Presented By:-Shifali Bhardwaj Himanshi Mohit Sharma Shivang Arvinder

What is Health Insurance?

It is a contract between the Insurer & the Insured wherein the former agrees to pay to the latter hospitalization expenses to the extent of an agreed sum assured in the event of any medical treatment out of an illness or an injury. Its an insurance which covers the financial loss arising out of poor health condition or due to permanent disability which causes a loss of income. It is an insurance policy that covers the risk of medical expenses at the situation of any unfortunate crisis.

Why you need health insurance?

To avoid increasing medical costs It helps securing a better future by paying a fraction as an expense today called the premium. It definitely induces a sense of security to the insured. It covers your hospitalization and medical bills.

You can avail tax benefits on the premium paid under section 80D of the Income Tax Act.

Health insurance companies in India

Apollo Munich Health Insurance Company limited Star Health and Allied insurance Co Ltd Bajaj Allianz General Insurance Co Ltd ICICI Lombard General Insurance Co Ltd National Insurance Co Ltd Reliance General Insurance Co Ltd

United India Insurance Co Ltd

TATA AIG General Insurance Co Ltd Religare Health Insurance Co Ltd

Health Care Financing In India

The share of public financing in total health care is just about 1% of GDP compared to 2.8% in other developing countries. Beneficiaries are both poor as well as well-fed section of society. Over 80% of the total health financing is private financing , much of which is out-of-pocket payments (i.e. User charges) and not any prepayment schemes.

Third Party Administration And Its Role

TPA stands for Third Party Administrator.
TPA is a middlemen between Insurer and the Customer . Customer can directly deal with TPA at the time of claim and TPA will help with all the process of claim settlement . A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement.

Third Party Administration And Its Role

Some of the services TPA provides are Maintain database of policyholders Issue of identity card to all policyholders Provide ambulance service Networking with the hospitals Provide Cashless service Process claims Claims settlement

Health Insurance Coverage

Offer basic coverage for hospital and doctor bills. Hospitalization Cover: Protects the insured person for inpatient hospitalization expenses for a minimum of 24 hours. These expenses include room and boarding charges as per policy conditions Nursing expenses Surgeon's fees, Consultant's fees, Anesthetist's and Specialist's fees Cost of medicines and drugs Expenses for Organ Donor Emergency Ambulance

Type of health insurance plan

Individual Health Insurance
Individual Health Insurance plan offer more protection to a policyholder, as in such a policy the policyholder can consume the entire amount alone without have to worry about sharing it with other members of his family incase of a floater policy.

Group Health Insurance

Whenever a large group of people say over 20 who work, stay or are bonded by some nature of job are willing to get a Health insurance plan, they should opt for a Group Health Policy. Under a group health policy people who may have adverse health condition can also easily get health cover due to the greater negotiating power that a group contains versus a individual policy.

Cashless Mediclaim
Cashless Mediclaim plans are those which allow a policyholder to get admitted into a network hospital without the need of a paying any upfront admission fee and discharge fee as the same is paid by the health insurer. The cashless mediclaim reimbursement is capped to the level of sum assured the person has and the coverages under the plan.

Family Floater Plan

Family Floater Plans refer to those which cover the entire family under one plan. Under a family floater plan the people covered share the total health insurance available to them. Taking an example, if a family of 4 (2 Adults and 2 Children) takes a family floater plan then there premium for a health cover of say around Rs. 5 Lacs would be close to Rs. 10,000, whereas, if all of them had a separate plan of Rs. 5 Lacs their premium would have exceeded Rs. 12,000 easily.

Critical Health Insurance

A critical health insurance policy hels cover certain set of diseases as prescribed under a policy only. As the name suggest critical health insurance, they cover all those major diseases which are either terminal or can reduce the human body to a vegetative state. Some of these would include, Alzheimer's disease, blindness, deafness, kidney failure, major organ transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or during an operation, Parkinson's disease.

Travel Health Insurance

Whenever a person is travelling outside the geographical boundary of his / her country it is always advisable that they take a Travel Health insurance plan. This is advised so that the person in-case falls sick or has any other medical emergency abroad need not worry about the high cost of healthcare in a foreign land. This is also mandatory to buy before travelling to a certain countries.

Structural facilities
The government has interfered whenever the cost of the medical

care has become unreasonable. Such government intervention is

required to make the process of medical insurance cost-effective and achievable especially for those who are financial deprived.

The government introduced innovative healthcare products to

the medical market .

The government established appropriate health infrastructure to support the Mediclaim conveniences that are offered in the market.

The government has also taken various proposals to support

the growth of the insurance sector such as Tax benefit offered under Sec 80 D of the Income Tax Act

Health insurance tips

Compare prices and features before buying. One policy can cost over 3 times the other! Its quite easy to do this on an aggregator like policybazaar.com If you have a family, go for a Family floater policy. It is more economical and gives higher coverage for each member of the family.

 Compare the terms of the policy so you do not get a shock later. A broker will be able to provide the best advice since he is largely independent.

Do not always adopt a policy with a cashless tie up with a hospital nearby. All good hospitals can be empanelled by insurance companies. Rather look for a policy that fulfils your requirements adequately. Find out all the hospitals that your insurance company has empanelled with and understand what their specialization is, so if you are in need you can use the appropriate hospital, rather than just one all the time.

 Always it is advisable to buy from a broker, ask for their license number, and check if the details provided are correct from the IRDA website. These brokers are independent and are paid for every policy they sell, so they are not inclined to push one over the other. An agent on the other hand sells for one company only and hence will generally push that company and its benefits. Be truthful and accurate in your declarations on the proposal form. That will only ensure payment when you have a genuine claim.

Role of the Private Sector Companies in promoting the Health Insurance Policies
The private players in the health insurance sector have supported their customers by providing them affordable, inexpensive and easily accessible insurance

The insurance companies have given a lot of importance to

convenience of the customer. Buying the e-policy online has become a much convenient alternative with the facility to renew it anytime, anywhere.

 The insurance companies have developed precocious Mediclaim insurance policies that not only provide comprehensive coverage but also induce various other benefits. Another major step in the health insurance sector is the floater concept, where they cover the entire family in one policy.
Private companies are constantly improving their products to meet the needs of the people as much as possible. Such steps include various plans that cover critical illnesses, outpatient expenses and others.