TYPES OF HEALTH INSURANCE

TYPES OF HEALTH INSURANCE COVERAGE

Types of health insurable or the fundamental policies issued by the insurance companies aiming to meet the requirements of general public are:

Medical expenses insurance: Basic hospitalization expenses are reimbursed. It covers payment of expenses related to hospitalization and the services rendered by the doctor and nursing home/hospital. Under these insurance schemes, the amin benefit is that predetermined number of days stay and hospital costs are covered.

Disability income cover: is primarily aimed at providing for the lost income during the disability period or during the treatment period. It tries to replace the income that cannot be earned due to sickness of the assured. The benefit is usually paid as a percentage of the capital sum insured and is paid weekly. The period for such compensation is short.

Long term care insurance: covers expenses related to major surgery or operations due to serious illness or disease. Major medical coverage continues protection after basic medical expenses insurance benefits have exhausted. It may add some benefits for services which is not covered by medical expenses cover. Insurance companies provide long term insurance in two major categories: Nursing home care and Community care. In community care, long term care policy provides benefit payments for the insured individuals who require assistance and stay in their homes.

Some of the popular policies are:

Individual Mediclaim Policy: also called as Hospitalization Benefit Policy. It provides reimbursement of medical expenses incurred towards hospitalization anywhere within India in case of sudden illness or accident and extends to pre-hospitalization of 30 days and post hospitalization of 60 days. This policy is available to any person in the age group of 5 to 80 years. However, children below 5 years but not below the age of 3 months can also be covered as long as one or both of the parents are covered at the same time. reimbursement is not commonly used as a claim settlement system in Mediclaim, and permitted only when the treatment is taken at a hospital or that meets the criteria prescribed in the policy

Group Mediclaim Policy: is available to any corporate association, institution and group of people provided they form the minimum number of persons to be covered under the policy. The policy holder of this type of insurance is the group itself and the premiums are payable by the group.

Overseas Mediclaim Policy: is particularly tailored to protect persons undertaking genuine overseas trips for business or holidays or studies or employment purpose. The benefit of the policy is that premium is payable in Indian currency while claims abroad are payable in foreign currency. Originally introduced in public sector general insurance companies in 1984 the policy was modified in 1991 and revised Videsh Yatra Mitra Policy was introduced in 1998. The final version of the policy covers several aspects of foreign travel that go beyond the ordinary such as loss of passport, personal accident, etc.

Other covers are:

Jan Arogya Bima Policy

Cancer Insurance

Bhavishya Arogya Policy

Hospital cash daily allowance policy, etc

 

TYPES OF HEALTH INSURANCE SCHEMES / PROGRAMS IN INDIA

Government or State based System: The largest system of health care is financed and managed by the central and state government of India. It delivers health care to the public through the diverse network of hospital, government hospitals, primary health centres, community health centers, dispensaires and speciality facilities. These facilities are officially available to the entire population either for free or for nominal charges. The central Government has been the main source of funds for primary health care facilities, whereas the states bear the major responsibility of recurrent costs, especially the costs of running hospitals, CGHS and ESIS as part of government schemes.

Central Government Health Scheme (CGHS): was introduced in 1954 as a contributory health scheme to provide comprehensive medical care to the Central Government employees and their families. Separate dispensaries are maintained for the exclusive use of the central government employees covered by the scheme. The list of beneficiaries includes all categories of current as well as former government employees, members of parliament and so on.

Employees State Insurance Scheme (ESIS): was introduced in 1948. This is an insurance system which provides both the cash and the medical benefits. It is managed by the Employees State Insurance Corporation (ESIS), a wholly government owned enterprise. It was made as a compulsory social security benefit for the workers I the formal sector. Now it includes all such factories which are not using power and employing 20 or more persons. Mines and plantations are excluded under this scheme.

Market Based System

General Insurance Corporation (GIC) Mediclaim Coverages: The GIC holds a major share in the market based health insurance segment. It introduced the Standard Mediclaim health insurance scheme in 1986, and became operational in 1987. This product was later on modified I 1997 to allow for premium differentials for various age groups meant for both individuals and groups. It provides various products like Mediclaim / Hospitalization Benefit Insurance Policy and Bhavishya Arogya Insurance Policy.

LIC Coverage: The Life Insurance Corporation of India introduced a special insurance programme in 1993 which covered medical expenses only from critical diseases. The plan provides health insurance against certain specified health risks and offers a great financial support during an urgent need or demand. Following are the key features of this plan,

-      Substantial Financial Protection in case of hospitalization or surgery

-      Lump sum benefit irrespective of actual medical costs

-      Increased health cover every year

-      No claim bonus

-      One can choose various flexible benefits

-      One can also choose various premium payment options

This health insurance plan provides various benefits like Hospital Cash benefit, day care procedure benefit, major surgical benefit, other surgical benefit, ambulance benefit and premium waiver benefit.

Private Insurance Company: The insurance sector was opened for private participation in 2000. Now, private players have largely existed in group health market. The private sector today provides nearly 80% of outpatient care and about 60% of inpatient care. Some private insurance companies are Star Health Insurance, Apollo Munich Health Insurance, Cigna TTK, Reliance General Insurance Co, etc. These companies provide various health insurance plans to the public.

Employer Provided Insurance System: Employer managed health facilities and the reimbursement of health expenses by employers are the other means of health insurance in India. Generally, the public sector undertakings and big industrial houses have their own hospital and provide medicines etc., across the counter, normally, within the company premises / township. In addition, there are various medical reimbursemnte plans offered by employers for private medical expenses in the private sector like commercial bank, autonomous institutions, etc. Some organizations may have self-insurance system known as medical benefit or medical allowance system. Insurance coverage under this system vary according to the employee’s salary or designation. Overall, the performance of this system in India has been satisfactory.

NGO System: In India, health facilities are also provided by voluntary and charitable or non-governmental organizations (NGOs) like Self-Employed Women’s’ Association (SEWA), Child in Need Institute (CNI) etc. The health care facilities offered by these organizations is a part of their main objectives. Most of the time they create awareness and associate themselves wit the major health insurers.