Introduction to Health Insurance in Tanzania

1. HEALTH INSURANCE
Fundamental of Insurance
Prepared By:
Salum Mlaponi
Insurance Practitioner-Tanzania

2. Introduction to Health Insurance
 In our everyday life we are exposed to numbers and innumerable risks. Those
risk can be physical risk that affect our health and safety or financial risk that
may result to declines in our income.
 Income can be reduced by death, accidental injury, sickness or disability or an
increase of liability due burden of medical expenses. The list of risk we face
is endless.
 If this risks remain uninsured forces poor households to undertakes costly
strategies to manage their incomes and assets which in return contributing to
increase of poverty.

3. Introduction Cont…….
 Many people manage those risk by their own means (especially informal
mechanisms) eg cash saving, informal borrowing or even selling of their assets
at lower price.
 Therefore these risk constitute the true need to insure some of or all risks to
protect our income, and this is the fundamental object of health insurance
 Health insurance protect our income reduction arise from risk of disease,
injury or damage to our physical self.

4. Category of Health Insurance
 Health Insurance Can be categorized as follow:
 Personal Accident
 Sickness Cover
 Medical Expenses

5. Personal Accident
 Accidents results to financial problem to the insured or his dependents.
Therefore this cover designed to provide compensation to individual if he
suffer from a serious injury or death as a results of an accident.
 Thus to say this type of health insurance provide a payment of agreed fixed
amount in the event of accidental death or if a person sustain bodily injury.
 This type of health insurance can be taken by private individual in respect of
their own welfare or by group of people of the same interest eg employers for
his employees.

6. Personal Accident Cont……
 The main benefit provided under personal accident cover are:
 Payment of sum fixed amount in the event of death.
 Payment of sum amount in the event a person loss his limbs, eyesight, etc
 Payment of agreed amount if a person suffer Permanent Total Disablement
(PTD) i.e certain condition where recovery is unlikely eg Paralysis.
 Payment of sum amount if a person suffer from Permanent Partial
Disablement (PPD) i.e permanent injury that do not prevent from returning to
normal life style eg Loss of finger

7. Continue……….
 Payment of weekly benefits if a person suffer from Temporary Total
Disablement (TTD) i.e an injury that does not result to death or PTD, but
makes an injured person unable to perform regular duties, but is likely to
return in his normal condition.
 Payment of weekly benefits if a person suffer from Temporary Partial
Disablement (TPD) i.e a person suffer an injury that results to loss the ability
to work in his full capacity for certain period of time but can perform some
sort of role at their job.

8. Sickness Cover
 This type of insurance that provide agreed weekly benefits to a person who
suffer from certain sickness.
 Sickness may result a person being unable to perform any part of their normal
job.
 But sickness cover normally does not provide compensation to a person if his
sickness associated with the following circumstances:
 His sickness influenced or being affected by, alcohol
 Self-inflicted injury or disease
 Childbirth, pregnancy, HIV
 Pre-existing illness or disease (unless notified to and agreed by insurance
company). etc

9. Medical Expenses
 This type of health insurance provide coverage for the cost of medical
expenses and/ or surgical expenses incurred by a person.
 Once a person is admitted to hospital or went to clinic, laboratory or to
healthcare practitioner or pharmacy for treatment incur various cost which
come in form of charges such as:
 Hospital Charges – Cost of incurred for consultation, theatre fees, surgical
expenses, nursing charges etc
 Specialist fees – Specialist consultations etc
 Additional fees – Eg Ambulance.
 Medical Expenses insurance is designed to cover such expenses based on the
level of benefits selected.

10. How Medical Expenses Works
 Example:
Mr Mlaponi purchased Medical expenses cover from ABC Insurance and pay
500,000 as annual premium (Price for obtaining medical expenses insurance
cover) from 1st January 2019 to 31st December 2019.
ABC Insurance has entered a contract to XYZ Hospital to provide healthcare to
ABC Insurance’s clients (Persons who has medical insurance cover from ABC
Insurance company).
On 28th April 2019 Mr Mlaponi suffered from illness and went XYZ Hospital for
treatment.

11. Example Continue…..
 He was admitted to XYZ Hospital on the same day, and directed to General
doctor for consultation, after answering several questions a Doctor order him
to go to laboratory for medical examinations.
 After medical examination it was suspected that he was suffering from heart
disease. Thereafter a Cardiologist was called for further examination.
 After examination it was discovered that he was suffering from Atrial
Fibrillation.

12. Continue………..
 Medical bill was as follow:
 Admission fee_____________________________ 10,000
 General Doctor Consultation_________________ 30,000
 Laboratory examination charges______________ 100,000
 Specialist Consultation fees__________________ 450,000
 Theatre fee_______________________________ 200,000
 Medicines________________________________ 600,000
 Total Cost_________________________________ 1,390,000
 This medical bill was forwarded to ABC Insurance company for payment and
Mr Mlaponi pay nothing to XYZ Hospital.

13. Question of thought.
 Poor household individuals are much exposed to health risk due to poor
hygiene, poor lifestyle and poor working condition, and also they are not able
to afford an increase healthcare expenses, but they still perceive health
insurance not important and luxury expenditure. Do you think health
insurance policy in most African countries especially Tanzania is committed to
respond in improving and eradicate this perception?