Health Insurance


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Health Insurance

  1. 1. Importance of HealthInsurance<br />
  2. 2. What is HealthInsurance?<br />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.<br />Buying a Promise<br />Types of Health Insurance Plans:<br /><ul><li>Group Insurance Plan– for groups like employees of a company, members of an association or a co-operative society and so on.
  3. 3. Individual Insurance Plan
  4. 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. 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.</li></li></ul><li>HealthInsurance further categorized<br />Private<br />Risk rated & offered by commercial organization<br />Social<br />Non risk rated & initiated by Govt.<br />Community Based/ NGOs<br />Leading health care insurance companies are constantly coming out with new plans to meet the requirements of their customers.<br />
  6. 6. The State of HealthCare in India:<br />India’s healthcare infrastructure has seen steady improvement in the recent past, but much remains to be accomplished.<br />Government spending is less than 25% against the average spending of 30 -40% in other neighboring countries.<br />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.<br />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.<br />
  7. 7. HealthInsurance Market size and Growth Rate<br />
  8. 8. Mixed perceptions about<br /> Health Insurance in India<br /><ul><li>Requirement of people over 45
  9. 9. Getting claims is difficult and important ailments not covered
  10. 10. Meant for the rich, educated or those in business
  11. 11. Uncertainty about benefits
  12. 12. Benefits hospitals more than holders
  13. 13. Money goes waste when young
  14. 14. Tax saving instrument
  15. 15. Good mix of return and security
  16. 16. Useful during emergencies
  17. 17. A way to take care of responsibilities and be self reliant</li></ul> Negative Perception<br /> Positive Perception<br />
  18. 18. What you spend on your health:<br />Indirect costs such as travel, lodging etc add to financial burden and most often these expenses are overlooked while planning for medical expenses.<br />
  19. 19. Why do we need HealthInsurance?<br />Having Health Insurance has become the need of the hour for several reasons:<br /><ul><li> Change in lifestyle and attitude have made Indians </li></ul> more prone to health issues<br /><ul><li>Rising medical costs
  20. 20. Uncertain hospital bills
  21. 21. Sharing the burden of health related risk
  22. 22. Securing the health of your family
  23. 23. Securing the health of senior citizens
  24. 24. Tax benefit under section 80D
  25. 25. Helps preserve savings/investment for life
  26. 26. Prevents indirect costs and extra expenses
  27. 27. Increases productivity of workforce
  28. 28. Helps represent a healthier state and country
  29. 29. Keeping pace with customer needs while achieving </li></ul> profitability.<br />
  30. 30. HealthInsurance: Challenges<br /><ul><li> Limited Influence over healthcare delivery </li></ul> mechanism<br /><ul><li> Limited bargaining power
  31. 31. High claim ratio - Insufficient data on consumers & disease </li></ul> patterns, absence of standardization of healthcare costs & <br /> significant levels of frauds leading to under-pricing of insurance <br /> products and higher value of claims<br /><ul><li> Low level of consumer awareness
  32. 32. TPAs facing funding support resulting in delays </li></ul> and impacting the claims disbursement time.`<br /><ul><li> Low health insurance penetration and lack of </li></ul> affordability for low income consumers<br />
  33. 33. Government Initiatives<br /><ul><li> CGHS Schemes for Government Employees
  34. 34. ESIS Schemes
  35. 35. Recent Initiative - covering mass populace PAN India
  36. 36. RSBY
  37. 37. With participation of health insurer
  38. 38. Implemented in 11 states
  39. 39. Extended to other section of populace other than BPL
  40. 40. State Government have also initiated several schemes where there is </li></ul> participation of Insurers to run the Scheme<br />
  41. 41. HealthInsurance – Focus <br /><ul><li>Creating awareness on Rights & Responsibilities
  42. 42. Data Pool – Regulator as a repository
  43. 43. Standardization of Cost
  44. 44. TPAs
  45. 45. Health Providers
  46. 46. Increased Tax benefit
  47. 47. Removal of Service Tax
  48. 48. Standardization of definition – a right step ahead
  49. 49. Standard Pre-Existing exclusion defined w.e.f. 01/06/08
  50. 50. Gradation of Health service providers
  51. 51. Pool for Senior Citizen
  52. 52. Renewability / Portability
  53. 53. Compulsory Health Benefits for organized sector
  54. 54. Government role on mass healthcare initiatives</li></li></ul><li>HealthInsurance – way to go <br />