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