Virendra Singh

Central university of Rajasthan

definition Present scenario health insurance penetration IRDA Initiatives and Committees Recent Developments Hard Choices

WHAT IS HEALTH INSURANCE?

 SYSTEM OF ASSURANCE TO MAKE

CONTINGENCIES OF HEALTH CARE EXPENSES.  TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BY UNFORSEEN SICKNESS.  TO MEET COST OF GOOD MEDICAL CARE.  RELIEVES ANXIETY AND TENSION.

Heath Insurance has been fastest growing segment in the non-life insurance industry in india in recent year. The segment has grows 60% during 2007-2008 to command a market of over rs. 5100 crores in non-life companies. The premium from health insurance products has grown from 675 crores in 2001-02 to rs. 5100 crores in 2007-08 that is over 7.5 times in the last six year. In the last two year alone the growth has been 130%.

BENEFITS
Rs.30,000 Sum Insured Limit for Anesthesia, Blood, Oxygen, etc. Rs. 4,500/Rs. 15,000/Limit for any one illness Rs.25,000/Personal Accident Cover NOT COVERED Pre Existing Diseases 30 days Waiting period NOT COVERED First Year Exclusions NOT COVERED Maternity Benefits Rs.548 PREMIUM (for a family of five) Rs.248 BPL Family Pays IT FAILED

holders. Absence of Nodal implementing agency Improper identification system of beneficiaries. Inadequate coverage / benefits. Huge premium burden Lack of awareness / publicity. Cost of collection of premium more than the premium No confidence of public about treatment in case of need

 Lack of willingness of Insurers / other Stake

Increasing awareness about health insurance. Rising healthcare costs. The recent detariffing of the general insurance industry.

With detariffing ,insurance companies have emphasized their efforts towards health insurance and other personal lines of business.

Despite the rapid growth of the health insurance segment in the past

few years, the health insurance penetration in the country continues to be low.
Overall, the Indian health sector is still characterized by the near

absence of any significant risk protection against major health related expenditure, as insurance and other organized forms of payment for health services, including ESIS,CGHS and other such schemes barely cover a tenth of all people in the country.
According to the National Health Accounts published by NCMH

in 2005 , almost four fifths of the health spending in the country is private, out-of-pocket expenditure.

be very pronounced, and indeed is reported as one of the leading causes of impoverishment in the country.(World Bank, 2002).
Many states have recently commenced large scale health insurance

In the absence of such protection, the financial impact of hospitalization can

programmes to protect their vulnerable groups from such health related financial needs, prominent being the Rajiv Aarogyasri Scheme in Andhra Pradesh and the centrally sponsored Rasthriys swasthya Bima Yojana (RSBY) being launched now in many states across the country.

Which are developed and implemented with the support of the insurance industry. Such schemes have contributed to increasing penetration of health insurance in the country.

IRDA has been taking many proactive steps in its developmental agenda for health insurance.
The authority had set up a National Health Insurance

Working Group in 2003, which provided a platform for various stake holder of health insurance industry.
1) To work together and suggest solutions to various

relevant issues in the sector. 2) Subsequently, realizing the importance of accurate and timely data for health insurance.

 16.3 million insured persons 3.8 million policies 1 million claims

There have been continuous improvements in the quality of this data.

 The sub-committees to specifically look into the areas of registration of stand alone health insurance companies and to suggest innovations in health insurance products.

The recommendations of these sub-committees have triggered progress in both these areas. Other committees in recent years which studied various aspects of health insurance include the Committee on Rural Health Insurance, and the Committee on parliamentary Undertakings.

 The committee has made several recommendations

regarding the concerns that senior citizens face on the health insurance front. Some of these fall under the domain of the government, while others need to be addressed by IRDA and the industry.

Data Standards 2) Provider Standards 3) Payer Standards 4) Awareness of health insurance

1)

 In the last few months, both the prominent industry chambers have, for the first time, held national level workshop exclusively on Health Insurance. These events have been supported by IRDA from their conceptualization state. IRDA is also co-ordinating with and supporting insurance industry initiatives in standardizing certain key terminology used in health insurance documents, for better comprehension and in the interest of policyholders.

We would request the IRDA to consider the matter in depth and undertake a scrutiny such claims so that in the event it is found that the insurance companies are taking recourse to arbitrary methodologies in the matter of entering into contracts of insurance or renewal thereof, appropriate steps in the behalf may be taken. Although this aspect of Renewability as also of cancellation/Termination of health insurance policies has been already considered by the Authority for all new products which have been field over the last one year or so, a more exhaustive effort on this concern is now being taken up in the department.

The judgments includes specific directions to IRDA

 All insurance companies have been advised that for

the purposes of calculation of premium for health insurance policies completed age of the prospect on the date of commencement of insurance should only be reckoned. Insurers have been instructed to submit half-yearly returns to the Data Repository appointed by the Authority for the purposes of building credible health insurance statistics.

address the health insurance related grievances of senior citizens in insurers and TPAs.

Mandated the establishment of a separate channel to

policies which states that a health insurance policy shall be ordinarily renewable except on grounds of fraud, moral hazard or misrepresentation. Specifically renewal shall not be denied on the grounds that the policyholder has made claim in earlier years.

Issued guidelines on Renewability of health insurance

 Issued circular on health insurance for senior citizens. All health insurance policies issued by general insurance companies for a duration of 3 years or more shall have a free look period of 15 days.

Health insurance raises complex goal conflicts. These include the goal of availability and the goal of nondiscrimination. Both goals push for universal health care at levels of adequate care for every one. The three other goals are not to exceed the capacity of the pool to pay for the services. To protect the autonomy of health care professionals and patients in medical decision To maintain the solvency of the insurance system.

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