MAJOR RESEARCH PROJECT

ON
STUDY OF EXISTING SYSTEM IN HEALTH INSURANCE

Submitted in the partial fulfillment of the attainment of Bachelor

Degree of Hospital Administration

DEVI AHILYA UNIVERSITY

INDORE, MADHYA PRADESH

Submitted to - Submitted by-

Mrs. Nisha Bano Siddiqui Roop Kumar Dehariya

Lecturer BBA (HA), V1 Sem
IMS, DAVV IMS,DAVV

INSTITUTE OF MANAGEMENT STUDIES

 DEVI AHILYA VISHVAVIDHYALAYA, INDORE

DECLARATION

I undersigned here by declare that, I the student of

Bachelor of Hospital Administration has done the major research project on
“STUDY OF EXISTING SYSTEM IN HEALTH INSURANCE ” & the
project is based on my own authentic work.

The work done by the other, if referred has been properly acknowledge.

Date: ROOP KUMAR DEHARIYA

BBA (H.A.) 6th sem

Place: IMS, DAVV Indore

BBA (HA), 6th Seem

BBA (HA), III Semester

CERTIFICATE

TO WHOMSOEVER IT MAY CONCERN

This is to certify that, Roop kumar Dehariya, student of B.B.A. (H.A.) 6TH Semester
from Institute of Management Studies has done the major research project on the
topic-

STUDY OF EXISTING SYSTEM IN HEALTH INSURANCE

His project work is original and up to my satisfaction.

I wish him all the best for his future.

Project guide:-

Mrs. Nisha Bano Siddiqui,

Lecturer,

IMS DAVV,

Indore,

ANOWLEDGEMENT

There are always many people behind the completion of any project. This project is
also completed with cooperation, suggestion and blessing of many people. Our
intellectual debts in preparing this project are large an unaccountable.

I am extremely grateful to

 ICICI Prudential Life Insurance Corp.

 Tata AIG Life Insurance of India.
 ING Vysya Life Insurance of India.
 I acknowledge with gratitude, the help I received from Mrs Nisha Bano Siddiqui,
Lecturer, and IMS who gives me her valuable time and help me to understand
things in the department.

Finally I would like to thank all those who directly or indirectly help me in
completing this project.

Roop kumar Dehariya

BBA (HA) VI Semester

Executive Summary

This project titled “STUDY OF EXISTING SYSTEM IN HEALTH INSURANCE”

done by me for accomplishing the objective.

What: - My project deals about the study of existing system in health insurance.

Why: -In future I intend to get linked to any of the insurance companies looking at better
prospect of insurance in future.

When: - I conducted my project from 1st March to 1st April 2008.

How: - This project is done by observing and analyzing the various insurance companies
in market and its shortcomings.

INDEX

1. ABOUT THE UNIVERSITY

2. ABOUT THE COLLEGE
3. INTRODUCTION TO THE HOSPITAL
4. INTRODUCTION TO THE TOPIC
5. AIM
6. OBJECTIVE
7. METHODOLOGY
8. INSURANCE:AN INSIGHT
9. ABOUT HEALTH INSURANCE
 10. HOW IT WORKS: THE PROCESS
11. PURPOSE
12. DESCRIPCTION
13. GROUP HEALTH PLANS
14. INDIVISUAL HEALTH PLANS
15. HEALTH CARE REGULATIONS
16. COMMON COMPLAINTS OF PRIVATE INSURERS
17. INSURANCE COMPANIES: AN OVERVIEW
18. QUESTIONNAIRES
19. CONCLUSION.
20. REFERANCES.

About the University

Devi Ahilya Vishwavidhyalaya, born in the Industrial township of Indore,

Madhya Pradesh offers mobility of education to the future builders of the country.

For the same, the Government of M.P has bestowed the university with “Center of

Excellence Award”. The executive committee of National Assessment of

Accreditation Council (NAAC) has accredited a four star status to university.

 In 1964, under the ‘Act of Legislature Madhya Pradesh, the university was

established. Over the journey of forty years it has expanded and diversified itself in

various academic fields. At present it has 32 Technical Departments imparting P.G.

courses in multidisciplinary fields such as management education, social sciences,

engineering, computer, biotechnology & I.T. and other sciences. The university has

approximately 40000 students at its campus. With its resources of facilities,

infrastructure and other academic inputs to provide specialized and high quality

education for preparing future professionals.

ABOUT THE INSTITUTE (IMS)

IMS is driven by the mission:

“Excellence in all areas of performance of everyone associated with the Institute and

to impart quality education.

Its underlying philosophy being:

“Where changing is a tradition and tradition, a way of life;

Where learning is an identity and identity, a strength; and

Where creativity is character and character, a part of soul.

"In this ocean of knowledge, we pursue education."

Institute of Management Studies is a premier institute of the university and among

the top ranked, A+ graded management institute in the nation for its quality of

education, teaching and research. The Institute was started, as a Department Of

Business Management in 1969 and by 1989 was a full-fledged Institute. The Institute

has formed a consortium with Tulane and Eastern Michigan University, USA, and

is very successfully carrying forward its mission and objectives with the support of

UGC and AICTE.

AIM

The aim of my project is to study the existing system of health insurance in our

country by studying the relevant data of various insurance companies regarding

their policies, procedures and claim processes.

Through my project I will bring into light facts and figures of various insurance

companies and also benefits of getting insured.

OBJECTIVE
 The objective of my project is to analyze the market of health

insurance in our country by going into the details of various insurance companies

and finally giving suggestions to make it more accessible to the people.

METHODOLOGY

1. Going the net to find out the details of various insurance companies to find
out their facts and figures. .

2. Visiting various insurance companies to know about them.

3. Designed a questionnaire to study the views of people.

 INTRODUCTION

The country is still struggling to come to grips with the liberalization and the
resultant opening up of the industry. The down of the first year in the new
millennium was hardly 26 days old and the whole nation was preparing for the
ceremonial republic parade when a devastating earthquake shattered the western
part of the country. It left behind a large trail of damage and colossal life o human
life’s and property. The event has struck a severe blow to the insurance industry
which is yet to recover from the tremors.
Globally USA has been undisputedly strongest country in the world, both in terms
of economic consideration as well as military might. The Americans has always
prided themselves over these facts which in facts have never been put to question or
doubt, at least in the recent years. All this myths of strength have been shaken by a
few terrorist attacks on the World Trade Centre and the Pentagon on September 11
and the whole country, the whole World gaped in utter disbelief and dismay. The
tragic event of Sep 11 2001, have affected individuals and business to an
unprecedented degree. Once again the one industry which had to beard the major
burnt was insurance albeit the effect this time was spread over a wider canvas-the
global insurance industry. The attacks have left such a trial or disaster that a very
fundamental concept f insurance is taking a new look.
Today we have become used to this most of the day to day events that fail the
press. Every day news papers and televisions demonstrate all the hazards that can
be fall in any one of us. Any one can be the victim. Whenever there is uncertainty,
there is risk. It involves the various losses including the major effect of the financial
losses.

INSURANCE: AN INSIGHT

MEANING OF INSURANCE

Insurance is a protection against financial loss arising on the happening of an

unexpected event. Insurance companies collect premiums to provide for this
protection. A loss is paid out of the premium collected from the insuring public and
the insurance companies act as a trustee to the amount collected.

Insurance is a contract whereby in returns foe the payment of premium by the

insured, the insurer paid the financial losses suffered by the insured as a result of
the occurrence of unforeseen events. With the help of the insurance large number of
people exposed to a similar risk make contributions to the common found out of
which the losses suffered by the unfortunate few, due to accidental events are made
good.
 It is a system by which the loses suffered by the few are spread over many,
expressed to similar risks

Insurance is based on two principles

• Principle of large numbers.

• Low of probability

HEALTH INSURANCE

Health insurance is a is a form of group insurance, where individuals pay premiums

or taxes in order to help protect themselves from high or unexpected healthcare
expenses. Health insurance works by estimating the overall "risk" of healthcare
expenses and developing a routine finance structure (such as a monthly premium, or
annual tax) that will ensure that money is available to pay for the healthcare
benefits specified in the insurance agreement. The healthcare benefit is
administered by a central organization, which is most often either a government
agency, or a private or not-for-profit entity operating a health plan.

History and evolution

The concept of health insurance was proposed in 1694 by Hugh the Elder
Chamberlain from the Peter Chamberlain family. In the late 19th century,
"accident insurance" began to be available, which operated much like modern
disability insurance. This payment model continued until the start of the 20th
century in some jurisdictions (like California), where all laws regulating health
insurance actually referred to disability insurance. Patients were expected to pay all
other health care costs out of their own pockets, under what is known as the fee-for-
service business model. During the middle to late 20th century, traditional disability
insurance evolved into modern health insurance programs. Today, most
comprehensive private health insurance programs cover the cost of routine,
preventive, and emergency health care procedures, and also most prescription
drugs, but this was not always the case.

HOW IT WORKS: THE PROCESS

A Health insurance policy is a contract between an insurance company and

an individual. The contract can be renewable annually or monthly. The
type and amount of health care costs that will be covered by the
health plan are specified in advance, in the member contract or
Evidence of Coverage booklet. The individual policy-holder's payment
obligations may take several forms

• Premium: The amount the policy-holder pays to the health plan each month
to purchase health coverage.

• Deductible: The amount that the policy-holder must pay out-of-pocket

before the health plan pays its share. For example, a policy-holder might
have to pay a $500 deductible per year, before any of their health care is
covered by the health plan. It may take several doctor's visits or prescription
 refills before the policy-holder reaches the deductible and the health plan
starts to pay for care.

• Co-payment: The amount that the policy-holder must pay out of pocket
before the health plan pays for a particular visit or service. For example, a
policy-holder might pay a $45 co-payment for a doctor's visit, or to obtain a
prescription. A co payment must be paid each time a particular service is
obtained.

• Coinsurance: Instead of paying a fixed amount up front (a co payment), the

policy-holder must pay a percentage of the total cost. For example, the
member might have to pay 20% of the cost of a surgery, while the health
plan pays the other %80. Because there is no upper limit on coinsurance, the
policy-holder can end up owing very little, or a significant amount,
depending on the actual costs of the services they obtain.

• Exclusions: Not all services are covered. The policy-holder is generally

expected to pay the full cost of non-covered services out of their own pocket.

• Coverage limits: Some health plans only pay for health care up to a certain
dollar amount. The policy-holder may be expected to pay any charges in
excess of the health plan's maximum payment for a specific service. In
addition, some plans have annual or lifetime coverage maximums. In these
 cases, the health plan will stop payment when they reach the benefit
maximum and the policy-holder must pay all remaining costs.

• Out-of-pocket maximums: Similar to coverage limits, except that in this

case, the member's payment obligation ends when they reach the out-of-
pocket maximum, and the health plan pays all further covered costs. Out-of-
pocket maximums can be limited to a specific benefit category (such as
prescription drugs) or can apply to all coverage provided during a specific
benefit year.

Prescription drug plans are a form of insurance offered through many employer
benefit plans in the U.S., where the patient pays a co-payment and the prescription
drug insurance pays the rest.

Some health care providers will agree to bill the insurance company if patients are
willing to sign an agreement that they will be responsible for the amount that the
insurance company doesn't pay, as the insurance company pays according to
"reasonable" or "customary" charges, which may be less than the provider's usual
fee.

Health insurance companies also often have a network of providers who agree to
accept the reasonable and customary fee and waive the remainder. It will generally
cost the patient less to use an in-network provider.

Health Insurance companies are now offering Health Incentive accounts (HIA), to
reward users for living healthy and making healthy choices, like stop smoking
and/or losing weight, may get you funds added into your Health Incentive Account,
which may lower your out of pocket costs. The health incentive accounts also carry
over from year to year but once you leave the program you lose those benefits in the
HI Average provided during a specific benefit year
 PURPOSE

The purpose of health insurance is to help people cover their health care costs.
Health care costs include doctor visits, hospital stays, surgery, procedures, tests,
home care, and other treatments and services.

DESCRIPCTION

Health insurance is available to groups as well as individuals. Government plans,

such as Medicare, are offered to people who meet certain criteria.

Group and individual plans can be further classified as either fee-for-service or

managed care. Cancer patients may have specific concerns, such as the freedom to
select specialists that play a factor in choosing a health care plan. Fee-for-service
plans traditionally offer greater freedom when choosing a health care professional.
Managed care often limits a patient to health care professionals listed by the
managed care insurance company
 GROUP HEALTH PLANS

A group health plan offers health care coverage for employers, student
organizations, professional associations, religious organizations, and other groups.
Many employers offer group health plans to employees and their dependents as a
benefit of working with that particular employer (medical benefits). The employer
may pay for part or all of the insurance cost (premium).

INDIVISUAL HEALTH PLANS

These type of health care plans are sold directly to individuals

 HEALTH CARE REGULATIONS

The Health Insurance Portability and Accountability Act (HIPAA), passed by the
U.S. Congress in 1996, offer people rights and protections regarding their health
care plans. Because of HIPAA, there are limits on preexisting condition exclusions,
people cannot be discriminated because of health factors, there are special
enrollment requirements for people who lose other group plans or have new
dependents, small employers are guaranteed group health plan availability, and all
group plans have guaranteed renewal if the employer wishes to renew. In summary
these rights and protections include:

 Portability. This is the ability for a person to get new health insurance if
a change is desired or needed.
 Availability. This refers to whether or not health insurance must be
offered to a person and his or her dependents.
 Renew ability. This refers to whether or not a person is able to renew
his or her health plan.

Questions to Ask the Doctor

  What types of insurance do you accept?
 Does your office file claims for patients?
 Will your office get pre-authorization for procedures where it is
required?
 Do you have a list of providers for my type of insurance in case a referral
is necessary?
 If an experimental procedure is recommended, what costs will be
involved?

COMMON COMPLAINTS OF PRIVATE COMPANY

Some common complaints about private health insurance include:

1. Insurance companies usually only re-price their coverage annually. This

means if one becomes ill, and is covered by a health insurance policy, and
that illness will continue and be subject to a re-priced policy that person may
find that their insurance premiums have increased to an amount they might
not be able to afford. However, some states have rules and regulations which
can limit price increases on certain types of health insurance coverage.
2. If insurance companies try to charge different people different amounts
based on their own personal health, people may feel they are unfairly treated.
Exceptions to this differential in pricing can be found when an individual
(and their dependents) become insured under a pre-existing pool of insured
such as a group of employees insured through their employer. In that
instance, the underwriter assesses the financial risk based upon the entire
group (sometimes referred to as a 'risk pool'). In these situations, a person
 with little or no medical expenses in their recent history will pay the same
premium cost (and be subject to the same co-pays and deductibles) as
someone who has had a large amount of medical expenses in their recent
history.
3. When a claim is made, particularly for a sizable amount, insured may feel as
though the insurance company is using paperwork and bureaucracy to
attempt to avoid payment of the claim or, at a minimum, greatly delay it.
One large industry survey suggests that claim processing times improved
between 2002 and 2006. More claims are being submitted electronically;
however, 29 percent of claims were not received by the insurer until more
than a month after the date on which medical care was provided. The
percentage of claims being adjudicated on an automated basis is also
increasing. 14 percent of claims are "pended" by the insurer while additional
information is requested or the information on the claim is verified. On
average, pended claims are delayed by 9 days. Over 95 percent of the
remaining "clean" claims are processed within 30 days; 57 percent are
processed within one week.
4. Health insurance is often only widely available at a reasonable cost through
an employer-sponsored group plan and online for individuals.
5. In the United States, there are tax advantages to Employer-provided health
insurance, whereas individuals must pay tax on income used to fund their
own health insurance, although a small number of pre-tax health plans exist.
6. Experimental treatments are generally not covered. This practice is
especially criticized by those who have already tried, and not benefited from,
all "standard" medical treatments for their condition.
7. The Health Maintenance Organization (HMO) type of health insurance plan
has been criticized for excessive cost-cutting policies in its attempt to offer
lower premiums to consumers.
8. As the health care recipient is not directly involved in payment of health care
services and products, they are less likely to scrutinize or negotiate the costs
 of the health care received. The health care company has popular and
unpopular ways of controlling this market force.
9. Some health care providers end up with different sets of rates for the same
procedure. One for people with insurance and another for those without.

INSURANCE COMPANIES: An Overview

Policy Coverage

The policy covers medical expenses:

 Incurred as an inpatient during hospitalization for more than 24 hours,

including room charges, doctor/ surgeon's fee, medicines, etc.
 30 days prior to hospitalization.
 60 days post hospitalization.
Day Care expenses incurred on advanced technological surgeries and procedures
like Dialysis, Radiotherapy, and Chemotherapy requiring less than 24 hours of
hospitalization.

Key Benefits

 One Policy – One Premium for the entire family.

 Income Tax benefits under Section 80D.
 No health check up required up to the age of 45 years (as on last
birthday).
 Hassle free claims procedure.

Additional Benefits

 FREE Health coupon - Avail free health check coupon for any 1 member in
the plan.
 Up to 2-year Cover - We offer a continuous 2-year protection with no
increase in premium in the second year. This one time payment of premium
for 2 years takes care of your renewal Hassles next year. Option for 1 year
cover also available

Claim Process

Health - Cashless Settlement

Cashless claims facility is available only at our network hospitals. This list of
network hospitals is enclosed with your policy. Under this facility you just sign the
bills at the time of your discharge and we shall settle the amount directly with the
hospital.

Under cashless facility, claims can be of two types:

Planned

Where the insured or covered family member(s) is aware of the hospitalization 2-3
days in advance.

 Fax / submit the pre-authorization form to TPA with doctor’s comments.

This form is available online and also at all our network hospitals.
 The TPA faxes pre-authorization form with approval within 2-3 hours.
Avail the health treatment.

On your discharge, the TPA settles bills with the hospital.

Emergency:
Where the insured or covered family member(s) meets with a sudden accident or
suffers from a bout of illness that requires immediate admission to the hospital.

 Rush the patient to the hospital.

 Patient avails the treatment.
 Family submits the pre-authorization form to TPA with doctor’s comments.
This form is available online and with all network hospitals.
 The TPA faxes pre-authorization form with approval within 2-3 hours.

On discharge, the TPA settles bills with the hospital.

Health - Reimbursement Settlement

Reimbursement claims facility is available at both the network and non-network

hospitals. The reimbursement claims process is as follows:

 Patient avails the treatment.

 Settle the hospital bills directly by paying the relevant charges.
 Submit the relevant bills / documents for the claimed amount to the TPA.
 The claims will be settled in 7 working days, from the time of submission of
bills.

Documents Required
  Duly completed claim form (available with all network hospitals).
 Original bills, receipts and discharge certificate / card from the hospital.
 Bills from chemists supported by proper prescription.
 Investigation test reports and payment receipts, supported by the note from
attending medical practitioner / surgeon prescribing the test.
 Doctor’s referral letter advising hospitalization in non-accidental cases.
 Nature of operation performed and surgeon’s bill and receipt.

Any other documentation / information as required by the TPA

Policies

Tata AIG Life Insurance announced the launch of three life insurance policies
exclusively designed for children — Assure EduCare 18, Assure Educare 21 and
Assure Career Builder in Mumbai. These juvenile life insurance policies from Tata
AIG work like an additional parent extending support to take care of the future of
the child.

Assure EduCare 18, Assure Educare 21 and Assure Career Builder have been
designed keeping in mind the funds needed to meet the university and specialization
education expenses of a child and also offer an insurance cover. While Assure
Educare 18 and Assure Educare 21 are endowment life insurance policies maturing
with the child attaining the age of 18 years and 21 years respectively, the Assure
Career Builder is a money-back life insurance policy maturing with the child
attaining the age of 27 years.
Mr. Ian J Watts, Managing Director, Tata AIG Life Insurance, said, "We are
delighted to offer three life insurance products tailored exclusively to meet the
educational needs of children and also offer insurance cover. Considering the costs
involved for pursuing higher education and also the competitive environment that a
child is exposed to, the need for planning the education of a child is an important
aspect for any parent."

"We have designed our juvenile life insurance policies keeping in mind the most
important thing a parent wants for his child, helping them provide for a bright
future for the child and also offering them an insurance cover. These plans help the
insurer get an uninterrupted cash-inflow at regular intervals to take care of the
education expenses of one’s child", Mr. Watts added.

Assure Educare 18 and Assure Educare 21 are participating endowment plans that
mature on a policy anniversary with the insured attaining the age of 18 years and 21
years respectively. These policies offer complete risk protection with guaranteed
benefits like ‘Guaranteed Addition’, that is 10 per cent of the sum assured of the
basic policy is payable if the insured dies after 10 years or with the maturity of the
policy; and guaranteed education amount, which is 20 per cent of the sum assured
of the basic policy on maturity of the policy.

The third juvenile life insurance offering — Assure Career Builder is a participating
modified anticipated endowment (money back) plan that matures on the policy
anniversary following the insured attaining the age of 27 years. The cash payments
payable following the insured attaining the age 18, 21, 21 and 27, will not reduce the
death benefit payments if death occurs before maturity.

Additionally, these three juvenile policies also offer non-guaranteed benefits like the
reversionary bonus declared annually and credited to the policy and a terminal
bonus based on accrued reversionary bonus, payable upon death or upon maturity
of the policy if it’s in force for more than ten years. Further, the policyholder can
also take the 'Payor Benefit Rider' along with the basic policy. This rider ensures
continuity of the policy by waiving-off all future premiums on the policy in the event
of death or disability of the premium payer.

These juvenile life insurance policies further add to the range of innovative life
insurance products introduced by Tata AIG in the last one year.

Tata AIG Life Insurance has simplified the claims processing system for
policyholders. The company's staff is visiting major hospitals and advising people
on how to expedite claims.

Tata AIG's customers can also call the 24-hour toll-free help line and get immediate
assistance and advice on the claims process. A special 24-hour help line has also
been set up.

Mr. Sunil Mehta, Country Head and Chief Executive, American International
Group (AIG), said Tata AIG had activated the Claims Catastrophe Management
Plan (CCMP) that was envisaged to meet claims under such calamities.
ING Vysya Life - An Overview

ING Vysya Life Insurance Company Limited a part of the ING Group the world’s
largest financial services provider^ entered the private life insurance industry in
India in September 2001. Headquartered at Bangalore, ING Vysya Life is currently
present in 246 cities and has a network of over 300 branches, staffed by 7,000
employees and over 51,000 advisors, serving over 5.5 lakh customers

Product Portfolio

ING Vysya Life follows a “customer centric approach” while designing its products.
The Company’s product portfolio offers products that cater to every financial
requirement, at all life stages.

In fact, the company has developed the Life Maker a simple tool which can be used
to choose a plan most suitable to a specific customer based on his needs,
requirements and current life stage. This tool helps you build a complete financial
plan for life at every life stage, whether the requirement is Protection, Savings,
Investment or Retirement. Suitable products from ING Vysya Life Insurance’s
product portfolio for each such requirement, makes selection of your plan an easy
exercise
The Company aims to make customers look at life insurance afresh, not just as a tax
saving device but as a means to live life to the fullest. It believes in enhancing the
very quality of life, in addition to safeguarding an individual's security.

Distribution Channels

ING Vysya Life has a diversified distribution platform. While Tied Agency remains
the strongest channel, the Alternate Channels business within ING Vysya Life is one
of the fastest growing distribution channels. ING Vysya Life has strengthened its
position as the unparallel leader in the life insurance industry in cooperative banks
tie ups. The company currently has tie ups with 130 cooperative banks across the
country. The Alternate Channels division has Banc assurance, ING Vysya Bank,
Corporate Agents and SMINCE.
 QUESTIONNAIRE

1) Are you aware of “HEALTH INSURANCE” polices? If yes then how many
members of your family are insured?

2) Which types of health insurance policy do you hold- either long term or short
term?

3) Are you satisfied with polices and procedures relating your health insurance
policies? If not, then what recommendations you suggest to better your
policy?

4) At present which company’s policy are you holding and would you to buy
policies of others companies or not? If yes, then which would you prefer?

5) Do you like the concept of broker between you and the company? If no, then
what should be the strategy according to you?

6) What do you think is the present status of health insurance in our country?

7) Are you satisfied with the present status? If no, then what do you suggest to
the policy-making companies to do to attract members?
8) Do you think the claim process laid down under the policy of the company is
suitable or not? Whether it is a lengthy process? To shorten it what should
you suggest?

9) Do you like the inclusion of other schemes under your policy? If yes, then
what type of the scheme would you prefer, either cash increasing schemes or
some types of incentives given often a fixed interval?

10) Do you (senior citizens specially) receive policy renewal letters from
insurance companies regularly? If not then what would you like to suggest.

11) In this competition era, health insurance policy recently launched by LIC of
India, would be successful in its policy? If no, then what steps it would take
to make its scheme better then its rival?

12) How do you feel the insurance companies should do to educate the people of
our country regarding the better future effects of being insured?

13) Is there a need to revamp the insurance companies and if so which areas will
you could suggest some techniques which should be adopted by the
companies?
 CONCLUSION

In India there is limited experience of health insurance. Given that government has
liberalized the insurance industry, health insurance is going to develop rapidly in
future. The challenge is to see that it benefits the poor and the weak in terms of
better coverage and health services at lower costs without the negative aspects of
cost increase and over use of procedures and technology in provision of health care.
The experience from other places suggest that if health insurance is left to the
private market it will only cover those which have substantial ability to pay leaving
out the poor and making them more vulnerable. Hence India should proactively
make efforts to develop Social Health Insurance patterned after the German model
where there is universal coverage, equal access to all and cost controlling measures
such as prospective per capita payment to providers. Given that India does not have
large organized sector employment the only option for such social health insurance
is to develop it through co-operatives, associations and unions. The existing health
insurance programmes such as ESIS and Mediclaim also need substantial reforms
to make them more efficient and socially useful. Government should catalyze and
guide development of such social health insurance in India. Researchers and donors
should support such development.
 REFERENCES

Bibliography

 Health care magazines

 Health Care express
 Health insurance magazines
 New papers
 Catalogs of Health Insurance Company

Web Pages

 www.google.com

 www.healthcareexpress.come

 www.healthinsurance.com

 www.answers.com