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PRESENTATION ON HEALTH PLANS
SHREYA RAJPALIYASH SHARMASHASHANK SHRIVASTAV
RAJBIRKAUR,MPH,PU
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WHAT DOES IT MEAN?Health plancan be defined as the "decisions, plans, and actions that are undertaken to achieve specifichealth caregoals within a society. In the layman language, the Health Plan is a policy which covers you & your family against medical expenses due to sickness, accident etc. All about protection against an illness.Pre-payment plan providing services or cash indemnities for medical care needed in times of illness or disability.
RAJBIRKAUR,MPH,PU
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TERMSPolicy The legal document issued by the insurance company that outlines the terms and conditions of the insurance.
Policyholder The person who buys the insurance; also called the "insured."
Premium The payment required to keep your insurance policy in force.
RAJBIRKAUR,MPH,PU
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Claim . a person's request for payment by an insurer of a loss covered by a policyFirst-party claims- claims to your own insurance company. Third-party claims- claims made by one person against another person's company.
Exclusion Specific conditions or circumstances listed in the policy that are not covered by the policy.
RAJBIRKAUR,MPH,PU
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Occurrence an accident that results in bodily injury during the period of an insurance policy.
Peril the cause of loss or damage.
Risk the chance of a loss.
Underwriting the process of selecting risks for insurance, and determining how much to charge to insure these risks and which coverage to provide.
RAJBIRKAUR,MPH,PU
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Why you need health plans?
To avoid increasing medical costs. Its a precautionary measures in todays tough time. To avoid hefty medical bills.To get services in best time available.
RAJBIRKAUR,MPH,PU
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AUTHORITYInsurance Regulatory and Development Authority (IRDA)
MISSIONTo Protect the interests of the policyholders, to regulate, promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto.
RAJBIRKAUR,MPH,PU
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INDIANo universal health insurance in IndiaLimited to industrial workers and their familiesCentral Govt. Health Scheme(1954)Employees state Insurance scheme(1948)
RAJBIRKAUR,MPH,PU
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CENTRAL GOVT. HEALTH SCHEMEProvides comprehensive medical care to central govt. employeesMutual advantage to both employee and employerStarted in 1954 with 16 allopathic dispensaries covering 2.3 lac beneficiariesNow, 320 dispensaries/hospitals in various systems of medicines covering 42.76 lac beneficiaries
RAJBIRKAUR,MPH,PU
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LIST OF HEALTH PLAN PROVIDERS Bajaj AllianzCholamandalamICICI Iffco-TokioNational Insurance New IndiaOriental InsuranceRelianceStar HealthUnited India
RAJBIRKAUR,MPH,PU
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UNDERSTAND AND DEFINE THE PROBLEMBEFORE TAKING ANY HEALTH PLAN
a) QuantifyBe specific about problems scope and magnitude Who is affected Specific nature of the problem
b) Past history
c) Causes Key factors (separate into actionable vs. not)
RAJBIRKAUR,MPH,PU
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BENEFITS OF INSURANCETimely coverage for regular or at least with annual health check ups.Ability to afford for the medical expenses.To avoid increasing medical costs. Its a precautionary measures in todays tough time. To get services in best time available.Get screening or preventive services.
RAJBIRKAUR,MPH,PU
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CHALLENGES
RAJBIRKAUR,MPH,PU
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. .Limited coverageOnly around 10% of the population is covered Geographic spread in terms of health care facilities and financing awareness is limitedSelection criteria by suppliers often restricts the poor (and more likely to be ill) from affordable pre-payment schemes
System leakagesProvider malpractices leading to over-charging or pre-selection / selective recommendation
Lack of universal schemesLimitations in terms of coverage of illnesses as well as treatment options Alternative therapies often not considered / included under insuranceThe extent of coverage as well as the type of coverage are the key issues related to insurance penetration
Some companies have put-off plans for India due to potential leakages in the system
RAJBIRKAUR,MPH,PU
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CRITICISM OF INSURANCE COMPANIES
RAJBIRKAUR,MPH,PU
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CONCLUSIONGrowth potential for the insurance sector is immense.
Consideration required to poor and unemployed.
Private health insurance has positive role to play.
Insurance sector needs to widen its scope from only providing treatment facilities to promote and preventive health care.
RAJBIRKAUR,MPH,PU
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