health insurance scheme by different insurance company

1. PSD In health insurance provided by
different private insurance company
of Nepal
Presented By: Sirjana Tiwari
Roll No: 17690006

2. ACKNOWLEDGEMENT
• As being MPH 3rd sem PHSM students, I am greatly
thankful to our subject teacher Naveen Shrestha for
an opportunity to learn in a real field.
• I gratefully acknowledge the contributions of Dr.
Damaru Prasad Paneru, Director of SHAS, Mr.
Chiranjivi Adhikari, Program Coordinator of MPH,
and Professor Dr. Arun Kumar Koirala for their
cooperation and guidance throughout the progra
• I would like to acknowledge the efforts Dr Rabindra
Ghimire for providing be necessary guideline and
reading material management. 2
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3. EXECUTIVE SUMMARY
Introduction
• Insurance is the equitable transfer of the risk of a loss
and is a form of risk management primarily used to
hedge against the risk of a uncertain loss.
• Health insurance from different insurance company
of Nepal includes insurance against the risk of
incurring medical expenses among individuals, for
the payments of benefits as a result of sickness or
injury includes insurance for losses from accident,
medical expense, disability, or accidental death and
dismemberment. (APA) 3
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4. OBJECTIVES
General objective
• To study about the health insurance and its
types provided by insurance company of Nepal
Specific objective
• To understand the detail about health
insurance.
• To study the types of health insurance
schemes.
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5. METHODOLOGY
method : Review of secondary data sources
Study area: School of Health and allied science,
Pokhara University.
Tool: Search engine Google and Google schloor
Technique: literature review
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6. BACKGROUND
• Insurance is the equitable transfer of the risk of a loss,
from one entity to another in exchange for payment.
• Health insurance can either reimburse the insured for
expenses incurred from illness or injury or pay the
care provider directly.
• In absence of government universal health insurance,
many health insurance schemes were initiated in rural
and semi urban area by non-insurance organizations.
• They have some limitations like: pricing of the
product is not supported by the actuarial pricing
approach 6
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7. RATIONALE
• The rationale behind the appraising of life insurance
performance is increasing interest of policyholders
and investors towards the life insurance sector,
growing share of life insurance to financial sector and
globally rising the financial vulnerability in life
insurance industry
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8. LITERATURE REVIEW
• There is free of cost health care facility to
government civil servants including army and police
form Government hospital but public has to pay for
medical treatment and medicine except general health
check-up and medical examination. A study shows
that more than 90 percent of the medical expenditure
is born by out of pocket expenses (MoHP, 2012).
• During the fiscal year 2072/73, we have settled 528
death claims for an amount of Rs 128.92 Millions.
The total death claims settled since inception is 2822
in which we have paid Rs 522.22 Million.
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9. Limitations of the study
• This study is only limited to medical insurance
scheme provided by different life insurance company
of Nepal.
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10. RESULTS
1. Shikhar Insurence
• Cover expenses and offers Cashless Treatments in
many hospitals in Nepal one can buy this policy for
self, couples, families, and/or corporate employees
from 2 Lakhs - 20 Lakhs.
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11. 1. Shikhar Insurence
The eligibility for this policy is from 5 - 65 years of age
• 100% coverage arising from medical expenses
incurred during hospitalization for
• More than 24 consecutive hours, 30 days pre
hospitalization ,60 days post hospitalization, 150
Named advanced technological surgeries and
procedures that require less than 24 hours of
hospitalization
• Health check up is required for people over the age of
45 plus or for anyone availing insurance exceeding
Rs. 5 lakhs
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12. 2.Sagarmatha Insurance
• Cover against any sudden illness, accident or injury to
the insured when travelling.
• Medical and emergency expenses.
• Personal accidents.
• Hospital benefits+ children health insurance
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13. 3. Rastriya Bema
• Medical Aid Insurance: In this insurance, the
expenses resulting from the medical treatment of the
personnel employed in any institutions or offices and
their families are covered for Illness during travel is
also embraced under this insurance policy.
• Workmen Compensation Insurance
• Personal Accident Insurance
• Traveling Medical Insurance
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14. 4. American life Insurance
Natural Death: Family gets the basic income
protection in the event of death. Accident +
Accidental Death+ Permanent Total Disability
• Covers a lump sum payment of cash to protect your
family against this serious and potentially devastating
risk.
• Pay for medical bills treated at any medical center.
• Cash compensation for temporary disability.
• Replaces loss of income due to Death and serious
disabilities by providing monthly Income for life
time, with a minimum guarantee of 20 years. 14
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15. 4. American life Insurance
Accident & Sickness In-Hospital Surgical Expenses
Provides cash compensation for surgical expenses as
per surgical schedule.
Key Features
• reimburse your Bills.
• Protection against financial burden caused by
unforeseen event like accident.
• compensates your Income when you are unable
to work
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16. 5. Surya life insurance
Death Benefits:
• In case of death during the premium paying term, the
basic sum assured plus vested bonus up to death is
paid.
• In case of life assureds death after the premium
paying term then, an amount equal to sum assured is
paid (without any bonus additions).
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17. 5. Surya life insurance
• Additional Benefits:
A double accident benefit is available up to age 70
irrespective of premium paying term, by payment of
additional premium as per accident benefit premium
table applicable to this plan, at the option of life
assured subject to maximum upto Rs. 50,00,000/-
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18. 6. Nepal insurance
• Travel Medical Insurance for traveling outside their
home country for certain period of time
• Personal Accident insurance: annual policy
compensation in the event of injuries, disability or
death caused soley by violent, accidental, external
and visible events.
• Group personal Accidental death cover, disability
covers all the employees under one policy.
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19. • Group Medical Insurance: includes hospitalization
expenses, medicine, consumables, and diagnostic
expenses.
• Health insurance: Covers the cost of an insured
individual's medical and surgical expenses
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6. Nepal insurance

20. 7. The Oriental
• Cover Hospitalisation/Domiciliary Hospitalisation of
the Insured in respect of the following situations:
• (A) In case of a sudden illness
• (B) In case of an accident
• (C) In case of any surgery of any disease
• The cover also extends to pre- hospitalsation and post
hospitalisation for periods of 30 days and 60 days
respectively
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21. 8. Prime Life
• Accidental Death Benefit (ADB)
• (Equal to basic sum assured or maximum NPR.
5,00,000 whichever is less)
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22. 9. Sunrise bank
• The health insurance facility shall be up to 25%
of weighted average deposit during last 365 days of
saving deposit or the bill amount whichever is lower,
with a maximum limitation of Rs. 1,00,000 (In
Words: One Lac Only) only hospitalized case once in
a year
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23. DISCUSSION
• Commercial insurers offered health insurance products in
different names since 1993.
• Travel insurance and group health insurance are more
popular health insurance policies in insurance industry.
• There are different names of health insurance products
offered by commercial insurers.
• The common products are: Travel medical insurance,
group and personal accident insurance, Medicare
insurance, international travel and Medicare insurance,
health insurance, Hospitalization Insurance and so on.
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24. CONCLUSION
• Doing life insurance culture is steadily growing in
Nepalese society through different insurance
company either they are private, joint venture or
government.
• Those live insurance which include health insurance
is more acceptable. Similarly, Most of Nepalese
people have growing concern on their health so they
are ready to purchase health insurance
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25. CONCLUSION
• Beside government free health care and health
insurance policy, the out of pocket expenditure in
Health is 63% so people are unhappy to spend major
portion of their income in health care.
• In such situation Nepalese people are happy for
health treatment through insurance. Instead most of
the people are unaware about different health
insurance scheme to claim in their critical situation
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26. RECOMMENDATIONS
• Health insurance scheme offered by different
insurance company is not actually Positive health
insurance/public health insurance. It's only for cost
increment. So it would be better to lunch such type of
health insurance that facilitates uplifting people
health through preventive health scheme.ie regular
monitoring of their health status through frequent
health checkup.
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27. LESSON LEARNED
• Enhanced the knowledge level through updated
information.
• New learning opportunity in health insurance scheme
besides health sectors.
• Identifying key management, policy and ethical
issues in Health insurance scheme provided by
different private insurance company of Nepal.
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28. REFERENCES
• Ghimire, R. (2013). Community Based Health
Insurance Practices in Nepal. International Research
and Reviews, 2(4)
• Kedare, S. D. M. (2012). Health insurance:
Identifying awareness, preference, and buying pattern
in Mumbai. Phil Dissertation for Padmashree Dr. D.Y.
Patil University, Department of Business
Management.
• Ghimire, R. (2018). "Health Insurance Awareness
Among the University Teachers in Pokhara Valley."
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