Health Insurance In India

Happiness lies, first of all, in health.  

Introduction :

Health Insurance Plan - The Best Bet For A Healthy Future

The importance of a timely health insurance plan cannot but be over stressed.The worst nightmare that anyone can have is when a family member is hospitalized without health insurance coverage

We live in the world of uncertainty. Sometimes a seemingly small ailment can turn into a major one. In a moment life can come to a grinding halt if you are involved in a major road traffic accident. And the situation is worse when the earning member of your family is hospitalized! But with a health policy you and your family can be rest assured and have some security!

Poor quality of service is rendered to the citizen by government hospitals while private medicare has become exorbitantly expensive; it is mandatory for a middle class person to seriously consider the option of health insurance.

A major surgical operation of the heart may cost anywhere between two to three lakhs today. Not many individuals can afford to spend out this amount in a short and sudden situation. Even if they have insurance that is reimbursable under their Mediclaim plans the strain on the family can be immense. The option of cashless hospitalization becomes attractive under these circumstances.

The entry of private players has stirred fierce competition, ultimately benefiting the consumer thereby heralding a new era in health insurance. The advent of foreign and private players into the life and general insurance sector has directly resulted in the huge development of insurance market including significant increase in medi-claim insurance. With the Indian middle-class population almost similar to the total population of United States, India looks attractive for business opportunities to international players in this field.

This is the ideal time to look at the health insurance market and make the best of what is available.

The insurance business professionals strongly say that the limitless medical insurance market has not been fully tapped so far due to lack of awareness among the public about the importance of health insurance and also due to the lack of rightly targeted policies from the companies. An appropriate policy has the potential to rope in more than 2 million customers. 

Basics :

Health insurance is protection,scheme to take care of health of a person and works it works by buying a policy from a company or an insurance agent. Depending on the premium paid the health insurance policy will pay specified amounts for the medical expenses incurred to overcome the health problem.

Currently the trend of some of the reputable companies seems to be to build in a health insurance policy as a benefit to an employee. Some countries offers free health insurance to their citizen. In India certain sectors like railways, army and the employees working with the central government are covered in a health scheme provided cover to almost 20 million people in different part of the country.

Health like education should be essential and should be freely available to all the citizens of a country. Some developed countries realizing the importance of the health of the nation spend as much as 6% to 8% of their GDP on it and have advanced facilities in their government run hospitals. Some examples include the United Kingdom where the National Health Services hospitals provide all the health requirements to majority of their citizens. Sweden and Norway follow similar government run health schemes.

As per the census of USA in the year 2004, it was noted that 245.3 million people had health insurance coverage; however 45.8 million lived without an insurance cover. In response to some of these stats Senator John Kerry said.

"Great physicians and nurses, skilled, caring and unparalleled in their training, intervened in my life and probably saved it. I was lucky but other Americans are not. It is time to speak again and stand again for the ideal that in the richest nation ever on this planet, it is wrong for 41 million Americans, most of them in working families, to worry at night and wake up in the morning without the basic protection of health insurance."

Developing countries like India have priority of spending in other sectors like the army and the infrastructure development and barely 2% of the GDP is spent on the health and results in the government hospitals lack in facilities especially for any advanced procedures such as heart surgery or hip replacement.

Health insurance schemes are particlulary important for individuals from the lower income group to provide them and their family members with adequate cover in event of any mishap or illness. The escalating medical costs are due to the advanced diagnostic and therapeutic procedures that have become the hallmark of modern medical care. An insurance scheme will guarantee that no compromises are made in your treatment for wants of funds

Remember when negotiating a policy you ask for adequate cover as the provided by the health insurance will depend on the type of policy purchased

Buying A Health Insurance

Let's begin with a list of questions to start the discussion:
Should one look for coverage, premium rate or brand name while buying insurance?
What should be the sum insured and should it be increased as a person grows older?
If one is already covered under a reimbursement based health insurance policy (commonly referred to as ‘Mediclaim’), should one still buy a critical illness or hospital cash cover?
If a person/family is covered under a health insurance plan provided by the organization one is working for, should they buy another health insurance policy?
What happens to a person who is covered under his or her company’s policy and is retiring?
Finally, the golden question, should one buy health insurance when young or old?
Rule 1 – Start Early
Typically when one is young one doesn’t buy health insurance as falling in love is more on ones’ mind than falling ill! As a person starts getting older High Sugar or Blood Pressure makes one think about health insurance. This is typically the time when insurance companies become hesitant to cover people with ‘pre-existing’ diseases. Thus starting early with health insurance is important.
Rule 2 – Increase you Sum Insured by 10 – 15% each year
Next is the question of how to select the sum insured? If one is starting at age of 35 or below, one should start with a sum insured of Rs. 1.5 lac. Also, instead of family floater cover, it is better to buy cover separately for each family member as premium difference is not much and God forbid in case of accident while travelling together, the sum insured will be insufficient.
Important: As health care inflation is high, one should increase the sum insured each year by 10-15 %.

Rule 4 – Evaluate the premium rates of a company over a period of last 5 years
 some insurance companies start with low premium rate and then after two years increase the rate dramatically. Whenever you are evaluating health insurance please look at premium rate/s of last five years for the insurance company to ensure that you are looking at pricing over a period of time. Coverage is more or less similar across companies but do look specifically for coverage of day-treatments and copayment (percentage of claim that you will have to bear).
If your policy has a co-payment option, it may be a good idea to go for it as it can bring down the premium rates significantly at a nominal cost.
Rule 5 – Avoid multiple insurance policies; go for a top-up cover instead
Buying another health insurance when one is already covered by company is not a good idea as both insurance policies will work simultaneously. However, a few insurance companies have introduced ‘top-up’ cover i.e. one can buy cover beyond a certain amount. Thus, if company is offering cover for `2 lac, one could buy a top-up cover for another 2 lac that kicks in beyond the `2 lacs for the first policy.
A recommendation, not a rule: Continuation of group health cover post-retirement
The group policies under corporate should have provision that in case of retirement a person can continue to buy health insurance on an individual basis without exclusions or waiting period. The premium rate can be different than group policies. Corporate should start bringing in this provision in their policies. Today lots of people struggle to buy health insurance on retirement.
Rule 6 – Continue your insurance cover with the same company
As the industry evolves  we will start seeing more and more niche prodThings to Consider While Buying a Health Insurance
This article covers some basic rules that can be kept in mind while buying health insurance. Let's begin with a list of questions to start the discussion:
Should one look for coverage, premium rate or brand name while buying insurance?
What should be the sum insured and should it be increased as a person grows older?
If one is already covered under a reimbursement based health insurance policy (commonly referred to as ‘Mediclaim’), should one still buy a critical illness or hospital cash cover?
If a person/family is covered under a health insurance plan provided by the organization one is working for, should they buy another health insurance policy?
What happens to a person who is covered under his or her company’s policy and is retiring?
Finally, the golden question, should one buy health insurance when young or old?
Rule 1 – Start Early
Typically when one is young one doesn’t buy health insurance as falling in love is more on ones’ mind than falling ill! As a person starts getting older High Sugar or Blood Pressure makes one think about health insurance. This is typically the time when insurance companies become hesitant to cover people with ‘pre-existing’ diseases. Thus starting early with health insurance is important.
Rule 2 – Increase you Sum Insured by 10 – 15% each year
Next is the question of how to select the sum insured? If one is starting at age of 35 or below, one should start with a sum insured of Rs. 1.5 lac. Also, instead of family floater cover, it is better to buy cover separately for each family member as premium difference is not much and God forbid in case of accident while travelling together, the sum insured will be insufficient.
Important: As health care inflation is high, one should increase the sum insured each year by 10-15 %.
Rule 4 – Evaluate the premium rates of a company over a period of last 5 years
some insurance companies start with low premium rate and then after two years increase the rate dramatically. Whenever you are evaluating health insurance please look at premium rate/s of last five years for the insurance company to ensure that you are looking at pricing over a period of time. Coverage is more or less similar across companies but do look specifically for coverage of day-treatments and copayment (percentage of claim that you will have to bear).
If your policy has a co-payment option, it may be a good idea to go for it as it can bring down the premium rates significantly at a nominal cost.
Rule 5 – Avoid multiple insurance policies; go for a top-up cover instead
Buying another health insurance when one is already covered by company is not a good idea as both insurance policies will work simultaneously. However, a few insurance companies have introduced ‘top-up’ cover i.e. one can buy cover beyond a certain amount. Thus, if company is offering cover for `2 lac, one could buy a top-up cover for another 2 lac that kicks in beyond the `2 lacs for the first policy.
A recommendation, not a rule: Continuation of group health cover post-retirement
The group policies under corporate should have provision that in case of retirement a person can continue to buy health insurance on an individual basis without exclusions or waiting period. The premium rate can be different than group policies. Corporate should start bringing in this provision in their policies. Today lots of people struggle to buy health insurance on retirement.
Rule 6 – Continue your insurance cover with the same company
As the industry evolves we will start seeing more and more niche products to cater to all segments. Always remember that continuing health insurance with the same company is always better than shifting to another insurer as coverage is not portable yet.

 
Third Party Administrators for Health Insurance
The Third Party Administrators are intermediaries who connect insurance companies, policyholders and health care providers

.The Insurance Regulatory Development Authority (IRDA) selects the TPAs on the basis of strict professional norms.

The Insurance industry in India has experienced a sea of change since the opening up of the sector for private participation. With a plethora of companies entering the foray in the near future, the health insurance sector is surging forward and is poised for a phenomenal growth.

Health insurance is an important mechanism to finance the health care needs of the people. To manage problems arising out of increasing health care costs, the health insurance industry had assumed a new dimension of professionalism with TPAs.

Further, the uncertainty related to a medical condition increases the need for a health insurance for all the citizens.

Health insurance is any health plan that pools resources up front by converting unpredictable medical expenses into a fixed health insurance premium. It also centralizes funding decisions on health needs of a policyholder. This covers private health plans as well as mediclaim policies.

While call center facilities and personalized financial planning tools are some of the innovative trends, experienced in the products front, the best thing to happen on the service front is the introduction of third party administrators as they serve as a vital link between insurance companies, policyholders and health care providers.

TPAs were introduced by the IRDA in the year 2001. The core service of a TPA is to ensure better services to policyholders. Their basic role is to function as an intermediary between the insurer and the insured and facilitate cash less service at the time of hospitalization.

A minimum capital requirement of Rs.10 million and a capping of 26% foreign equity are mandatory requirements for a TPA as spelt by the IRDA. License is usually granted for a minimum period of three years. Ideally, The TPA functions by collaborating with the hospitals in order for the patient to enjoy hospitalization services on a cashless basis.

 

List Of Health Insurance Companies :

Apollo DKV Insurance Company Ltd. 

 Aviva Life Insurance 

 Bajaj Allianz General Insurance Co. Ltd. 

Birla Sun Life Insurance 

E-Meditek Solutions Limited 

Family Health Plan Limited 

Health India-Bhaichand Amoluk Insurance Services Pvt. Ltd. 

 HSBC Health Insurance 

 ICICI Lombard General Insurance Co. Ltd. 

 Life Insurance Corporation Of India 

 Max New York Life Insurance 

Med Assist India Ltd. 

MetLife India Assurance Company 

National Insurance Company 

Paramound Health Group 

Reliance Health 

 Royal Sundaram Alliance Insurance Company Limited 

Star Health and Allied Insurance Company Limited 

Tata AIG 

The New India Assurance Co. Ltd. 

United Healthcare 

United India Insurance

 

Health Precautions Before, During and After Travel
Fear of flying
Fear of flying is common, especially for those flying for the first time. It is a kind of anxiety syndrome. You can over come the same by positive thinking and relaxation techniques. Your doctor can give you a mild tranquilizer that will help you relax and reduce anxiety.


Insurance
Health insurance coverage is crucial for international travel. Many insurance companies offer insurance plans to cover different requirements. Travelers should have a clear view of what they require and what is offered and select the one best suited for their needs. They should also know the modalities to make a claim, whenever the situation arises.

 

Vaccinations
Vaccination is recommended for common infections like Hepatitis A & B, Yellow fever and Polio, Japanese B encephalitis, Typhoid fever, Rabies, Meningococcus, while traveling to developing countries and some countries require them at the entry point. A vaccination certificate obtained from an authorized medical practitioner or clinic listing the names, dates and validity time of the vaccinations taken, should be ideal to carry along for any International travel.

Precautions For Travelers With Medical Condition


The presence of medical conditions among prospective travelers requires special preparations. Prior to departure, a visit to the doctor is a must to re-check the stability of their medical condition and evaluate the dosage of medication. They should also obtain a letter from their medical practitioner giving details of their medical history, drug names, dosages prescribed with complete details of treatment. This document will be the reference point in case of a medical emergency during their stay in a foreign destination.

They should also carry an extra dose of medical supplies in their hand baggage to compensate for any loss or delay of check in baggage.

Even a healthy traveler may encounter the following problems while traveling by air, sea, road or by rail.

 

Motion sickness
The main symptoms of motion sickness are nausea, vomiting, stomach upset, dizziness and sweating. This sickness can be minimized by limited intake of fluids, food and alcohol. Choose a seat where the movement is felt less, lying down if the travel is by sea, keeping the eyes closed and avoiding reading are some of the measures to overcome the sick feeling.

Dehydration
Dehydration generally occurs while flying because of the low humidity in the aircraft. Feeling light headed, drowsy, sleepy or confused are the common symptoms. Some may experience a fainting episode. Dry skin is another problem due to dehydration. Drinking plenty of fluids, avoiding caffeine and alcohol will help ease the symptoms. Frequent application of a good moisturizer can cure dryness of the skin.

Injuries
Minor injuries during travel may occur due to lifting of suitcases. The unaccustomed weight may cause sprain to the shoulders or back.

Sometimes baggage stored in the overhead bin in the cabin may fall and cause injuries to people sitting closer to the storage area.

It is advisable to wear good quality shoes to avoid slipping and falling in wet surfaces, especially during travel by sea.

Carrying a torch during nighttime will also protect from unexpected falls and injuries.

Always remain alert in unfamiliar circumstances.

Travelers with medical conditions are likely to have special problems during travel. Sometimes they turn out to be major ones.

Most of the injuries occur because of water and vehicle accidents.

Avoid self-driving if the traffic patterns and laws are unfamiliar in the host country. It is sensible to use public transportation for local travel. It is better to avoid travel during night and swimming in areas where the lighting is poor. It is good to limit the intake of alcohol especially before swimming or driving. Avoid going out alone at night, especially in poorly lit and deserted areas. It is a good idea to join a group for sight seeing and other adventure tours.

Medical kit
It is imperative to have a medical kit containing first-aid supplies, antacids, pain relievers, anti diarrheal medication, decongestants, anti inflammatory drugs (non-steroidal),: One’s own brand of Vitamins and any other supplement required..

Medical information of vaccination and medication details can also be carried in a hard copy to facilitate speedy medical attention in an emergency.

Blood clots (DVT) Deep Vein Thrombosis
The risks of DVT is higher for those who sit for long periods in a stationary or immobile state, especially during travel by any mode, It affects pregnant women, seniors, overweight or obese people, and those prone to varicose veins or blood clots. The risks are high for those who have undergone recent surgery. The risks of DVT during travel can be offset by moving legs frequently in sitting position, getting up and walking every half an hour and stretching whenever possible. It is advisable to avoid smoking, excessive consumption of fluids or alcohol and prolonged crossing of the legs in the sitting position. Stockings with tight bands must be avoided.

Sinus and Ear pressure
Sinus and ear pressure while flying may occur because of the change in the air pressure inside the cabin. When an aircraft takes off, the air pressure inside the cabin decreases and while landing the air pressure increases, thus expanding the small pockets of air trapped in the sinus and middle ear. This discomfort generally disappears after landing, though for some it may prolong.

Swallowing and yawning while take off and landing should relieve the discomfort. Pinching the nose with two fingers and blowing air through the ears is another remedial measure.

People suffering from serious sinus and nasal congestion should avoid any kind of travel especially air travel till their condition improves.

Sleep pattern disturbance or Jetlag
Jetlag occurs only with air travel when one flies through different time zones. It does not occur during travel by road, sea or rail. This is because the body has the time to adjust to time zone differences.

Common symptoms of jet lag are tiredness, difficulty in sleeping, irritability, inability to concentrate and headache. This problem can be minimized by adjusting sleep and wake up time according to the intended destination one or two days before departure. Air passengers should drink plenty of fluids during flight, avoid smoking and caffeine, and avoid consuming excessive alcohol. Such measures should minimize jetlag.