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Health insurance ppt


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  • 1. Health Insurance Challenges & Opportunities
  • 2. What is Health Insurance? Health Insurance covers your medical expenses due to diseases and accidents Health Insurance is a contract between an individual/group and the insurer The policy provides specific health cover for a particular premium
  • 3. Reasons for Health Problems Fast Lifestyle Diseases common in children Food Habits Lack of Exercise Mental Stress & Strain Pollution New Types of Diseases Expect the unexpected like Accidents .
  • 4. Rising Health Care Costs - Reasons Speciality health care Investigative type of treatment Hospital infrastructure Medical equipment Cost of living/Inflation Rising drug prices Super speciality doctors Defensive Medical practice
  • 5. Why is health insurance essential? Unaffordable health care No basic public health services Increasing life expectancy Increasing percentage of the elderly persons Health is wealth Good news – Health insurance is affordable
  • 6. Health Insurance Market in India Fastest growing segment (avg. 20% growth) Growth: Expected By 2015: 30000 Cr. 24companies offering health insurance 100+ types of medical insurance policies Potential market: Semi- urban areas
  • 7. Health Care Scenario in India Health care expenditure is 6% of GDP Govt. spending < 25% as against 30%-40% in other countries Only a small section of the population is covered
  • 8. Health Insurance – Role of Hospitals In Kerala, people are conscious of health care; but mostly unaware of health insurance Hospitals are the right place for creating awareness of health insurance Enough time for patients and relatives to study various types of policies and their benefits
  • 9. Issues & Challenges for Insurance companies Limited Influence over healthcare delivery mechanism High claim ratio – Around 140% Low level of consumer awareness Limited product development Limited knowledge for staff/Agents
  • 10. Issues & Challenges: Healthcare providers Pricing demands from Insurance companies Lack of proper communication between TPAs and Hospitals Delay in Settlement of Claims Lack of Training support from Insurers as well as TPAs Pre existing diseases disputes between consumer and TPAs Different Insurance Companies – different policies, terms etc
  • 11. Expectations from Hospitals No overcharging for insured patients No fraudulent medical certification Pre-existing diseases & treatment education No mis-handling of patients in front office Classification of hospitals & transparency Economical treatment for poor / BPL patients No unwanted investigations, treatments, delays No manipulation of records Ex: [Alcoholic accidents and into Road accidents]
  • 12. Insurance Education Health Insurance–different types Proposal fillings Premium calculation Income Tax benefits Cashless/Reimbursement Group/family discounts Policy comparisons Claims process Prompt reimbursements
  • 13. Recommended Policies Individual Policies Family Floater Policies Group Policies (customized) Senior citizen Plans Critical Illness Policies Surgical benefit policy Hospital Daily Cash Policies Super Top up Policies Students Policies Micro & social security Schemes
  • 14. Health Insurance Promotion Health Insurance Posters/ Banners etc Simple Health insurance leaflets in Malayalam Insurance Help Desk Policy details, comparisons, premium charts, claim procedure Documentation assistance
  • 15. Benefits to the public Developing insurance awareness Selection of suitable insurance policies No immediate cash outgo thanks to cashless facility Tension free claim settlement process
  • 16. Encash the opportunity Developed Countries – 100% health insured India Emerging Economy – Untapped Market Kerala - Health conscious people Kerala – Low awareness of Health Insurance Be a part of social development through promoting health insurance
  • 17. Thank You Prepared by Viswanathan Odatt Director Aims Insurance Broking