
Prime Minister Health Ins Scheme
Jubilee life ; 1570
Adamjee ; 1272
Allianz EFU ; 994
Jubilee General; 801
IGI Life ; 411
AsiaCare; 340
Al-falah; 286
Others; 806
Gross Premium (Million)
Jubilee life 24%
Adamjee 20%
Allianz EFU 15%
Jubilee General12%
IGI Life 6%
AsiaCare5%
Alfalah4%
Others12%
Market size in (%)
Jubilee life Adamjee Allianz EFU Jubilee General IGI Life AsiaCare Alfalah IGI General
87%104%
94%
114%
102%
122%
92%
131%
75%
90%74%
83%81% 80% 79%
106%
Loss Ratio of Top 8 CompaniesWith Admin Exp Without Admin Exp
H Hospitalization Premium
On average per year 10 % of Insured shall be hospitalized
10% of the insured Average hospital Bill
0-17 18-25 26-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
0
2000
4000
6000
8000
10000
12000
14000
16000 Rise of premium with age
Premium
Age Premium % Loading or discount
0 - 17 1287 44 %
18 - 25 1543 _ 33 %
26 - 29 1794 _ 22 %
30 - 34 2048 _ 11 %
35 - 39 2297
40 - 44 2608 + 14 %
45 - 49 3054 + 33 %
50 - 59 4758 + 106 %
60 - 64 5956 + 160 %
65 - 69 7146 + 210 %
70 - 74 14294 + 520 %
Maternity Premium
On average 30% of Total Fertile ( below 45) shall avail maternity benefit
30 % of fertile female Average Maternity bill
Coverage• Inpatient Hospitalization / Surgery • Maternity• D & C / Missed abortion• Daycare procedures under local anesthesia• Cataract• Biopsy• MRI/ CT Scan• Endoscopy• Angioplasty / CABG• Chemotherapy• ICU
Exclusions• Dental• Cosmetic• Emergency / short stay• Hormonal therapy• External devices / Implants• Experimental treatment• Out of country planned treatment• Self inflicted / suicide • Sports injury• Psychiatric Treatment
Percentage of medical cost shared by the insured patient as agreed upon at the time of policy inception, with or without a cap limit
e.g 10% copayment means for a medical claim of Rs 10,000 insured shall pay Rs 1000 whilst insurance company shall pay Rs 9000
Deductible
A fixed amount ( regardless of cost of medical claim ) to be paid by the insured patient at the time of medical claim, as agreed at the time of policy inceptione.g Rs 2000 deductible means for a medical claim of Rs 20,000 insured shall pay Rs 2000whilst insurance company shall pay Rs 18,000
Pre existing conditions
Any disease ,condition or symptom for which the insured sought treatment , consultation or was aware of , before the inception of policy
Reimbursement
• Policy of Reasonable & customary reimbursement
• REASONABLY AND CUSTOMARY (Bench Marking )• Hospitalization expenses for a particular surgical
procedure / conservative management by a panel hospital of similar standard in the vicinity