Presentation By
Dr. Rajesh Kumar Attri, Deputy General Manager National Insurance Company Ltd. Pune Regional Office
4th May, 2012
HEALTH INSURANCE Financial security and protection to the insured
person in case of hospitalization and/or domiciliary hospitalization arising out of
1. Illnesses/Diseases
2. Accidents
TWO METHODS OF PAYMENT
1. Reimbursement
2. Cashless
PRINCIPLES OF INSURANCE Insurance is a mechanism where the losses of a few are
shared through contribution by many. It is based on the basic principles of insurance
1. Utmost Good Faith- Proposal form
2. Insurable Interest – The legal right to insure
3. Indemnity –Reimbursement subject to the limits agreed in the policy
Population Global population, 700 crs
India, 130 crs, 1.64% growth
17.5% of world population in India
2nd largest in world
China, largest, 19.4% of globe, , 0.53% growth
USA, 3rd, 4.5% of globe, 0.70% growth
Globe growth 1.30%
THE HEALTH PORTFOLIO General Insurance Industry Premium- Rs. 58325 crores
Health Premium Incl Social Sector- Rs. 13325 crores (22%)
Incurred Claims Ratio 101%
Loss Including Management Expenses 30%
POINTS TO PONDER Our Life Expectancy has risen from 36 years in 1951 to
67 years today.
Health Insurance is a necessity rather than an option
HEALTH PORTFOLIO IS THE FASTEST GROWING BUT LOSS MAKING PORTFOLIO
Health insurance schemes Voluntary health insurance schemes
Employer-based schemes
Insurance offered by NGOs
Community based health insurance (Self Help Groups, Bidi Workers, Mine Workers, Unorganized labor like Construction workers etc)
Government run schemes (ESIS, CGHS)
Health Insurance Companies
LIST OF GENERAL INSURANCE COMPANIES Bajaj Allianz
Bharti AXA General Insurance
Cholamandalam MS
Future Generali India Insurance
HDFC ERGO General Insurance
ICICI Lombard
IFFCO Tokio
L & T General Insurance
LIST OF GENERAL INSURANCE COMPANIES (contd) National Insurance Co Ltd
New India Assurance Co Ltd
Oriental Insurance Co Ltd
Raheja QBE General Insurance
Reliance General Insurance
ECGC
Agricultural Insurance Co. Ltd.
LIST OF GENERAL INSURANCE COMPANIES (contd) Royal Sundaram
SBI General Insurance
Shriram General Insurance
Tata AIG General
United India Insurance Co Ltd
Universal Sompo General Insurance
Standalone health insurance Companies Apollo Munich Health Insurance
Max Bupa Health Insurance
Star Health Insurance
Religare Insurance Company
VARIETY OF COVERS IN GENERAL BRANCH Individual Health Policies
Group Health Policies
Family Floaters
Students Health covers
Senior Citizens covers
Overseas Health Covers
Critical Illness cover
Tailor Made Group Health Covers
Specially designed covers for Bank Tie Ups
Special policies for the social sector like UHIS, RSBY, RGJAY
INDIVIDUAL MEDICLAIM POLICY Individuals from the age of 18 till 59 can take this
cover.
Sum Insured ranges between 50000 to 5 lacs. Can be increased subsequently upto 10 lacs
Hospitalisation expenses arising due to disease and illness is covered.
Pre-existing diseases covered from the fifth year onwards after 4 claim free year.
GROUP MEDICLAIM POLICY Pre-Defined Groups/
Association/Institution/Corporate body like Employer Employee, subscribers to common facility like Account holders of banks, Credit Card holders etc.
Maternity Extension allowed with 10% loading in premium and benefits upto Rs. 50000/-
PARIVAR MEDICLAIM INSURANCE A Family Floater cover
Self, Spouse and 2 Children upto 25 years.
Age band 3 months to 60 years
One illness upto 50% of Sum Insured
SI from Rs. 2 lacs to Rs. 5 lacs. In multiples of Rs. 50000
VIDYARTHI MEDICLAIM FOR STUDENTS Age Group from 3 to 25 years.
Three Sections, Section I covers hospitalization of the student, Section II covers PA to Parents and Section III covers PA to the Student.
Sum Insured under Sec I ranges from Rs. 50000 to Rs. 2 lacs, Sec II will be twice Sec I and Sec III is restricted to Rs. 50000
VARISHTA MEDICLAIM FOR SENIOR CITIZENS Individuals above the age of 60 upto 80 years
Sum Insured of Rs. 1 lac for hospitalization and Rs. 2 lacs for Critical Illness or dreaded diseases cover. (Cancr, stroke, Multiple schlerosis,Coronary Artery Surgery, Renal failure, Major Organ Transplant and optional covers are Paralysis and blindness)
OVERSEAS HEALTH INSURANCE Specialy designed to protect persons travelling
overseas for business, holiday, studies or employment when sponsored or posted by Indian employer.
Emergency health expenses incurred to relieve immediate pain and to save life
Apart from illnesses and diseases, covers accident, loss of checked baggage, delay of checked baggage, loss of passport and personal liability during travelling abroad.
CIRITICAL ILLNESS INSURANCE Benefit policy targeting age group from 18 to 60 years.
Covers eight dreaded diseases (Cancer, Stroke, multiple sclerosis, major organ transplant, paralysis, blindness, renal failure and coronary artery surgery)
Person is given the sum insured in the event of inception or manifestation of the disease and survival of 30 days thereof. No claim is payable for the first 90 days.
SOCIAL SCHEMES UHIS: Sum insured of Rs. 30000/- per family with a
per sickness limit of Rs. 15000/- Premium is shared by the Central Government for persons below poverty line.
Rajiv Gandhi Jan Arogya Bima: Scheme introduced by Maharastra Government (Operated by National Insurance ) Sum Insured per family is Rs. 150000.
Rastriya Swasthya Bima Yojana
Some important features. Pre-existing exclusions.
Waiting period of 30 days
1st/2nd year exclusions.
Free Health check up after 4 continuous claim free years.
Cumulative Bonus
GLARING TRUTHS Health Premium grew from 774 crs (Out of 12100 crs
overall) in 2000 to 13325 crores (Out of 58325 crs overall ) in 2012
It was a meagre 6% of the GDPI in 2000 and has reached the figure of 23% of the GDPI in the year 2012. It will very soon cross the Motor portfolio, which is the major contributor to the GDPI
WHY IS THIS PORTFOLIO LOSS PRONE Improper Underwriting Management
Policies are not taken by persons who should. Proposers in higher age bracket and prone to sickness. Thus there is an adverse Selection against Insurers
Hospitals charges are not Regulated
Failure of rural schemes due to mismanagement; Benefits do not reach the target beneficiaries, due to many reasons ; eg lack of awareness, exorbitant medical expenses etc.
THE REMEDY: TOWARDS PROFESSIONAL UNDERWRITING
Have a more scientific method of rating proposals.
Lower the age, lesser the premium
Lower premium for non-smokers and non-drinkers
Lifestyle discount like Gym members etc.
Active grievance redressal system
THE REMEDY: TOWARDS PROFESSIONAL UNDERWRITING
Medical Underwriting, Recruitment of Medical Professionals to assist in underwriting
Targeting the young world Creating proper awareness, Product improvement and development etc. Redefining the need of health insurance, by inspiring the youth to take
covers. This can be achieved through Publicity in the print and visual media,
seminars and conferences, Interaction with the insuring public, the hospitals , the Third Party Administrators etc.
INSPIRING THE YOUTH TO EARN WHILE THEY EARN. Insurance Agency is the best method of earning while learning.
MAKING HEALTH INSURANCE VIABLE AND A WIN WIN SITUATION FOR BOTH THE INSURED AND THE INSURERS
OPPORTUNITIES/STRATEGIES MEDICAL PROFESSIONALS FOR UNDERWRITING
AND CLAIMS ASSISTANCE
INSURANCE AGENCY TO SELL HEALTH INSURANCE
PRODUCT DEVELOPMENT TO ENCOMPASS WORLDWIDE HEALTH COVER
Medical Tourism Indian medical tourism that was valued at US$350
million in 2006, is estimated to grow into a US$2 billion industry by 2012
Medical Tourism has a great potential for development of Health Insurance
Health cover should be considered for NRIs .
CONCLUSION Insurance Awareness and Feasibility should reach the
levels of Western Countries.
It is a long way to go but we shall achieve.