Health insurance

Samiran kundu

A-06

Health insurance is insurance against the risk of incurring medical expenses among individuals.

A contract between an insurance provider and an individual or his sponsor

The contract can be renewable or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans.

The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance

DEFINITION

In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance.

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850.

History and evolution

Health insurance, as we know it today, was introduced only in 1912 when the first Insurance Act was passed.

The penetration of health insurance in India has been low. It is estimated that only about 3% to 5% of Indians are covered under any form of health insurance.

In terms of the market share, the size of the commercial insurance is barely 1% of the total health spending in the country.

FACTS AND FIGURES

Health insurance is one of the fastest growing areas in the insurance industry with annual growth rate of 25%.

Health Premium has risen to Rs. 11000 crores in 2010-2011.

As per the recent reports from various agencies the health sector has the potential to become a Rs. 30000-crore industry by 2015.

According to World Bank Report 1 in 3 Person

Will develop some life threatening cancer. 1 in 4 Person

Will contact heart disease before they retire. 1 in 20 Person

Risk the chance of having stroke before the age of seventy

WHY HEALTH INSURANCE

85 % of the working population in India DO NOT have Rs. 5,00,000 as instant cash.

14 % have Rs. 5,00,000 instantly BUT will subsequently will face a financial crunch

Only 1% can afford to spend Rs. 5,00,000 instantly and easily.

99 % of Indians will face financial crunch in case of any critical illness.

Let us look at what it costs in a good/ reputed hospital for treatment of

Angioplasty Rs. 2,00,000 to Rs. 3,00,000 Open heart surgery Rs. 2,50,000 to Rs. 4,50,000 Liver Transplant Rs. 30,00,000 Kidney Transplant Rs. 18,00,000 to Rs. 30,00,000 Hernia surgery Rs. 30,000 to Rs. 60,000 Cancer-Chemotherapy - Rs. 7000 to Rs. 10000 per

visit and number of visits may be 4 to 20 means that cost can be as high as Rs. 2,40,000. It is only that Health insurance policy taken by a person can take care of hospitalization costs of this magnitude.

Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan to purchase health coverage.

Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share.

Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service.

Terms and Obligations

Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay.

Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.

Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount.

Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs.

Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.

Apollo Munich Insurance Company Limited Bajaj Allianz General Insurance Co. Ltd. Bharti AXA General Insurance Co. Ltd. Cholamandalam MS General Insurance Co. Ltd. Future Generali India Insurance Co. Ltd. HDFC ERGO General Insurance Co. Ltd. ICICI Lombard General Insurance Co. Ltd. IFFCO Tokio General Insurance Co. Ltd. Larson & Toubro General Insurance Co. Ltd. Max Bupa Health Insurance Co. Ltd. National Insurance Co.Ltd. New India Assurance Co. Ltd. Oriental Insurance Co. Ltd. Raheja QBE General Insurance Co. Limited Reliance General Insurance Co. Ltd. Royal Sundaram Alliance Insurance Co. Ltd SBI General Insurance Co. Ltd. Shriram General Insurance Co. Ltd. Star Health and Allied Insurance Company Limited Tata AIG General Insurance Co. Ltd. United India Insurance Co. Ltd. Universal Sompo General Insurance Co. Ltd.

Companies Offering Health Insurance

Health Insurance Covers hospitalization when a patient is in hospital for more than 24 hours due to:

Illness Accident Surgery requirement Symptoms, when diagnosis is been done,

the costs covered are

What Health Insurance Policy Covers in India

Room, Boarding Expenses in Hospital/Nursing Home

Nursing Expenses, intensive care unit expenses, Surgeon, Anesthetist, Medical Practitioner,

Consultants, Specialist fees Anesthesia Pre-Hospitalization Expenses Post-Hospitalization Expenses General Health and Eye Examination (Optional

with extra premium) Local Ambulance Services (Optional with extra

premium) Hospital Daily Allowance (Optional with extra

premium)

Treatment of illness at home by consulting doctor in your locality

All diseases /injuries which are pre-existing when the cover incepts for the first time.

Any disease other than those stated in the in clause contracted by the Insured Person during the first 30 days from the commencement date of the Policy.

Injury or Disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operation (whether war be declared or not).

What Health Insurance Policy in India does not Cover

MONEY SPINNERS IN HEALTH INSURANCE.

CELEBRITIES

If David Beckham ever stops being able to "bend it," his posh lifestyle will go on. His magic legs are insured for a cool $70 million

NFL player Troy Polamalu is famous for more than his moves on the field

Bruce Springsteen knows his voice is a hot commodity. The Boss' pipes are insured for $5 million.

Rolling Stone Keith Richards has his middle finger insured for $1.6 million in case he ceases to be able to flip people off ... or play the guitar.

“If anything happened to my assets, I’d be out for a few months and I’d probably be out a million dollars,” “I thought I’d cover my assets… They’re my primary money makers.”

THANK YOU