HEALTH INSURANCE

Presented By:-
Bhagirathi Das
Debabrata Dash
Mousam Pattnaik
Sanujeet Mohanty
Sandeep Mishra
PRESENTATION PLAN
INTRODUCTION
HEALTH INSURANCE MARKET PRIOR TO
LIBERALISATION
HEALTH INSURANCE MARKET IN THE
LIBERALISED MARKET
LAW AND REGULATIONS
INITITATIVES OF FEW STAKEHOLDERS
WAY FORWARD
 INTRODUCTION
PROVIDING QUALITY HEALTHCARE
—A CONCERN

GOVERNMENT ROLE IN HEALTH

CARE

HEALTH CARE FINANCING –

INSURANCE AS AN OPTION
HEALTH INSURANCE MARKET
PRIOR TO LIBERALISATION

PRE-NATIONALISATION :
Hospitalisation and Sickness Insurance

POST NATIONALISATION:
Prior to 1986
1986: Introduction of Mediclaim
HEALTH INSURANCE IN THE
LIBERALISED MARKET

Growth in Health Insurance premium

Product Development

Customer Service

Market share
LAW AND REGULATIONS
‘Health Insurance’ defined
Priority in licensing
Other relevant regulations:
IRDA Protection of policyholders interests, 2002
IRDA Advertisements and Disclosures
Regulations, 2002
IRDA Third Party Administrators- Health Services
Regulations, 2001
File & Use procedure
HEALTH INSURANCE:
ISSUES AND CONCERNS
ADVERSE SELECTION
MORAL HAZARD
HIGH PAYOUTS
SELF-FUNDED HEALTH INSURANCE
 INITIATIVES

PRIVATE INSURERS KEEN TO DEVELOP HEALTH

POLICY: PORTFOLIO

DEVELOPED NEW PRODUCTS

INCREASED THEIR MARKET SHARE

LIFE INSURERS HAVE SHOWN INCREASED

INTEREST
 INITIATIVES …contd
INTRODUCTION OF GOVT. FUNDED HEALTH INSURANCE
FOR POOR

STATE GOVTS. INTRODUCING SCHEMES FOR POOR IN

PANCHAYAT ANDVILLAGE LEVELS

INCREASED GOVT. SPENDING TO STRENGTHEN PRIMARY

HEALTHCARE FACILITY IN SELECTED STATES.

PRELIMINARY STUDY BEING HELD FOR EVOLVING

HEATH INSURANCE SCHEME FOR URBAN AND RURAL
POOR.
 INITIATIVES …contd
MORE TPAs LICENSED AND EXISTING TPAs
STRENGTHENED THEIR OPERATIONS

EMERGENCE OF COMMUNITY AND GROUP

INSURANCE

INVOLVEMENT OF NGOs AND MICRO FINANCE

INSTITUTIONS
RECOMMENDATIONS OF SUB-
COMMITTEES
Sub-group on Health Insurance Data
1)Collection of existing data
2)Collection of future data in standardized formats
3)Training of personnel
Sub-group on Product Innovation ( & definition of pre-existing
disease)
disease
Distinction made between pre-existing disease and condition
and common definitions recommended
Medical Savings Accounts recommended
Creation of a pool for covering senior citizens
Committee to study insurance cover for common man in rural
area
RECOMMENDATIONS OF
SUB-COMMITTEES…contd,
Sub-group on registration of stand-alone Health
Insurers
1) Minimum Required Capital of Rs.50 Crores
recommended
2) Foreign Direct Investment of 51% suggested
3) Adoption of Risk Based Capital proposed
4) Besides health, it was recommended that companies
be allowed to write Personal Accident and Travel
Insurance
 WAY FORWARD
Insurers to – collect correct data,develop new products
price properly, improve u/w and claims management
Explore possibilities of setting up pure health insurance
company with JV partners
Insurers TPAs Data Warehouse to have common IT
framework to facilitate easy data transfer
Govt. to evolve National health scheme for common man
in urban and rural area and Sr.citizen and terminally ill
WAY FORWARD….contd,

Support health Insurance scheme for population

below poverty line.
Foster Public – private partnership
Providers to be more disciplined, bring
standardization.
Govt. to regulate the healthcare providers
THANK YOU