UNIT: IX

Health insurance

INTRODUCTION

Over the last 50 years India has achieved a lot in terms of health improvement. How many accident you need to realize that you need Health Cover? It takes just one visit to a hospital to make us realize how vulnerable we are, every passing second. For the rich as well as poor, male as well as female and young as well as old, being diagnosed with an illness and having the need to be hospitalized can be a tough ordeal. Heart problems, diabetes, stroke, renal failure, cancer – the list of lifestyle diseases just seem to get longer and more common these days. Thankfully there are more specialty hospitals and specialist doctors – but all that comes at a cost. The super rich can afford such costs, but what about an average middle class person. For an illness that requires hospitalization/ surgery, costs can easily run into five digit bills. To get rid of health worries health/ medical insurance is the answer.

In 2001 with entry of various private Insurance companies now the customers have choice of buying this insurance from 21 Insurance companies. On August 15, 2007 Prime Minister had announced Rs 2000 Crores for Health Insurance for poor citizens and the impact of the same is being seen by us in the form of success of RSBY (Rashtriya Swasth Bima Yojna). In India it is also known as “Mediclaim” because the first health insurance policy which was launched in India was called Mediclaim.Health Insurance and Mediclaim are two different names for the same product. The change has started coming and now we have started calling it Health Insurance. Calling is as Health Insurance is a positive way of looking at this Insurance. It also giving us a feeling that we as a society have started moving from curative medical care to preventive medical care.

MEANING

♦ The concept of health insurance was proposed in 1964 by Hugh

♦ Health insurance is an insurance Policy that insures the beneficiary and the family against

any medical expenses. The medical expenses will be taken care of by the insurance company provided you pay your premium regularly. Cover extends to pre-hospitalization and post-hospitalization for periods of 30 days and 60 days respectively. Domiciliary hospitalization is also covered.

♦ The term health insurance is generally used to describe a form of insurance that plays for

medical licenses. It is sometimes used more broadly to include insurance covering disability or long term nursing custodial care needs. Health insurance is a type of health care system. It may comprise of a government medical care system and or a nongovernmental insurance.

1

HEALTH INSURANCE POLICY

It is a contract between an insurance company and an individual. The contract can be renewable annually or monthly. Health insurance policy not only covers expenses incurred during hospitalization but also during the pre as well as post hospitalization stages like money spent for conducting medical tests and buying medicines. This covers will be to the extent of the sum insured.

FINANCE STRUCTURE

It consists of the beneficiary and the provider and the media is the insurance premium. The beneficiary may be an individual or his family or may be group of individuals as in the case of employee’s state insurance scheme. The insurance premium may be paid by the individual (as in case of personnel policies) or may be shared by the individual and employer When you buy a health Insurance policy you need to pay an annual fee to the company known as ‘premium’. The amount of coverage or ‘cover amount’ or ‘sum assured’ that you want will primarily decide the premium which you need to pay. Higher the coverage amount higher the premium. In the event of a claim, the maximum amount which the health insurance company pays you will be this coverage amount. (as in case of ESIS). The provider may provide the benefit in the form of re- emberesement of the expenses incurred to the person insurance or to be provided in the form of various services and benefit.(as in ESIS). It may be provided through a government- sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect them. From high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government. Health insurance works by estimating the overall risk of healthcare expenses and developing a routine finance structure (such as a monthly premium or annual tax) that will ensure that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization, most often either a government agency or a private. Health insurance companies are offering innovative products to their customers these days. The latest product in this line is ‘cashless hospitalization’. Here individuals do not have to pay for their hospital bills in case of hospitalization; the insurance company settles the bill directly. But certain condition like the hospital needs to have a tie-up with the insurance company.

DOES AGE EFFECTS HEALTH INSURANCE PLANS AND PREMIUMS

As age definitely affects your insurance plan in terms of coverage as well as cost. The older we are, the costlier the health insurance premiums.

2

As we grow older, the body becomes increasingly prone to illnesses, disorders, and malaise hence the increased insurance premium costs

TYPES OF HEALTH INSURANCE

Individual Mediclaim:

The simplest form of health insurance is the Individual Mediclaim policy. Health insurance policy for an individual person providing that person cover for the expenses incurred due to treatment of disease or injury is called as Individual Mediclaim policy. it covers the hospitalization expenses for an individual for up to the sum assured limit. The insurance premium is dependent on the sum assured value. Example: If you have 3 family members you can get an individual cover of Rs 2 lacs each. In this case each of you are covered for 2 lacs , if 3 members face a need for hospitalization , all 3 of them can get expenses recovered upto Rs 2 lacs All the 3 policies are independent.

Family Floater Policy:

Family Floater Policies are enhanced version of the mediclaim policy. A floater health insurance policy covers your entire family under one policy with one sum insured and one premium. It covers all the expenses just as covered under individual mediclaim except that the cover is now extended to the family instead of one person. Under this, insurance will reimburse the cost of hospitalization of any family member covered, but the total reimbursement during the policy year is restricted to the sum insured .Example: In this case if suppose there are 3 family members, you can take a Family floater policy for Rs 6 lacs in total. Now anyone can claim upto 6 lacs in expenses, but then the cover will go down by that much amount for that year. So if one of the family members is hospitalized and the expenses are 4.5 lacs. It will be paid and then the cover will be reduced to 1.5 lacs for that particular year. Next year again it will start from fresh 6 lacs. Family floater makes sense for a family because that way each one in family gets a big cover and probability of more than 1 getting hospitalized in same year is too low until and unless whole family is travelling together most of the times in a year. -

Unit Linked Health Plans:

Taking the ULHP route, health insurance companies too have introduced Unit Linked Health Plans. Such plans combine health insurance with investment and pay back an amount at the end of the insurance term. The returns of course are dependent on market performance. These plans are very new and still in development phase. This is only recommended for people  who can handle market linked products like ULIP and ULPP

Group Health Insurance from an Employer

3

It is a much more affordable type of health insurance only when your employer will pay for most or the entire premium (which many employers will do). Because premiums are based on the group as a whole, the risk is spread out over many people. These policies are often the most expensive and the most popular type of private health coverage. One of the benefits to group health insurance coverage is that one cannot typically be denied coverage due to pre existing conditions or other health problems. There may sometimes be a waiting period if one has not maintained continuous coverage but everyone will be accepted.

Group Health Insurance from a Non Employer Group

It is another option to consider for obtaining health coverage. For those who have no policy available through work or an inadequate one, group rates can be obtained from church groups, professional and business associations such as a Chamber of Commerce. This can help you obtain health insurance if you are unable to obtain an individual health insurance policy due to your health.

Student Health Insurance

It is usually either a temporary health insurance plan offered through the university or college and may sometimes be available through a private insurance company. The cost of health care while studying abroad is covered by Students Medical Insurance. It is an essential requirement with many foreign universities for their overseas students.

Short Term Health Insurance

It is a plan that as its name implies only offers coverage for a short amount of time, usually anywhere from 1 month to 1 year (although some short term plans offer coverage up to 3 years). Although short term health insurance plans are typically very cheap; they are also typically very bare bones coverage and should never be relied upon as a long term solution to finding affordable health insurance coverage.

Critical Illness Policy

If we have a Critical Illness policy, the insurance company will pay you a lump sum amount if you are diagnosed with a critical illness as defined by the insurance company. (Catastrophic illness or major medical clauses Treating and managing most cancers costs a lot of money. Some insurance plans provide for extra coverage under a "catastrophic illness" clause. These are policies that cover major medical care needs. The policies usually have very high deductibles and fairly low premiums. They can be good for people with chronic illnesses. Senior Citizen Policy

It is generally for people above the age of 60 and has a shorter waiting period. The entry age as well as renewable age (age up to which renewal is available) is higher.

4

Overseas Mediclaim Policy

An Overseas Mediclaim Policy provides cover for medical expenses incurred abroad for treatment of illness and diseases contracted or injury sustained during the period of insured’s of overseas travel. Any person going abroad on holiday, business, study or employment can avail this policy. Coverage under the medical expense section of this insurance is intended for use by the Insured person in the event of a sudden and unexpected sickness or accident arising when the Insured is outside the Republic of India. 

HEALTH INSURANCE CLAIMS SETTLEMENT PROCESS

A bit on how health insurance claims processing works. In most cases, the Insurance companies appoint a third part administrator (TPA) for claims processing. That means once the health insurance policy is sold, the insurer passes on the baton to the TPA. In case of a claim, the insured has to get in touch with the TPA for all versification and formalities. Mainly by two ways.

Cashless settlement: If the treatment is sought in a network hospital of the insurance provider the insurance company pays the hospital directly through their Third Party Administrator. This type of settlement is called as “Cashless settlement”.

Reimbursement: If the treatment is done at some other hospital, you can file a claim for reimbursement with the health insurance company’s Third Party Administrator after you have paid your bills. The insured can claim reimbursement for hospitalization by submitting relevant bills/ documents for the claimed amount to the TPA.Then the TPA will pay you back the amount after examining your claim. Here the insured avails the treatment and settles the hospital bills directly at the hospital.

HEALTH INSURANCE SCHEMES

There are mainly two ways of health insurance schemes like governmental health schemes and non governmental health schemes.

1. Governmental Health Insurance Schemes

Under the governmental health insurance schemes mainly two types of insurance plans are following in India they are ESIschemes and central governmental health schemes.

5

a) THE EMPLOYEE STATE INSURANCE ACT (1948)

The ESI act passed in 1948 is an important measure of social security and health insurance in this country. It provides for certain cash and medical benefits to industrial employees in case of sickness, maternity, and employment injury.

Scope

The act extends to the whole of India.

♦ Small power using factories employing 10 to 19 persons, and non power using factories

employing 20 or more persons.♦ Shops

♦ Hotels and restaurants

♦ Cinemas and theatures

♦ Road motor transport establishments

♦ Newspaper establishments

Administration

The administration of the ESI scheme under the act is entrusted to an autonomous body called the ESI Corporation. The union minister for labor is the chairman and the secretary to govt. of India ministry of labor is the vice chairman of this corporation. It consists of members representing central and state governments, employers and employees organizations, medical profession and parliament. There is a standing committee, constituted from the members of the corporation, which acts as an executive body for the administration of the scheme. The chief executive officers of the corporation are the director general who is assisted by four principal officers.

♣ Insurance commissioner

♣ Medical commissioner

♣ Financial commissioner

♣ Actuary.

There is a medical benefit council which is headed by the director general of health services, government of India who is assisted by the medical commissioner in all matters relating to medical relief .Besides the head office in newdelhi, the corporation has 23 regional office an d12 sub- regional offices and 844 local offices and cash offices all over the country for the administration of the scheme.

Finance

6

The scheme is run by contributions by employees and employers and grants from central and state governments. The employer contributes 4.75% of total mage bill; the employee contributes 1.75% of wages. Employees getting daily wages of below Rs50 are exempted from payment off contribution. The state government’s share of expenditure on medical care is 1/8 of total cost of medical care; the ESI Corporation’s share of expenditure on medical care is 7/8 of total cost of medical care.

Benefits of Employees

The act has made provision for the following benefits to insured persons or, to other dependants as the case may be;

Medical benefit Sickness benefit Maternity benefit Disablement benefit Dependants benefit Funeral expenses Rehabilitation allowance.

a) Medical benefit

Medical benefit consists of ‘full medical care’ including hospitalization, free of cost, to the insured persons in case of sickness, employment injury and maternity. The services comprise;

¶ Outpatient care¶ Supply of drugs and dressings¶ Specialist services in all branches of medicine¶ Pathological and radiological investigations¶ Domiciliary services¶ Antenatal, natal, and postnatal services¶ Immunization services¶ Family planning services ¶ Emergency services¶ Ambulance services.¶ Health education¶ In patient treatment

In complicated cases where specialized treatment is necessary, patients are sent for institutional treatment is necessary; patients are sent for institutional treatment even outside their state at the expense of the ESI Corporation.

7

b) Sickness benefit

It consists of periodical cash payment to an insured person in case of sickness, if his sickness is duly certified by an insurance medical officer or insurance medical practitioner. The benefit is payable for a maximum period of 91 days, in any continuous period of 365 days, the daily rate being about 50% of the average daily wages. A person receiving the sickness benefit is required to remain under medical treatment provided under the act. In addition to 91 days of sickness benefit, insured persons suffering from certain long- term diseases are entitled to extend sickness benefit.

c) Maternity benefit

The benefit is payable in cash to an insured woman for confinement/ miscarriage or sickness arising out of pregnancy/ confinement or premature birth of child or miscarriage. For confinement, the duration of benefit is 12 weeks, for miscarriage 6 weeks and for sickness arising out of confinement (30 days). The benefit is allowed at about full wages.

d) Disablement benefit

The act provides for each payment, besides free medical treatment, in the event of temporary or permanent disablement ass a result of employment injury as well as occupational diseases. The rate of temporary disablement benefit is about 70% of the wages as long as the temporary disablement lasts. In case of total permanent disablement, the insured person is given life pension worked out on the basis of loss of earning capacity determined by a medical board, while in cases of partial permanent disablement a portion of it’s granted as life pension.

e) Dependants benefit

In a case of death, as a result of employment injury, the dependants of an insured person are eligible for periodical payments. Pension at the rate of 70% of wages is payable, shared by dependants in a fixed ratio. On monthly basis in accordance with the prescribed share. An eligible son or daughter is entitled to dependants benefit up to the age of 18; the benefit is withdrawn if the daughter marries earlier.

f) Funeral expenses.

Funeral benefit is a cash payment on the death of an insured person towards the expenses on his funeral, the amount not exceeding Rs 2500.

g) Rehabilitation

8

On monthly payment of Rs 10, the insured person and his family members continue to get medical treatment after permanent disablement, or retirement.

Benefits to employers

ᴥ Exemption from the applicability of workmen’s compensation act 1923

ᴥ Exemption from maternity benefit act 1961

ᴥ Exception from payment of medical allowance to employees and their dependants or

arranging for their medical care. ᴥ Rebate under the income tax act on contribution deposited in the ESI account.

ᴥ Healthy work force.

About 3 lakh employers were covered under the scheme.

B) CENTRAL GOVERNMENT HEALTH SCHEME

The central government health scheme for the central government employees was first introduced in New Delhi in 1954 to provide comprehensive medical care to central government employees. The scheme is based on the principal of cooperative effort by the employee and the employer, to the mutual advantages of both.

The facilities under the scheme include

Outpatient care through a network of dispensaries. Supply of necessary drugs. Laboratory and x ray investigations. Domiciliary visits. Hospitalization facilities at government as well as private hospitals recognized for the

purpose. Specialist consultation Pediatric services including immunization Antenatal, natal and postnatal services Emergency treatment Supply of optical and dental aids at reasonable rate Family welfare services.

The scope of the scheme has been gradually extended over the year to cover cities outside Delhi as well as other sectors of population such as the employees of the autonomous organizations, retired central govt servants, widows receiving family pension, members of parliament, ex-governors and retired judges. The employee’s state insurance scheme and the central government health scheme cover two large groups of wages earners in the country. They are well organized health insurance and are providing reasonable medical acre plus some essential preventive and promotive health services.

9

2. Non – Governmental Health Insurance Schemes.

In nongovernmental or private voluntary agencies will come under 2nd category. Now so many groups of companies are issued the health insurance policies.

List of Some Health Insurance Companies.

Apollo DKV Insurance Company Ltd. Aviva Life Insurance Bajaj Allianz General Insurance Co. Ltd. Birla Sun Life Insurance E-Meditek Solutions Limited Family Health Plan Limited Health India-Bhaichand Amoluk Insurance Services Pvt. Ltd. HSBC Health Insurance ICICI Lombard General Insurance Co. Ltd. Life Insurance Corporation Of India Max New York Life Insurance Med Assist India Ltd. MetLife India Assurance Company National Insurance Company Paramount Health Group Reliance Health Royal Sundaram Alliance Insurance Company Limited Star Health and Allied Insurance Company Limited Tata AIG The New India Assurance Co. Ltd. United Healthcare United India Insurance

There Are Two Major Insurance Companies In India Namely:

- The Life Insurance Company of India (LIC) - The General Insurance Company of India (GIC)

a).The Life Insurance Corporation (LIC) offers:

The Asha Deep Plan:

It provides cover for cancer, paralytic stroke resulting in permanent disability, renal failure and coronary artery disease where by-pass surgery has been done. It caters to people between 18 - 65 years.

10

Jeevan Asha:

The Jeevan Asha policy is the other healthcare product offered by LIC. It is an open-ended scheme covering many surgical procedures. . b) The insurance policies offered by GIC are: While LIC deals with insurance for life coverage only, the GIC deals with the other aspects of insurance, including health. Following are the main health policies offered by the Indian Insurance Companies. These policies are regulated by the General Insurance Corporation and are marketed by the four big insurance companies: United India Insurance Co Ltd., New India Assurance Co Ltd., Oriental Insurance Co Ltd. and National Insurance Co Ltd

1. Mediclaim

Insures against any hospitalization expenses that may arise in future. This policy is designed to prevent the insured from paying for any hospitalisation expenses owing to illness or injury suffered by the insured, whether the hospitalisation is domiciliary or otherwise.

It covers the expenses incurred on the following:

Room boarding expenses by the hospital nursing home Nursing expenses Operation theatre expenses Surgeon, anaesthetist, medical practitioner, consultants, specialist’s fees Also for any cost of equipment like pacemaker, artificial limbs and charges paid for

anaesthesia, blood, oxygen, operation charge, surgical appliances, medicines and drugs, diagnostic material and x-rays, dialysis and chemotherapy, radiotherapy, and cost of organs etc.

2. Jan Arogya Bima Policy

It insures hospitalization or domiciliary hospitalization expenses incurred on medical or surgical treatment for any illness or disease (contracted after 30 days from the commencement of the policy) or injury. Any person in the age group of three months to 70 years can be insured under this. The risk insured include sudden illnesses like heart attack, jaundice, pneumonia, appendicitis, paralytic attack, food poisoning or accidents that require hospitalization. This insurance policy was designed for the lower income group of society and the common masses. The entire idea was to protect them from high costs of hospitalization.

3. Overseas Mediclaim Policy

11

Any person going abroad on holiday, business, study or employment can avail this policy. Coverage under the medical expense section of this insurance is intended for use by the Insured person in the event of a sudden and unexpected sickness or accident arising when the Insured is outside the Republic of India.

4. Personal Accident Policy

The policy compensates an individual against death, loss of limbs, loss of eyesight, permanent total disablement, permanent partial disablement and temporary total disablement, solely and directly resulting from accidental injuries.

5. Critical Illness Policy

Critical Illness Policy is an exclusive benefit policy for individuals in the age group 20-65 years covering coronary artery surgery, cancer, renal failure, stroke, multiple sclerosis and major organ transplants like kidney, lung, pancreas or bone marrow.

6. New India Assurance Bhavishya Arogya

This caters to persons between 3 to 50 years. This policy is essentially to take care of medical expenses needs of persons in their old age. The policy provides for expenses in respect of hospitalisation and domiciliary hospitalisation during the period commencing from the Policy Retirement Age selected till survival. This is selected by the insured for the purpose of commencement of benefits in the policy.

Health insurance products from some private insurance companies:

1. Bajaj Allianz Health Guard Covers individuals between 5 to 55 years. Children below 5 years can be insured if the parents are conurrently insured with the company. It provides cashless facility across various hospitals across India. Herein pre-existing illness and injuries are covered in the year of cover, if the insured renews his policy consecutively for 5 years.

2. Royal Sundaram Health Shield Gold

Covers individuals between 5 to 55 years. From 91 Days to 75 years and also persons above the age of 55 years are covered as a part of family and not on individual basis. All in hospitalization expenses are covered (period of stay in hospital should be more than 24hours). Pre hospitalization expenses are covered for a period of 30 days &

12

post hospitalization for 60 days. Under this policy pre-existing illness and injuries are covered in the 6th year of cover, if the insured renews his policy consecutively for 5 years. Maternity treatment charges are covered upto the extent of Rs. 20,000. These include expenses incurred in hospital/ nursing homes as in –patient in India.

3. Birla Sun Life

Birla Sun Life Insurance is the coming together of the Aditya Birla group and Sun Life Financial of Canada to enter the Indian insurance sector. The Aditya Birla Group, a multinational conglomerate has over 75 business units in India and overseas with operations in Canada, USA, UK, Thailand, Indonesia, Philippines, Malaysia and Egypt to name a few.

4. HDFC Standard Life

HDFC Standard Life Insurance Co. Ltd. Is a joint venture between HDFC Ltd., India’s largest housing finance institution and Standard Life Assurance Company, Europe’s largest mutual life company.

5. ICICI Pru

ICICI Prudential Life Insurance is a joint venture between the ICICI Group and Prudential plc., of the UK. ICICI started off its operations in 1955 with providing finance for industrial development, and since then it has diversified into housing finance consumer finance, mutual funds to being a Virtual Universal Bank and its latest venture Life Insurance.

6. Om Kotak Mahindra

Established in 1985 as Kotak Capital Management Finance promoted by Uday Kotak the company has come a long way since its entry into corporate finance. It has dabbled in leasing, auto finance, hire purchase, investment banking, consumer finance, broking etc.

7. Tata AIG General Insurance Company

The Tata AIG joint venture is a tie up between the established Tata Group and American International Group Inc. The Tata Group is one of the largest and most respected industrial houses in the country, while AIG is a leading US based insurance and financial services company with a presence in over 130 countries and jurisdictions around

13

the world.

8. Max India

Max India Limited is a multi-business corporation that has business interests in telecom services, bulk pharmaceuticals, electronic components and specialty products. It is also the service-oriented businesses of healthcare, life insurance and information technology.

BENEFITS OF HEALTH INSURANCE COMPANIES IN GENERAL

- The cost of doctor’s fees, - It reimburses the medical expenses.

Medicine and hospitalization expenses are getting dearer by each day. Rising medical expenses can burn a hole in your pocket in case of a medical emergency or during an illness. By taking a health insurance policy a person can safeguard himself and his family from the burden of high cost of treatment.

- Discount on insurance premium is available on family package. - The Premiums are lower for younger people. - Disability benefits

If we get to the point that you cannot work, find out if the employer has a long-term disability insurance policy before we leave the job. This type of policy often replaces 60% to 70% of the income.

HEALTH INSURANCE FOR NURSES

  It has often been said that, “Nurses make the worst patients.” Although this may be hard to believe, it is very true, as many nurses refuse to take the time to get the treatment necessary for a specific ailment or follow the doctor’s orders when it comes to their own health needs. Nurses need to be conscious of their own personal obligation to take care of themselves, even when it comes down to health insurance. In the United States today, nursing is a highly lucrative business and any nurse can have his or her choice of which hospital to work at, which benefits package to go for, and which job specialization to follow. There is a misconception when it comes to nurses, or anyone working in the medical field, and health insurance. Many assume that nurses are eligible for, and receive, the best health insurance possible at a very affordable cost, or

14

even free insurance. That is not always the case for nurses. There are several factors that need to be looked at that really influence who gets insurance, from where, and at what cost. Health insurance quotes for nurses can actually be quite high, despite preconceptions about policies for this occupation. Aside from the usual factors that determine costs and eligibility, such as age, gender, pre-existing conditions, etc, nurse health quotes are not easy to come by and much research needs to be done in order to ensure nurses get the best coverage.

The first consideration is that type of nurse you are. Several types of nurses, as is well known, work in different sectors of the medical field. The type of nurse you are determines just how high your rates will be. For trauma nurses, for example, health insurance quotes may be high because of the stress and quick reactions associated with the job. Trauma nurses must respond quite quickly to several different accidents and patients, so there is a high risk of injury due to mistakes or errors. On the other side of the spectrum are traditional nurses, who work in a more relaxed setting, typically in areas where there are run-of-the-mill patients and where they simply take a person's blood pressure, or draw blood. Traditional nurses may still be placed in the high risk pool, however, despite the decreases amount of danger that an injury or the like could occur. For those nurses whose employer does not provide insurance, they do but the rates are very high, there are other options. Nurses, who help people when they get sick, should be able to get help when they themselves get sick. There are options and ways of finding affordable nurse health quotes that will contain all the coverage needed to keep nurses in good health. The same types of policies are available to nurses, such as Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and Point of Service (POS) plans. But because nurses are put in the high risk category by insurance companies,

Why Is It Different?

What makes health insurance for nurses different than other health insurance?  There are a couple key points to remember.  First of all, nursing is a profession that often puts an individual in a potentially harmful situation. This may include exposure to radiation, drugs, abuse from patients, or other such things. As a result, a nurse is often considered higher-risk. Some hospitals cover their nurses in this and many of these items are covered in workman’s compensation or in the nurses’ personal insurance. But, when it comes to off the job activities, hospitals may be more willing to slack off, letting the nurse cover expenses even when it seems like the medical needs should be covered under insurance

Responsibility of the Nurse

First of all, you need to talk to the hospital that you work for. See if there is any way that they can up your insurance or else explain where they are coming from with the coverage that they offer. Next, check into secondary insurance options for you and for your family. You may be able to find an accident health insurance or another primary health insurance that gives you better options than what you already have. Although this option may be a little more expensive,

15

you will feel much more comfortable in the long run with a health insurance that you can trust with your life. Finally, make sure that you are reducing the factors in your life that could tend to create health problems. Follow a healthy diet, exercise on a regular basis, cut smoking and drinking, and make sure that you follow all medical procedures with caution.

Challenges to Finding Affordable Health Insurance for Nurses

Nurses are exposed to HIV, Hepatitis, measles, tuberculosis and other communicable and blood borne diseases as well as x-ray exposure, chemical exposure, back injury, stress, and exhaustion.  What is even more ironic is that many nurses tend to fight for health care for their patients and the uninsured, before ensuring they have their own coverage. While this all seems like bad news, the good news is there are insurance companies that have set up health insurance programs for nurses

Conclusion:-

The escalating cost of medical treatment today is beyond the reach of a common man. In case of a medical emergency, cost of hospital room rent, the doctor's fees, medicines and related health services can work out to be a huge sum. In such times, health insurance provides the much needed financial relief. An investment in health insurance scheme would be a judicious decision. The health insurance scheme could either be a personal scheme or a group scheme sponsored by an employer. So health insurance is very importand to preservethe precious health by investing the money.

BIBLIOGRAPHY.

Book reference:-

1. Dr Park JE. Park’s textbook of preventive and social medicine. 20 th ed. Banarsidas

Bhanot Publications: India; 2008.p. 743- 746, 832

2. Ellis RJ, Hartley CL. Nursing in today’s world. 5 th ed. J.B Lippincott publications:

Philadelphia; 1998. P. 296

16

3. Cassel.J, The contribution of the social environment to host resistance: the Fourth Wade

Hampton Frost Lecture. Am J Epidemiology 1976, 234-38

4. Wilkinson RG. Income distribution and life expectancy. BMJ, 1992, 387

5. Ben SholmoY, White IR, Marmot M. Does the variation of socio-economic

characteristics of an area affect mortality? BMJ, 1996. 456.

6. Kaplan G Pamuk E Lynch JW Cohen RD Inequality in income and mortality in the

United States: Analysis of mortality and potential pathways. BMJ, 1996, 356

7. Kennedy BP, Kawachi I, Prothrow-Stith D. Income distribution and mortality: Cross

sectional ecological study of Robin Hood Index in the United States. BMJ 1996, 312,

8. Ahluwalia MS. Economic performance of states in post-reforms period. Economic and

Political weekly, May 6 2000, p- 1676

Web address:-

1) www.healthinsuranceindia.org/2) www.searo.who.int/linkfiles/social_health_insurance_an2 3) en.wikipedia.org/wiki/Healthcare_in_India.4) www.srtt.org/downloads/communityhealth.pdf 5) www.healthinsurancebox.com/ 6) http://doctor.ndtv.com/storypage/ndtv/id/3723/type/feature/Health_Insurance_in_India.html?cp

17