HEALTH INSURANCE

Presented By:Bhagirathi Das Debabrata Dash Mousam Pattnaik Sanujeet Mohanty Sandeep Mishra

PRESENTATION PLAN
INTRODUCTION HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION HEALTH INSURANCE MARKET IN THE LIBERALISED MARKET LAW AND REGULATIONS INITITATIVES OF FEW STAKEHOLDERS WAY FORWARD

INTRODUCTION
PROVIDING QUALITY HEALTHCAREA CONCERN GOVERNMENT ROLE IN HEALTH CARE HEALTH CARE FINANCING INSURANCE AS AN OPTION

HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION

PRE-NATIONALISATION : Hospitalisation and Sickness Insurance
POST NATIONALISATION: Prior to 1986 1986: Introduction of Mediclaim

HEALTH INSURANCE IN THE LIBERALISED MARKET

Growth in Health Insurance premium
Product Development Customer Service Market share

LAW AND REGULATIONS

Health Insurance defined Priority in licensing Other relevant regulations: IRDA Protection of policyholders interests, 2002 IRDA Advertisements and Disclosures Regulations, 2002 IRDA Third Party Administrators- Health Services Regulations, 2001 File & Use procedure

HEALTH INSURANCE: ISSUES AND CONCERNS

ADVERSE SELECTION MORAL HAZARD HIGH PAYOUTS SELF-FUNDED HEALTH INSURANCE

INITIATIVES

PRIVATE INSURERS KEEN TO DEVELOP HEALTH POLICY: PORTFOLIO

DEVELOPED NEW PRODUCTS INCREASED THEIR MARKET SHARE LIFE INSURERS HAVE SHOWN INCREASED INTEREST

INITIATIVES contd
INTRODUCTION OF GOVT. FUNDED HEALTH INSURANCE FOR POOR STATE GOVTS. INTRODUCING SCHEMES FOR POOR IN PANCHAYAT ANDVILLAGE LEVELS INCREASED GOVT. SPENDING TO STRENGTHEN PRIMARY HEALTHCARE FACILITY IN SELECTED STATES. PRELIMINARY STUDY BEING HELD FOR EVOLVING HEATH INSURANCE SCHEME FOR URBAN AND RURAL POOR.

INITIATIVES contd
MORE TPAs LICENSED AND EXISTING TPAs STRENGTHENED THEIR OPERATIONS EMERGENCE OF COMMUNITY AND GROUP INSURANCE INVOLVEMENT OF NGOs AND MICRO FINANCE INSTITUTIONS

RECOMMENDATIONS OF SUBCOMMITTEES
Sub-group on Health Insurance Data 1)Collection of existing data 2)Collection of future data in standardized formats 3)Training of personnel Sub-group on Product Innovation ( & definition of preexisting disease) Distinction made between pre-existing disease and condition and common definitions recommended Medical Savings Accounts recommended Creation of a pool for covering senior citizens Committee to study insurance cover for common man in rural area

RECOMMENDATIONS OF SUB-COMMITTEEScontd,
Sub-group on registration of stand-alone Health Insurers 1) Minimum Required Capital of Rs.50 Crores recommended 2) Foreign Direct Investment of 51% suggested 3) Adoption of Risk Based Capital proposed 4) Besides health, it was recommended that companies be allowed to write Personal Accident and Travel Insurance

WAY FORWARD
Insurers to collect correct data,develop new products price properly, improve u/w and claims management Explore possibilities of setting up pure health insurance company with JV partners Insurers TPAs Data Warehouse to have common IT framework to facilitate easy data transfer Govt. to evolve National health scheme for common man in urban and rural area and Sr.citizen and terminally ill

WAY FORWARD.contd,
Support health Insurance scheme for population below poverty line. Foster Public private partnership Providers to be more disciplined, bring standardization. Govt. to regulate the healthcare providers

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