Health Insurance Penetration

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Virendra SinghCentral university ofRajasthan


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definitionPresent scenario

health insurance penetration

IRDA Initiatives and Committees

Recent DevelopmentsHard Choices


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WHAT IS HEALTH INSURANCE? SYSTEM OF ASSURANCE TO MAKE

CONTINGENCIES OF HEALTH CARE EXPENSES.

TO PROVIDE PROTECTION AGAINST FINANCIALLOSS BY UNFORSEEN SICKNESS.

TO MEET COST OF GOOD MEDICAL CARE.

RELIEVES ANXIETY AND TENSION.


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BENEFITS

Sum Insured Rs.30,000Limit for Anesthesia, Blood, Oxygen, etc. Rs. 4,500/-Limit for any one illness Rs. 15,000/-Personal Accident Cover Rs.25,000/-Pre Existing Diseases NOT COVERED Waiting period 30 daysFirst Year Exclusions NOT COVEREDMaternity Benefits NOT COVEREDPREMIUM (for a family of five) Rs.548BPL Family Pays Rs.248

IT FAILED


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Increasing awareness about health insurance.

Rising healthcare costs.

The recent detariffing of the general insurance industry.

With detariffing ,insurance companies haveemphasized their efforts towards health insurance

and other personal lines of business.


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Despite the rapid growth of the health insurance segment in the past

few years, the health insurance penetration in the country continues tobe low.

Overall, the Indian health sector is still characterized by the nearabsence of any significant risk protection against major health related

expenditure, as insurance and other organized forms of payment forhealth services, including ESIS,CGHS and other such schemes barelycover a tenth of all people in the country.

According to the National Health Accounts published by NCMHin 2005 , almost four fifths of the health spending in the country isprivate, out-of-pocket expenditure.


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In the absence of such protection, the financial impact of hospitalization can

be very pronounced, and indeed is reported as one of the leading causes ofimpoverishment in the country.(World Bank, 2002).

Many states have recently commenced large scale health insuranceprogrammes to protect their vulnerable groups from such health relatedfinancial needs, prominent being the Rajiv Aarogyasri Scheme in Andhra

Pradesh and the centrally sponsored Rasthriys swasthya Bima Yojana (RSBY)being launched now in many states across the country.

Which are developed and implemented with the support of theinsurance industry.Such schemes have contributed to increasing penetration ofhealth insurance in the country.


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16.3 million insured persons 3.8 million policies

1 million claims

There have been continuous improvements in thequality of this data.


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The sub-committees to specifically look into the areas ofregistration of stand alone health insurance companies and

to suggest innovations in health insurance products.

The recommendations of these sub-committees havetriggered progress in both these areas.

Other committees in recent years which studied variousaspects of health insurance include the Committee onRural Health Insurance, and the Committee onparliamentary Undertakings.


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The committee has made several recommendations

regarding the concerns that senior citizens face on thehealth insurance front.

Some of these fall under the domain of thegovernment, while others need to be addressed by

IRDA and the industry.


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1) Data Standards

2) Provider Standards

3) Payer Standards

4) Awareness of health insurance


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In the last few months, both the prominent industrychambers have, for the first time, held national level

workshop exclusively on Health Insurance.

These events have been supported by IRDA from theirconceptualization state.

IRDA is also co-ordinating with and supporting insuranceindustry initiatives in standardizing certain keyterminology used in health insurance documents, forbetter comprehension and in the interest of policyholders.


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The judgments includes specific directions to IRDA We wouldrequest the IRDA to consider the matter in depth and undertake ascrutiny such claims so that in the event it is found that the insurancecompanies are taking recourse to arbitrary methodologies in the matterof entering into contracts of insurance or renewal thereof, appropriatesteps in the behalf may be taken.Although this aspect of Renewability as also ofcancellation/Termination of health insurance policies has been alreadyconsidered by the Authority for all new products which have been fieldover the last one year or so, a more exhaustive effort on this concern isnow being taken up in the department.


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All insurance companies have been advised that for

the purposes of calculation of premium for healthinsurance policies completed age of the prospect onthe date of commencement of insurance should onlybe reckoned.

Insurers have been instructed to submit half-yearlyreturns to the Data Repository appointed by theAuthority for the purposes of building credible healthinsurance statistics.


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Mandated the establishment of a separate channel toaddress the health insurance related grievances ofsenior citizens in insurers and TPAs.

Issued guidelines on Renewability of health insurancepolicies which states that a health insurance policyshall be ordinarily renewable except on grounds offraud, moral hazard or misrepresentation. Specificallyrenewal shall not be denied on the grounds that the

policyholder has made claim in earlier years.


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Issued circular on healthinsurance for senior citizens.

All health insurance policiesissued by general insurancecompanies for a duration of 3

years or more shall have a freelook period of 15 days.


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Health insurance raises complex goal conflicts. Theseinclude the goal of availability and the goal of non-discrimination. Both goals push for universal health

care at levels of adequate care for every one. The threeother goals are

not to exceed the capacity of the pool to pay for theservices.

To protect the autonomy of health care professionalsand patients in medical decision

To maintain the solvency of the insurance system.


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IRDA website

YOJANA


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Health Insurance Penetration

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