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Introduction to Health Insurance in India
 
Health Insurance provides risk coverage against unforeseen health expenditure that may result in financial hardship. Health insurance is one of the fastest growing areas in the insurance industry and is expected to grow to Rs. 30,000 crores in 5 years from the current Rs. 8,100 crores.
(1) Introduction of Health Insurance Policies   (2) Need of Health Insurance Policy
(3) Companies Offering Health Insurance/Mediclaim   (4) Salient Points of Various Products of Insurance Companies
(5) What Health Insurance Policy Covers in India   (6) What Health Insurance Policy in India does not Cover
(7) Selection of Health Insurance Product/Company   (8) Health Insurance through Life Companies
(9) Concept of :
 
a- Concept of Day Care Surgeries/Treatments Covered Insurance b- Cooling Off Period/ 30 days Waiting Period
c- Co-Pay Concept in Health Insurance Policy in India d- Health Insurance Through Credit Card
(10) Specimen:
 
a- Proposal Forms of Insurance Companies b- Non Receipt of Policy Letter to Send to Insurance Companies
   7- Selection of Health Insurance Product/Company
Now a days you see many advertisements of Insurance companies in print media / electronic media about Health Insurance / Mediclaim Policy.
This does not mean that you are in a buyer's market.
Reason being, the insurance companies are finding claim ratio of 140%+ on health insurance to be on high side and as a result it becomes a loss-making proposition for them. Most of the Companies do not want to increase their exposure to this risk.
Some of the PSU's recently come out with instructions under which agents are not to be paid any commission if the age of insued is 50+. This is a clear indication that they do not wish their sales force to promote/push health insurances among 50+ age group but want to focus on younger age group/families. This is being done with a view to enlarge the portfolio and spread the risk.
This being the reason that they may not accept each and every proposal received by them for underwriting the risk and issuing of policy.
Common reasons given by these Insurance Companies when the proposal is being rejected are: -
1.
Proposal for an individual - Stand-alone cases are generally not covered .But the same individual proposal as a part of the family would be accepted.
2.
Age is above 50 - We are not covering risk of those who are 50+. If itwould have been lower than 50 we would have covered.
3.
Preexisting Disease - The person is having preexisting disease. If the was not having such preexisting disease we would have provided them with insurance cover. This is very much common in case of people who have heart disease history (under gone angiography, angioplasty & heart surgery).
Keeping in mind the above information you should compile a set of criteria on the basis of which you decide about the Insurance Product and Insurance Company to be selected :
The data you need is :
 
Example 1
Names of family Members  Age Preexisting disease Sum assured
A 52 None Rs.1,00,000
B 47 None Rs.1,00,000
C 22 None Rs.1,00,000
D 16 None Rs.1,00,000
 
On the basis of this information you get an idea about the premium, which gives you an indication of the funds required. Depending on your budget, you may adjust the sum assured.
Some questions before you are: -
  • City where you are living and the list of authorized hospitals where Insurance Companies/TPA has arrangement for cash less settlement.
  • On the basis of this data you may have the option of going to many Insurance Companies and chances are that Insurance proposal will be accepted if four individuals are to be insured.
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