Date post: | 08-Mar-2015 |
Category: |
Documents |
Upload: | majibul-rehman |
View: | 3,664 times |
Download: | 2 times |
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