ROUGH DRAFT OF HEALTH LAW

ON

HEALTH INSURANCE: - EMERGING LEGAL ASPECTS

SUBMITTED TO: - KUMAR GAURAV

FACULTY OF HEALTH LAW

SUBMITTED BY: - DEEPAK KUMAR

ROLL No. 1015

5TH Year B.B.A. LL.B. (Hons)

CHAPTER 1- INTRODUCTION

Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly
to include insurance covering disability or long-term nursing or custodial care needs. It may be
provided through a government-sponsored social insurance program, or from private insurance
companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or
purchased by individual consumers. In each case, the covered groups or individuals pay
premiums or taxes to help protect themselves from high or unexpected healthcare expenses.

CHAPTER 2- CONSTITUTIONAL PERSPECTIVE OF RIGHT TO HEALTH IN INDIA

Health is the general condition of a person’s mind, body and spirit, usually meaning to be free
from illness, injury or pain. Right to health is central to all human rights and denial of health
right would mean denial of all human rights. The framers of the constitution incorporated right to
health in the Directive Principles of State policy (DPSP) which enjoins the state to provide
comprehensive, preventive and promotional health services and proper nutrition to all the people
of India.

The Supreme Court has interpreted the right to health into article 21 of the Constitution in the
case of Consumer Education and Research Centre v. Union of India, by stating that the right to
health and medical care is a fundamental right under Art. 21 of the Constitution as it is essential
for making life of a workman meaningful. Furthermore, Article 47 makes improvement of public
health a primary duty of State.

CHAPTER 3- HEALTH INSURANCE SCENARIO IN INDIA

Healthcare in India is in a state of enormous transition. Before independence, the health structure
was in dismal condition i.e. high morbidity and high mortality and prevalence of infectious
diseases. Since independence, emphasis has been put on primary health care and we made
considerable progress in improving the health status of the country. India spends about 4.9% of
GDP on health.

The Insurance Regulatory and Development Authority (IRDA) bill, passed in Indian parliament,
is the important beginning of changes having significant implications for the health sector.

CHAPTER 4- ROLE OF IRDA

The government has established Insurance Regulatory and Development Authority (IRDA)
which is the statutory body for regulation of the whole insurance industry. As the health
insurance is in its very early phase, the role of IRDA will be very crucial. They have to ensure
that the sector develops rapidly and the benefit of the insurance goes to the consumers. But it has
to guard against the ill effects of private insurance. IRDA will need to evolve mechanisms by
which it puts some kind of statue in place that private insurance companies do not skim the
market by focusing on rich and upper- class clients and in the process neglect a major section of
India's population. Government companies can take the lead in this matter and catalyze new
products for the poor and lower middle class as they have done in the past.

Thirdly the regulators should also encourage NGOs, Co-operatives and other collectives to inter
into the health insurance business and develop products for the poor as well as for the middle
class employed in the services sector such as education, transportation, retailing etc and the self
employed.
CHAPTER 5- CHALLENGES IN HEALTH INSURANCE INDUSTRY

The privatization of insurance sector and constitution of IRDA envisage improving the
performance of state insurance sector in the country by increasing benefits from competition in
terms of lowered costs and increased level of consumer satisfaction. However, the implications
of the entry of private insurance companies in health sector are not very clear. In many cases
private health insurance largely neglects the social aspect of health protection. In the contrast,
private health insurance can bridge financing gaps by offering consumers value for money and
help them avoid waiting lines. Private health insurance can be valuable tool to compliment or
supplement existing health financing options only if they are carefully managed and adapted to
local needs and preferences.

Compared to other countries that have either Universal Health Coverage or moving towards it,
India’s per capita public spending on health is low. Even compared to other developing nations,
the state of Indian public healthcare is dismal with a growing shortage of public health facilities.

CHAPTER 6- ROLE OF GOVERNMENT IN PROMOTING HEALTH INSURANCE

Here are five cost effective government-sponsored healthcare schemes you can access.
 Central Government Health Scheme (CGHS):
This scheme is for central government employees, pensioners and their dependents residing in
cities covered by CGHS.
 Employment State Insurance Scheme (ESIS):
Employees’ State Insurance Scheme of India is applicable for non-seasonal factories with 10
or more employees, and certain establishments (shops, hotels, restaurants, cinemas,
newspapers, etc) employing 20 or more people.
 Rashtriya Swasthiya Bima Yojana (RSBY)
RSBY ( Rashtriya Swasthiya Bima Yojana) has been launched by Ministry of Labour and
Employment, Government of India to provide health insurance coverage for Below Poverty
Line (BPL) families for financial liabilities arising out of health shocks that involve
hospitalization.
 Aam Aadmi Bima Yojana(AABY)
Aam admi bima yojana, a Social Security Scheme for rural landless household was launched
on 2nd October, 2007. The head of the family or one earning member in the family of such a
household is covered under the scheme. The member to be covered should be aged between
18 and 59 years.
 National Health Insurance Scheme – Budget 2018

Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor
and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh
rupees per family per year for secondary and tertiary care hospitalization. The beneficiaries
can avail benefits in both public and empanelled private facilities.

For giving policy directions and fostering coordination between Centre and States, it is
proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-
NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. In partnership
with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made
operational which will entail a paperless, cashless transaction.