Health Insurance
Challenges & Opportunities
What is Health Insurance?Health Insurance covers your medical expenses due to diseases and accidents
Health Insurance is a contract between an individual/group and the insurer
The policy provides specific health cover for a particular premium
Reasons for Health Problems
Fast Lifestyle
Diseases common in children
Food Habits
Lack of Exercise
Mental Stress & Strain
Pollution
New Types of Diseases
Expect the unexpected like Accidents .
Rising Health Care Costs - Reasons
Speciality health care
Investigative type of treatment
Hospital infrastructure
Medical equipment
Cost of living/Inflation
Rising drug prices
Super speciality doctors
Defensive Medical practice
Why is health insurance essential?
Unaffordable health care
No basic public health services
Increasing life expectancy
Increasing percentage of the elderly persons
Health is wealth
Good news – Health insurance is affordable
Health Insurance Market in India
Fastest growing segment (avg. 20% growth)
Growth:Expected By 2015: 30000 Cr.
24companies offering health insurance
100+ types of medical insurance policies
Potential market: Semi-urban areas
Health Care Scenario in IndiaHealth care expenditure is 6% of GDP
Govt. spending
< 25% as against
30%-40% in other countries
Only a small section
of the population is covered
Health Insurance –Role of Hospitals
In Kerala, people are conscious of health care; but mostly unaware of health insurance
Hospitals are the right place for creating awareness of health insurance
Enough time for patients and relatives to study various types of policies and their benefits
Issues & Challenges for Insurance companies
Limited Influence over healthcare delivery mechanism
High claim ratio – Around 140%
Low level of consumer awareness
Limited product development
Limited knowledge for staff/Agents
Issues & Challenges: Healthcare providers
Pricing demands from Insurance companies
Lack of proper communication between TPAs and Hospitals
Delay in Settlement of Claims
Lack of Training support from Insurers as well as TPAs
Pre existing diseases disputes between consumer and TPAs
Different Insurance Companies – different policies, terms etc
Expectations from HospitalsNo overcharging for insured patients
No fraudulent medical certification
Pre-existing diseases & treatment education
No mis-handling of patients in front office
Classification of hospitals & transparency
Economical treatment for poor / BPL patients
No unwanted investigations, treatments, delays
No manipulation of recordsEx: [Alcoholic accidents and into Road accidents]
Insurance EducationHealth Insurance–different types
Proposal fillings
Premium calculation
Income Tax benefits
Cashless/Reimbursement
Group/family discounts
Policy comparisons
Claims process
Prompt reimbursements
Recommended PoliciesIndividual Policies
Family Floater Policies
Group Policies (customized)
Senior citizen Plans
Critical Illness Policies
Surgical benefit policy
Hospital Daily Cash Policies
Super Top up Policies
Students Policies
Micro & social security Schemes
Health Insurance Promotion
Health Insurance Posters/ Banners etc
Simple Health insurance leaflets in Malayalam
Insurance Help Desk
Policy details, comparisons, premium charts, claim procedure
Documentation assistance
Benefits to the public
Developing insurance awareness
Selection of suitable insurance policies
No immediate cash outgo thanks to cashless facility
Tension free claim settlement process
Encash the opportunityDeveloped Countries –100% health insured
India Emerging Economy – Untapped Market
Kerala - Health conscious people
Kerala – Low awareness of Health Insurance
Be a part of social development through promoting health insurance
Thank You
Prepared by
Viswanathan OdattDirectorAims Insurance Broking
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