Health insurance1


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Health insurance1

  1. 1. Health Insurance<br />By <br />LokeshPayasi<br />
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  4. 4. What is Health Insurance<br />The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs.<br />To understand it in simple words , you pay some amount of premium every year to a company and if some thing happens to you like an accident or if you have to through an operation or a surgery , they will pay for it provided , its covered under the Health Insurance.<br />
  5. 5. Types of Health Insurance1. Individual Mediclaim<br />The simplest form of health insurance is the Individual Mediclaim policy. It covers the hospitalization expenses for an individual for up to the sum assured limit. The insurance premium is dependent on the sum assured value. Example : If you have 3 family members you can get an individual cover of Rs 2 lacs each . In this case each of you are covered for 2 lacs , if 3 members face a need for hospitalization , all 3 of them can get expenses recovered upto Rs 2 lacs . All the 3 policies are independent .<br />
  6. 6. Types of Health Insurance2. Family Floater<br />Family Floater Policies are enhanced version of the mediclaim policy. The sum assured value floats among the family members. i.e  each opted family member comes under the policy, and it covers expenses for the entire family up to the sum assured limit. The premium for family floater plans is typically less than that for separate insurance cover for each family member<br />
  7. 7. Taking the ULIP route, health insurance companies too have introduced Unit Linked Health Plans. 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. These plans are very new and still in development phase . <br />Types of Health Insurance2. Family Floater<br />
  8. 8. Why Health Assurance<br />Increasing incidence of chronic ailments and lifestyle diseases results in a steady outflow of funds to meet medical expenses such as diagnostics, medicines and doctor visits which are usually not covered by traditional health insurance plans. This becomes more pronounced in old age, as very few individuals plan for it. Further, the increasing health cover premiums at higher age groups are also a cause of concern.(I-PRU)<br />
  9. 9. Some Statistics(Road Accident)<br />Road accidents last year – more than 130,000 dead, set to increase to jump to 150,000 (per annum) by 2015. <br />10 percent of the (million-plus) fatal accidents in the world happen in India <br />India has just 1 percent of the world’s vehicles, but accounts for 10 percent of the world’s road accidents <br />We lose 3 percent of our GDP per annum due to road accidents <br />70 percent of road accidents take away the main wage earner <br />Total number of people killed in road accidents was 94,985, next only to China where 98,738 people were killed.<br />
  10. 10. Some Statistics( Critical Illness)<br />Heart Attacks are the number one cause of death globally: more people die annually from CVDs than from any other cause. <br />An estimated 17.1 million people died from CVDs in 2004, representing 29%of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke. <br />82% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women. <br />By 2030, almost 23.6 million people will die from CVDs.<br />
  11. 11. Some Statistics( Critical Illness)<br />Cancer is a leading cause of death worldwide: it accounted for 7.9 million deaths (around 13% of all deaths) in 2007. <br />Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year. <br />The most frequent types of cancer differ between men and women. <br />About 30% of cancer deaths can be prevented. <br />About 72% of all cancer deaths in 2007 occurred in low- and middle-income countries. <br />Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.<br />
  12. 12. Health Insurance Plans1. Critical Illness<br />Plz Answer<br />Aren’t we in Hurry for every work?<br />Do we exercise?<br />Aren’t our eating habit good?<br />Critical <br />Illness<br />
  13. 13. This all-inclusive long term insurance policy provides coverage against some critical illnesses, total and permanent disability, and also death.<br />So, get the right protection tailored to suit your lifestyle, with these kind of plans which are• Comprehensive• Affordable• Long Term<br />Health Insurance Plans1. Critical Illness<br />
  14. 14. Health Insurance Plans1. Critical Illness<br /> Key benefits of plans based on critical illness.<br />Benefit amount paid on diagnosis of any of the diseases i.e. critical Illnesses(max is 35), disability or death <br />Receive lump-sum benefit amount irrespective of actual billing <br />Benefit amount will be paid in addition to payment received by you from other medical insurance plan <br />Long term coverage upto 75 years of age <br />Coverage continues even after claiming benefit on select critical illness <br />Premium paid is eligible for deduction under section 80C & section 80D<br />
  15. 15. Health Insurance Plans2. Hospital Benefits<br />Hospital Benefits plans offer the following key benefits:<br />Fixed benefits to cover hospitalisation, ICU admission, surgical procedure and also recuperating benefit  <br />Benefit amount in addition to other medical insurance plans, irrespective of actual billing <br />Additional benefits for prolonged stay & non surgical hospitalisation<br />Guaranteed insurability at renewal for whole life <br />Tax benefits under section 80D <br />Cashless claim settlement  <br />A family floater option <br />Health check-up<br />
  16. 16. Others plan (ULIP+HEALTH)<br />
  17. 17. (ULIP+HEALTH)cont…<br />Cover Continuance Option<br />This option ensures that your policy continues subject to foreclosure in case you are unable to pay premiums, any time after payment of the first five years’ premium. All applicable charges will be automatically deducted from the units available in your fund. You will need to opt for cover continuance, if you wish to avail of this benefit.<br />Death Benefit<br />In the unfortunate event of death of the primary insured member during the term of the policy, the nominee shall receive the total fund value and the policy shall be terminated.The fund value paid out on death of the primary insured may be taxable in the hands of the nominee as per the prevailing tax regulations at that time.<br />In the unfortunate event of death of any other insured members the policy would continue for remaining insured members with the appropriate reduction in health insurance charges.<br />Increase or Decrease in Premium <br />You can increase or decrease the annual premium under the policy (subject to minimum premium grid), but such an increase or decrease would be allowed at next premium due date.<br />Next Slide for Health Saver from ICICI-Pru.<br />
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  19. 19. Health Insurance Claims settlement process<br />Cashless : For availing cashless treatment (only at authorized network hospitals), the TPA has to be notified in advance (for planned hospitalization) or within the stipulated time limits (for emergencies). The insurance desk at hospitals usually helps with all paper work. The claim amount need to be approved by the TPA, and the hospital settles the amount with the TPA/ Insurer. Typically there will be exclusions and such amount will have to be settled directly at the hospital.<br />
  20. 20. Reimbursement : Reimbursement facility can be availed at both the network and non-network hospitals. Here the insured avails the treatment and settles the hospital bills directly at the hospital. The insured can claim reimbursement for hospitalization by submitting relevant bills/ documents for the claimed amount to the TPA.<br />Health Insurance Claims settlement process<br />
  21. 21. Thank You<br />