Health Insurance industry

7/28/2019 Health Insurance industry

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Presented By:-Shifali Bhardwaj

Himanshi

Mohit SharmaShivang

Arvinder


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What is Health Insurance?

It is a contract between the Insurer & the Insured wherein the

former agrees to pay to the latter hospitalization expenses to

the extent of an agreed sum assured in the event of any

medical treatment out of an illness or an injury.

Its an insurance which covers the financial loss arising out of

poor health condition or due to permanent disability which

causes a loss of income.

It is an insurance policy that covers the risk of medical

expenses at the situation of any unfortunate crisis.


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Why you need health insurance?To avoid increasing medical costs

It helps securing a better futureby paying a fraction as an

expense today called the premium.

It definitely induces a sense of security to the insured.

It covers your hospitalization and medical bills.

You can avail tax benefits on the premium paid under section

80D of the Income Tax Act.


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Health insurance companies in India

Apollo Munich Health Insurance Company limited

Star Health and Allied insurance Co Ltd

Bajaj Allianz General Insurance Co Ltd

ICICI Lombard General Insurance Co Ltd

National Insurance Co Ltd

Reliance General Insurance Co Ltd

United India Insurance Co Ltd

TATA AIG General Insurance Co Ltd

Religare Health Insurance Co Ltd


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Health Care Financing In IndiaThe share of public financing in total health care is

just about 1% of GDP compared to 2.8% in other

developing countries.Beneficiaries are both poor as well as well-fed section

of society.

Over 80% of the total health financing is private

financing , much of which is out-of-pocket payments

(i.e. User charges) and not any prepayment schemes.


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Third Party Administration And Its Role

TPA stands for Third Party Administrator.

TPA is a middlemen between Insurer and the Customer .

Customer can directly deal with TPA at the time of claim and

TPA will help with all the process ofclaim settlement .

A TPA is a specialized health service provider rendering varietyof services like networking with hospitals, arranging for

hospitalization and claim processing and settlement.


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Third Party Administration And Its Role

Some of the services TPA provides are

Maintain database of policyholdersIssue of identity card to all policyholdersProvide ambulance serviceNetworking with the hospitalsProvide Cashless serviceProcess claimsClaims settlement


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Health Insurance Coverage

Offer basic coverage for hospital and doctor bills.

Hospitalization Cover: Protects the insured person for in-patient hospitalization expenses for a minimum of 24 hours.

These expenses include room and boarding charges as perpolicy conditions

Nursing expenses

Surgeon's fees, Consultant's fees, Anesthetist's and

Specialist's fees

Cost of medicines and drugs

Expenses for Organ Donor

Emergency Ambulance


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Type of health insurance plan

Individual Health Insurance

Individual Health Insurance plan offer more protection to a policyholder, as in sucha policy the policyholder can consume the entire amount alone without have to

worry about sharing it with other members of his family incase of a floater policy.

Group Health Insurance

Whenever a large group of people say over 20 who work, stay or are bonded bysome nature of job are willing to get a Health insurance plan, they should opt for aGroup Health Policy. Under a group health policy people who may have adversehealth condition can also easily get health cover due to the greater negotiatingpower that a group contains versus a individual policy.


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Cashless Mediclaim

Cashless Mediclaim plans are those which allow a policyholder to get admitted

into a network hospital without the need of a paying any upfront admission fee

and discharge fee as the same is paid by the health insurer. The cashless

mediclaim reimbursement is capped to the level of sum assured the person has

and the coverages under the plan.

Family Floater Plan

Family Floater Plans refer to those which cover the entire family under one plan.

Under a family floater plan the people covered share the total health insurance

available to them.

Taking an example, if a family of 4 (2 Adults and 2 Children) takes a family

floater plan then there premium for a health cover of say around Rs. 5 Lacs

would be close to Rs. 10,000, whereas, if all of them had a separate plan of Rs. 5

Lacs their premium would have exceeded Rs. 12,000 easily.


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Critical Health Insurance

A critical health insurance policy hels cover certain set of diseases as prescribedunder a policy only.

As the name suggest critical health insurance, they cover all those major

diseases which are either terminal or can reduce the human body to a vegetative

state.

Some of these would include, Alzheimer's disease, blindness, deafness, kidney

failure, major organ transplant, multiple sclerosis, HIV/AIDS contracted by bloodtransfusion or during an operation, Parkinson's disease.

Travel Health Insurance

Whenever a person is travelling outside the geographical boundary of his / hercountry it is always advisable that they take a Travel Health insurance plan.

This is advised so that the person in-case falls sick or has any other medical

emergency abroad need not worry about the high cost of healthcare in a foreign

land.

This is also mandatory to buy before travelling to a certain countries.


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Structural facilities

The government has interfered whenever the cost of the medical

care has become unreasonable. Such government intervention is

required to make the process of medical insurance cost-effective

and achievable especially for those who are financial deprived.

The government introduced innovative healthcare products to

the medical market .


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The government established appropriate health

infrastructure to support the Mediclaim conveniences that are

offered in the market.

The government has also taken various proposals to support

the growth of the insurance sector such as Tax benefit offered

under Sec 80 D of the Income Tax Act


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Health insurance tips

Compare prices and features before buying. One policy cancost over 3 times the other!

Its quite easy to do this on an aggregator like

policybazaar.com

If you have a family, go for a Family floater policy. It is more

economical and gives higher coverage for each member of the

family.


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Compare the terms of the policy so you do not get a shocklater. A broker will be able to provide the best advice since he

is largely independent.

Do not always adopt a policy with a cashless tie up with a

hospital nearby. All good hospitals can be empanelled byinsurance companies. Rather look for a policy that fulfils yourrequirements adequately.

Find out all the hospitals that your insurance company has

empanelled with and understand what their specialization is,so if you are in need you can use the appropriate hospital,rather than just one all the time.


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Always it is advisable to buy from a broker, ask for theirlicense number, and check if the details provided are correct

from the IRDA website. These brokers are independent and

are paid for every policy they sell, so they are not inclined to

push one over the other. An agent on the other hand sells for

one company only and hence will generally push that

company and its benefits.

Be truthful and accurate in your declarations on the proposal

form. That will only ensure payment when you have a genuine

claim.


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Role of the Private Sector Companies inpromoting the Health Insurance Policies

The private players in the health insurance sector have supported

their customers by providing them affordable, inexpensive and

easily accessible insurance

The insurance companies have given a lot of importance to

convenience of the customer. Buying the e-policy online has

become a much convenient alternative with the facility to renew it

anytime, anywhere.


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The insurance companies have developedprecocious Mediclaim insurance policies that not only providecomprehensive coverage but also induce various other benefits.

Another major step in the health insurance sector is the floaterconcept, where they cover the entire family in one policy.

Private companies are constantly improving their products to meetthe needs of the people as much as possible. Such steps includevarious plans that cover critical illnesses, outpatient expenses andothers.


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Health Insurance industry

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