HEALTH INSURANCE

Growth in national income by itself is not enough, if the benefits do not manifest themselves in the form of more food, better access to health and education: -------Amarty K Sen

Expenditure on health by the Government continues to be low. It is not viewed as an investment but rather as a dead loss! States under financial constraints cut expenditure on health Still India is way behind many fast developing countries such as China, Vietnam and Sri Lanka in health indicators

In case of government funded health care system, the quality and access of services has always remained major concern. Very rapidly growing private health market has developed in India & they are helping in bridging the gap between what government offers and what people need

Why there is need of huge health insurance demand in India? With proliferation of various health care technologies and general price rise, the cost of care has also become very expensive and unaffordable to large segment of population. The government and people have started exploring various health financing options to manage problems arising out of growing set of complexities of private sector growth, increasing cost of care and changing epidemiological pattern of diseases. Health scenario in India India spends about 6.5 to 7% of GDP on Health care (official estimates hover around 6%) out of which 1.3% is in the Govt. sector (this accounts for 22% of overall spending) and 4.7% in private sector (78% of overall spending). National level of spending on Health care under five year plans has decreased - it was 3.3% in first plan & 0.7% in eighth plan. The national spending also includes family planning, water, sanitation for rural areas etc. Majority of funds (approx. 50%) go in salary & administration from Govt. spending budget. There are various types of health coverage's in India. Based on ownership the existing health insurance schemes can be broadly divided into categories such as: Government or state-based systems Market-based systems (private and voluntary) Employer provided insurance schemes Member organization (NGO or cooperative)-based systems

Popular plans of ICICI Lombard Critical Care Insurance 80 D of the Income Tax Critical Care protects you or your spouse against loss of income on diagnosis of any of the 9 major medical illnesses and procedures. The first of its kind, it offers a lump sum benefit on diagnosis of Cancer, Bypass Surgery, Heart Attack, Kidney Failure, Major Organ Transplant, Stroke, Paralysis, Heart Valve Replacement Surgery or Multiple Sclerosis. Critical Care Insurance also provides cover against accidental death and permanent total disablement (PTD). 10 K Tax Saver Plan - Introduction The `10K Tax Saver Health Insurance Policy has a fixed premium and enables you to save up to Rs. 3,366* under Section 80 D of the Income Tax Act. Family Floater Health Plan - Introduction For the first time in India, one single policy takes care of the hospitalization expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents

Personal Accident Insurance ICICI Lombard Personal Accident Insurance policy covers you against Accidental Death, Permanent Total Disablement (PTD) and Permanent Partial Disablement (PPD). As a special offer, we now bring 3 new Personal Accident flexible plan options (Accidental Death & Permanent Total Disablement cover only) with a sum insured of Rs. 3, 5 and Rs. 10 Lakh.

Bajaj Allianz Health Guard : Bajaj Allianz covers you and your family against expensive medical care including pre & post hospitalization expenses. Sum assured up to 5 lacs per insured. Critical illness: Protection against the 10 major life threatening illness like Cancer, Heart Attack, Paralysis, Kidney failure, Stroke, etc. In transplant surgery donor expense are covered. Sum assured apt 50 lacs per insured. Silver health : Bajaj Allianzs Silver Health is a health insurance plan specifically for people aged between 46-75yrs which protects you and your spouse in case you need expensive medical care. Hospital cash : A policy that provides a daily allowance for each day of hospitalization. Benefits is doubled in case of ICU admission. Income tax exemption under SEC 80 D. Personal guard :This policy covers against accidental death and comes with several additional benefits like hospital confinement allowance, children's education bonus. E- opinion: Bajaj Allianz launches e-opinion rider, which will cover the expenses of 2nd opinion e-consultation services for serious illness in India

United India Insurance Products Personal Accident Policy Mediclaim Policy Overseas Mediclaim Policy for Business and holiday Overseas Mediclaim Policy for Employment and Studies Overseas Mediclaim Policy for Corporate Frequent Traveler Road safety package Policy Uni medicare Policy The New India Assurance Health Plus Medical Expenses Policy Mediclaim Policy Personal Accident Policy Overseas Mediclaim Policy

Star Health And Allied Insurance Company Star True Value Health Insurance is an offering designed to offer health insurance to the masses. The premiums are very economical, making it within the reach of many. The insurance is available in various options ranging from a minimum sum assured of Rs.30,000 to a maximum of Rs. 80,000. The premium depends on the age of the person proposed for the insurance.

STAR Medi Classic policy to provide for reimbursement of hospitalization expenses. NRI All Care, to insure the health of family members of NonResident Indians. It provides for financial help and assistance, should a medical emergency arise. Family Health Optima to protect all members of a family from financial setbacks in the event of a serious illness. The coverage is applicable equally to all members of the family. Senior citizen red carpet It provides cover for anyone over the age of 60 and permits entry right up to the age of 69 with continuing cover after that. It is our way of caring for a generation that has done so much to build the country we have today.

US Vs GERMAN HEALTH INSURANCE MODEL

Conclusion From Comparison

German system is clearly superior to American system German system is social health insurance based on solidarity delegation and free choice American system is based on private market philosophy . Thus the German system is much more suited to the needs of the developing countries.

Constraints in adopting German models in India For social health insurance to work the work force has to be organized and working in formal sector so that their incomes are clear and there is a mechanism for payroll deduction of the contribution. It also needs a well-developed regulatory framework and culture of solidarity and self-regulation so that well off section of the community is willing to pay for the costs of sickness Universal compulsory social health insurance is not possible in India at this stage.

Micro Health Insurance

Characteristics of the MHIs Organized by NGOs Targeting the poor Provides a comprehensive package Collects affordable premiums NGOs and communities manage the administration Usually requires some external resources for financial viability.

Imperative of Liberalization in Health insurance Poor country like India ,where only asset people have is their bodies Early 1990 govt key tool to manage fiscal deficit was decrease Govt Expenditure Poor Quality of health service by govtClients did not demanded better service as it was free of cost

Current health scenario Accounts for 1.2% of expenditure on health of country TPA has not only speeded the claim process but reduced the insurer burden Total claim 64% were settled in 1 month & 89% in 1-3 month Challenges Faced by India India has 48 doctors per 100,000 persons which is fewer than in developed nations Wide urban-rural gap in the availability of medical services: Inequity Poor facilities even in large Government institutions compared to corporate hospitals (Lack of funds, poor management, political and bureaucratic interference, lack of leadership in medical community