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  • State Planning CommiSSion 07th February 2014

    Workshop Series : 1 / HSW / 2014

  • 11State Planning Commission

    Workshop Series : 1 / HSW / 2014

    State Planning Commission 07th February 2014

    Health Insurance Schemes for Senior Citizens

  • 2 State Planning Commission

    Tamil Nadu State Planning Commission The State Planning Commission was constituted in Tamil Nadu as an Advisory body on 25th May 1971 under the Chairmanship of the Hon’ble Chief Minister to make recommendations to the Government on various matters pertaining to the development of the State. The Chairman of the Commission is assisted by Vice Chairman, Full Time Member & Part Time Members who are experts in various fields. The Principal Secretary to Government, Planning, Development and Special Initiatives and the Principal Secretary to Government, Finance Department are the ex- officio members. The Member Secretary is responsible for administration in the Commission.

    The Commission has the following technical divisions: 1. Agricultural Policy and Planning 2. Industries, Power and Transport 3. Land Use 4. Education and Employment 5. Health and Social Welfare 6. District Planning and Rural Development 7. Plan Co-ordination.

    Main activities of SPC: 1. Preparation of Five Year and Annual Plans based on the policies and priorities of the Government. 2. Undertake Mid Term review of the Five Year Plan, other special reviews on the Economy and

    advise the Government on appropriate modification and restructuring of the schemes. 3. Monitor development indicators that influence the Human Development Index, Gender

    Development Index, etc., at a disaggregated level and suggest correctional measures. 4. Undertakes special studies as required for formulation and implementation of plan projects

    and programmes. The State Planning Commission also organizes seminars/workshops. 5. Tamil Nadu State Land Use Research Board (TNSLURB) is functioning under the chairmanship

    of Vice Chairman, State Planning Commission as a permanent body in the State Planning Commission. This Board is intended to promote interaction and study the vital areas of Land Use. The State Planning Commission organizes seminars/workshops and undertakes studies on Land Use.

    6. Human Development Reports (HDRs) were prepared for Dindigul, Sivagangai, Tiruvannamalai, Cuddalore, Nagapattinam, the Nilgiris, Kanyakumari and Dharmapuri districts. The concept of Human Development has been disseminated to all districts through workshops organized in the concerned districts. Preparation of District Human Development Reports (DHDR) for the remaining districts is under process.

    7. State Balanced Growth Fund (SBGF) is operated to bridge the regional imbalances among the districts.

  • 33State Planning Commission

    CONTENTS

    Page No

    Workshop Team 4

    Executive Summary 6

    Introduction 7

    Health Insurance Policy 7

    Health Insurance Industry in India 8

    Features of Health Insurance Schemes 10

    Health Insurance Policies for Senior Citizens 11

    Chief Minister’s Comprehensive Health Insurance Scheme 12

    New Health Insurance Scheme - 2012 13

    Comparison of Senior Citizens Mediclaim Policies in India 13

    Best Health Insurance Plans as reported by HelpAge India 15

    Remarks / Suggestions of the Participants 16

    Recommendations made by the State Planning Commission 21

    List of Participants 22

  • 4 State Planning Commission

    WORKSHOP TEAM

    State Planning Commission

    Tmt. Santha Sheela Nair, I.A.S. (Retd.) Vice Chairman

    Dr. V. Shantha Member (Health)

    Dr. K. Sridhar Member (Health)

    Tmt. S.R. Navaneetham Head of Division - Health and Social Welfare Division

    Tmt. S. Rajalakshmi Planning Officer - Health and Social Welfare Division

    Th. S. Boopathy Mohan System Analyst

    Tmt. K.S. Jayanthi Technical Assistant - Health and Social Welfare Division

    Tmt. S. Vijayalakshmi Typist - Health and Social Welfare Division

  • 55State Planning Commission

    WORKSHOP TEAM

    Presentations by

    Dr. V. Sathish Raghavan Deputy Director Tamil Nadu Health System Project

    Th. V. Kumaravelu Regional Manager United India Insurance Company Ltd.

    Th. H. Srinivasan Assistant Vice-President Star Health and Allied Insurance Company Ltd.

    Th. R. Muthukrishnan Senior Manager HelpAge India

  • 6 State Planning Commission

    Executive Summary ......................................................................................................

    an option of affordable premium instead of bearing high medical care costs, health insurance makes the medical care journey simple.

    There are Insurance Companies who provide such Health Policies for Senior Citizens and to know and understand the details of the benefits extended under these policies, a workshop was organized in the State Planning Commission under the Chairmanship of the Vice-Chairman. Resource persons working in the domain of Insurance sector and representatives of organizations working for the welfare of Senior Citizens contributed vital inputs for improving the services.

    Health an asset for all irrespective of age, becomes a major concern once age advances and there arises a need for adequate health cover. When a person crosses retirement age, steady income stops and any expense due to health problems eats into the savings. The increased healthcare cost stands as a huge impediment and it hinders the path of the elderly in taking good care of personal health. This is where a Health Insurance Policy comes into assistance by extending reimbursement of hospitalisation costs incurred due to an unfortunate health problem, subject to terms and conditions. People in general consider investment in health insurance as an additional expenditure. But, it is something that can bring best healthcare well in reach of all. Giving

  • 77State Planning Commission

    Health insurance is defined as coverage that provides for the payments of benefits as a result of sickness or injury. It provides protection against financial losses resulting from injury, illness and disability.

    Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organisation such as a government agency, private business or not-for-profit entity.

    Health Insurance Policy

    The term ‘Health Insurance’ relates to a type of insurance that essentially covers the medical expenses. A health insurance policy like other policies is a contract between an insurance provider (e.g. an insurance company or a government) and an individual / group or his/her sponsor (e.g. an employer or a community organization) in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy. The premium is the amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.

    The Contract / policy is generally renewable on yearly basis by payment of annual premium. The renewals are guaranteed lifelong by the insurance companies unless there is an element of fraud / non disclosure of material facts by the insured. In the case of National plans by the Governments or organized by the Government, generally the cover is available for life long. 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.

    Introduction .....................................................................................................................

  • 8 State Planning Commission

    Health Insurance Industry in India

    In India, the Insurance Industry can be broadly classified as Life Insurance and General / Non- Life Insurance. Under General Insurance, there are various types of Insurance, among which Health Insurance, which was once given least importance, is nowadays being given prime importance because of the high incidence of diseases and the huge costs involved in treatments.

    The uninsured population is very high in India. However, Health insurance has become one of the fastest growing segments of India's economy. Launched in 1986, the health insurance industry has grown significantly, mainly due to liberalisation of economy and general awareness. The first health policies in India were Mediclaim Policies. In the year 2000, the Government of India liberalised insurance and allowed private players into the insurance sector. By 2010, more than 25% of India’s population had access to some form of health insurance.

  • 99State Planning Commission

    The reports on the Health Insurance indicate that, the total Health Premium which was Rs.2,222/- crore in 2005-06 has increased to Rs.17,620/- crore in 2013-14. The Share of Health Insurance premium has improved from 11% in 2005-06 to 23% in 2013-14.

    There are standalone health insurers along w