Health Insurance Issues Challenges And Perspectives

Health care  insurance  or Medi claim,  as it is popularly known in  India is a comparatively new, and at the same time, fast-developing   insurance  segment. Until the time the industry was opened up for private participation  the concept of healthcare   insurance  was alien to a major  segment of then insurable  population  of India. Until the time the nationalized non-life   insurance  sector, represented by the General  insurance  corporation  of India and its four subsidiaries  were transacting health care  insurance  under a single brand Mediclaim, Mediclaim  was a ‘ Reimbursement Plan.  wherein the insured was entitled  for the reimbursement  of hospitalization  charge as per the terms of the contract. 

the concept of  ‘ Cash Plan” under which the contract provides for the payments of a predetermined amount per day of hospitalization irrespective of the actual  expenditure, was popularized by the private  insurance  companies  once they started marketing healthcare products. For want of proper promotions  and creation of awareness  by the public sector companies the health  insurance  sector  had  almost stagnated. After the advent of the private players,  the sector companies, the health  insurance  sector had almost stagnated. After the advent of the private players the sector became more vibrant . During the decade 1992-2002, the premium income had grown phenomenally 

. During  this period , the sector had grown at an average  rate of 125% per year. the premium from a more Rs. 35 Crores in 1980s had touched Rs. 477 Crores as at the end of the fiscal 2002, and had more than doubled during the fiscal 2002-03. According to estimates, the healthcare premium is expected to be around is Rs. 1,753 crores by the year 2005. To harness the huge unexplored  segment of the health sector, many studies have been conduct  . the principles among the them are the CII-McKinsey  Report and the Report on Health  insurance  by the committee  constituted by the Ministry of Health and family welfare. There are many areas where the reports show agreements.  the following are the areas that are common to both reports.  To attract proper and qualified insurers, the Government  should take necessary initiative  to stimulate the growth of private , social and community sector  insurance .

Multi -tiered insurers  with better understanding  of the regional requirements  should be  encouraged  to set up shop. Health   insurance  is to be  recognized  as a  separate line of  insurance . The entry  level of Rs. 100 crores  and the solvency norms are discouraging because stringent norms  make it difficult  to break-even within a reasonable  time. Reduction  in the entry norms will improve stability  of the business. A view is emerging that the capital adequacy  should be have a relationship  to the type of business of the insurer and the nature of operations. The IRDA should develop separate  regulations for the health score and make registration with the IRDA mandatory for all health care providers , including  NGO’S All private  employees should be mandated to provide  health care  insurance .

 The government should provide guidelines for social  insurance  and set up  pilot projects to monitor existing  schemes. there should be health care  insurance  products to meet the needs of various segments  of society. Developing  proper underwriting standards, effective, management  of hospitals, effective management of claims and offering  diseases specific covers for cost containment are necessary. Presently  the health care business is not attractive because  health care providers are not able to achieve even the viable margin of 3% for the loss Ratio is more than 120%.  To  streamline health care  insurance  in India , a working group has been constituted under the  aegis of the USAID (United States Agency) for International Development) to assist  to IRDA in developing  future policies on health care  insurance . This committee  is studying  a wide range of references.

PLAN YOUR GREAT ESCAPE ON A BUDGET

 Summer usually heralds  the beginning  of a lot off  fun things for Indian  families. Kids complete their academic year and look forward to go on a vacation with the entire family parents make elaborate  holiday plans to switch off from  work and spend time with their children. Some people prefer adventure holiday while  others would rather laze around the sunny beaches. You may even  ask every member of the family to vote on what type of the holiday they want and then zero in on a place that is according  to everybody liking . If you are in the mood to  spend some me time, minus the spouse the and kids,  you should book a sitter ask either your spouse, parents or friends to take care of the children while you are a away. This leaves you  free to plan a holiday according to your mood– be it a girl’s holiday out, or  a quiet  spa retreat.

PLAN IT WELL: You should  keep several factors in mind while planning your holiday. After  you decide  the destination, calculate the holiday budget. A  budget in general helps you control your spending habits and ensures that the monthly  expenses  are lower than the monthly income. A similar budget can be prepared  for a holiday as well, which includes all categories. Start by  reviewing  your income, expenses  and loan obligations and set aside  money for emergency  and set aside money for emergency  expenses . It is advisable  to prepare this budget before you plan for your holidays, so that you plan for your holiday, so that you know how much you need a to save  for the vacation . Put away money into a savings account in a advance on a monthly  basis. also  ensure  that you don’t  withdraw from investments  that are meant for other life goals.

  SET MONEY  FOR BUDGET: Depending on the  time remaining for the holiday, you can act accordingly . If the money into a  dedicated savings  account and so do not touch it until the holiday. If you have planned several months in advance then up put the money into debt funds or fixed deposits , so that you not only  have your holidays case, but also earn some interest on it while planning the trip. Some online sites give you the option to book with a token advance and pay the rest to the hotel directly.

INSURE YOUR TRAVEL:  Keep in mind that you need to take travel insurance  before you travel this can be done easily online on the portals of most insurance companies. There are various types of coverage  to insure onself against  the risk faced as a treveller. You can purchase this from insurance companies , travel agents, tour operators  rental companies or even travel assistance companies. The coverage , cost and terms vary widely   depending upon the policy purchased. Factor to keep in mind while purchasing  travel insurance.

A.  TRIP CANCELLATION INSURANCE:   This  protects you from the risk of cancellation  of trip due to unforseen events  are such as the financial  failure of the airline or  travel agency, bad weather , illness or death.  B.  TEMPORARY  HEALTH POLICIES: This provides short-term supplemental  health insurance coverage . This type of coverage may be helpful while travelling abroad ,. since  some health insurance providers  don’t  have coverage  for overseas travel and an\y kind of the  treatment in most places, can cost you a fortune.   C.  BAGGAGE INSURANCE: This  reimburses you if your personal belonging are lost stolen or damaged in travel.   D.  ACCIDENTAL DEATH AND DISMEMBERMENT  INSURANCE: This compensates and if you end up  being  disable or it compensates  your beneficiary  if you die in an accident.

LIFE POLICY CONDITION AND POLICY

 A condition is a stipulation  essential to the main purpose of an   insurance   contract a breach of such condition gives rise o a  right to the insurer to repudiate  the contract. The conditions limit the scope of  insurance . Certain  conditions are only of informative nature to the assured. Generally   the conditions are printed on the back of the policy bond. The conditions attached  with Life  insurance  policies are as follows:

  (1) COMMENCEMENT OF RISK: The risk under a policy ordinarily commences on the date of receipt of the first premium  in full or from the  date of the company’s  acceptance letter whichever  is later and the second instalments of the premiums falls due on a date calculated from the   above date of commencement  of risks, if the acceptance  letter is a conditional one, the risk will commences on the fulfilment  of that condition.    

  (2) PROOF OF AGE: Age is the  very basis which governs  risk level and its pricing in life  insurance . Thus age is important for determining  the risk involved and the premium  amount. The life insurer will insist  on proof of age at the tome of submitting the proposal. The following  are considered  standard age proofs. (a) Certified extract from Municipal or other records made at time  of birth.    (e) Passport: In case  the age of the life assured at entry is found  to be lower than the age given the proposal from the premium shall be payable at the correct age and the excess of premium already collected with will be  refunded. If it is higher  than the age given in the proposal  the differences  between the premium for the correct  age and the original premiums already paid will collected  with interest. 

(3) PAYMENT OF PREMIUM: The premium rate is a calculated  annually, but for the convenience of the assured, it can be paid half-yearly, quarterly  or even monthly. It should  be noted that these premiums  are not just the portion  of yearly premium since the insurer losses interest on the unpaid premium  of a year and expenses  are involved for frequent calculations of premium. When premiums are not  annual but fractional and if death takes places  before all the premiums have fallen due for the current policy year, the insurer deducts  the  unpaid instalments  from the assured sum at the time of settling  the claim.

  (4): DAYS OF GRACE: To show consideration for the unintentional delay in payment of premium  on the due date a grace time is allowed  for paying  the premium on the  which is 30 days for yearly, half-yearly and quarterly  premiums and 15 days for monthly  premium. The days of grace means that if premiums is paid during the period of grace, no interest or fine is charged, it being  presumed  that premium has been paid when due. The rule for computation  has been that the day upon which the premium becomes  due and payable is not to be counted and the following day is the first day of grace.