1

Author:

Development officerMR.RAVI KUMAR

L.I.C. Of India

HEALTH INSURANCEHEALTH INSURANCEDeeHe k

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'SWASTHA BIMA - EK VISHLESHAN'

HEALTH INSURANCEDeeHe k

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'SWASTHA BIMA - EK VISHLESHAN'

Author:MR.RAVI KUMAR

Development officerL.I.C. Of India

It isn’t What the Book Costs.It’s What it will Cost you if you

Don't Read it

ALL RIGHT RESERVED

No part of this book may be reproduced in any form or by any means, electronic,

mechanical photocopying, recording or otherwise without the prior permission form

the Author.

DISCLAIMER & TERM OF USE

This report contains the ideas & opinions of the Author. The information contained

here is strictly for educational & general guidance only. If you wish to apply the ideas

you are taking full responsibility for your actions. The Author disclaims any warranties

(express or implied), or fitness for any particular purpose. The Author shall in no event

be held liable to any party for any direct ,indirect, punitive, special incidental or

consequential damages arising directly or indirectly from the use of any of this

material which is provided 'as is' and without warranties.

The article represented here does not form official views of L.I C of India. The

reproduced content is independent research done by Author from various sources.

CONCEPTUALISED, CREATED,&DESIGNED BY:-

MR RAVI KUMARM: 9820971317 e-mail:ravilic08@gmail.com

TYPE SET BY:-

MR JYOTHIPRAKASHA

www.vinnovations.in

Bangalore Office:-

F-211, 'O'BLOCK PLATINUM CITY,

YESHWANTPUR, BANGALORE – 560 022

Mumbai office:-

912/26, CHEMBUR COLONY,MUMBAI – 400074

Copyright©

‘Dedicated this book to all people in general who are keen to have reasonable

good health & also plan for financially secured future. Also Agents / marketing

persons who would like to update their knowledge in health insurance to help

them sell correct health insurance plans.’

UNIVERSAL PRAYERS

Om Saha Nau-Avatu | Saha Nau Bhunaktu | Saha Viiryam Karavaavahai |

Tejasvi Nau-Adhiitam-Astu Maa Vidvissaavahai | Om Shaantih Shaantih

||

Meaning:-

1: Om, May God Protect us Both (the Teacher and the Student),

2: May God Nourish us Both,

3: May we Work Together with Energy and Vigour,

4: May our Study be Enlightening and not give rise to Hostility,

5: Om, Peace, Peace, Peace.

Om Asato Maa Sad-Gamaya | Tamaso Maa Jyotir-Gamaya | Mrtyor-Maa Amrtam

Gamaya | Om Shaantih Shaantih Shaantih ||

Meaning:-

1: Om, Lead us from Unreality (of Transitory Existence) to the Reality (of the

Eternal Self),

2: Lead us from the Darkness (of Ignorance) to the Light (of Spiritual Knowledge),

3: Lead us from the Fear of Death to the Knowledge of Immortality.

4: Om Peace, Peace, Peace.

ॐ सह नाववतु । सह नौ भुनक्तु । सह वीर्यं करवावहै ।

तेजस्वि नावधीतमस्तु मा विद्विषावहै । ॐ शान्तिः शान्तिः शान्तिः ॥

ॐ असतो मा सद्गमय । तमसो मा ज्योतिर्गमय । मृत्योर्मा अमृतं गमय ।

ॐ शान्तिः शान्तिः शान्तिः ॥

Shaantih

TABLE OF CONTENTS

i. Universal prayers

ii. Introduction

iii. Preface

iv. PM Modi’s message

v. What is Health Insurance

vi. LIC Jeevan Arogya Plan

vii. Mistakes people make while buying Health Plan

viii. Are you covered enough to fight medical inflation?

ix. Traditional Mediclaim

x. Waiting period in Health Insurance

xi. Case Studies

xii. Concluding note

xiii. Demographics & Health quotes

xiv. LIC Branches

PREFACE

Dear Investor / Agents Growing health care medical cost during the working period of ones life time has been ever increasing. The same becomes very crucial after retirement when no employment coverage exists. It is very essential that one covers adequately towards, disability due to any Accident / Disease .There is always lack of education mainly on Mediclaim policies covering cash / cashless benefits. Wrong information of policy benefits / its inclusions / exclusions / tax benefits, coverage of family members always delays in decision making process. These financial burden or loss of deceased / disabled dependent is passed on to the general healthy class of society.In absence of health covers one has to run pillar to post for financial help from Temple Trust, Foundations / Philanthropic organisations where help may be denied or delayed citing various reasons.

So it becomes very important to have suitable adequate health cover for all family members including parents as well as In-laws.

I wish all readers in general as well as Agents in particular make informed view of the subject so that facts are presented without ambiguity or vague information which is very harmful for growing Industry like ours. I wish readers to circulate this small booklet among your known family, friends & colleagues to bring general awareness. I would be very happy to have your feedback so that I can also correct / improve upon the changing needs of consumers in this health Indust

My sincere thanks to Mr .Vivek paul SDM MDOII LIC & friend Mrs Vanita Srinivas ADM N Z LIC of India for giving valuable support & motivation for this edition. My special sincere appreciation to Managers & officers at L.I.C of India, who were instrumental in giving us help / guide / knowledge in these complicated world of health insurance. Hope you all have great year ahead with health / wealth & prosperity.

Ravi Kumar

INTRODUCTION

In our daily life when we take a pause & think of some reasons of human development in the current scenario we find many intriguing facts of life.Our pressure to perform meet dead lines & face last minute challenges/travel/schedule fast changing market dynamics ,technological ,user friendly apps embedded into tiny handset called M O B I L E which has taken a toll on humans both at physiological & psychological state .

The advent of ONLINE markets serving 24X7 deliveries right from groceries/toys etc to big home furnitures have indeed made us glued to chair & technology.

At the start of millennium we have invited more health hazards than comfort .

The small experience & learning through the course of my job gave me a chance to clarify more on health insurance importance/advantages/ adequate coverage one must have during his working life as well as retired life.

We are sure this will help unravel many startling facts & cobwebs helping all in taking in depth understanding of health /medical insurance.

I hope to serve you better through your valuable suggestions.Happy investing through health insurance ....may good health prevail.

FOREWORD BY S.D.M MDO-II

MR VIVEK PAUL

SR.DIVISIONAL MANAGER

MDO II

FOREWORD BY A.D.M

‘Prime Minister Narendra Modi wants Health Insurance for All’

PM Narendra Modi has directed a meeting this week over health reforms in which

the setting up of Medical colleges in every district, format for health insurance for

all, and a Bachelor’s in Science course in community health are to be discussed.

Improvement of facilities for public health has been a priority in Narendra Modi’s

agenda and the Minister of Health Harsh Vardhan has been planning a series of

reforms to avail affordable health insurance for all the people. In a drive to

improve the country’s health infrastructure, Modi Government has already

announced the setting up of AIIMS (All India Institute of Medical Sciences) in

different States. The official sources suggest that the meeting of all health officials,

including the pharmaceutical department has been called for the meeting to take

the agenda forward.

Sources suggest that the Modi Government is looking forward to a proposal for

nominal priced premium health insurance for everyone which would cover all the

major diseases such as diabetes, cancer and heart ailments. The Government

official further stated that the aim is to provide at least the basic health cover for

the poor class, while the middle class would be payable for the health insurance

services in accordance to their income.

What is Health Insurance?

Health insurance is insurance against the risk of incurring medical

expenses among individuals. By estimating the overall risk of health

care and health system expenses, among a targeted group, an insurer can develop

a routine finance structure, such as a monthly premium or payroll tax, to ensure

that money is available to pay for the health care benefits specified in the

insurance agreement. The benefit is administered by a central organization such

as a government agency, private business, or not-for-profit entity. According to

the Health Insurance Association of America, health insurance is defined as

"coverage that provides for the payments of benefits as a result of sickness or

injury. Includes insurance for losses from accident, medical expense, disability, or

accidental death and dismemberment"

Why insurance?

There is a popular saying about health insurance: "Buy health insurance when

you don't want it, because you may not get it when you want it."

I have a Dream....

`

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25 35 45 55

` 0.00Severe Financial problems

Diabetes

Pre-Diabetes

4.8

3.9

6 9.2

77.2

62.4

0.96 1.5 0.12 0.13

Tamil Nadu Maharashtra Jharkhand Chandigarh

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20

10

0India

No. OF PEOPLE WITH DIABETES & PRE - DIABETES IN INDIA - 2011

PREVALENCE OF DIABETES AND PRE-DIABETESIN INDIA: ICMR- INDIAB STUDY

(Pre

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in

Mill

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77.2 Million Indians are at risk of becoming diabetic soon*

If you suffer from

FREQUENTURINATION

BLURRYVISION

EXCESSIVE

THIRST

FATIGUE

TINGLING

Source : Diabetologia 2011As per ICMR Study

Medical care costs are rising

faster than inflation

And there is no respite

Medical Care Cost Cost of Living

Sources

HEALTH INSURANCE

Health Insurance Premiums Leverage Many Times their Value In Coverage

SmallPremiums

Paid inAdvance

WithMeticulousPlanning

High

Financial

Burden of an

Unexpected

Mishap

Sources

it is an uphill battle. But.......

A 30 year old can buy a Rs 5 Lakh cover for just Rs 6,000 per annum

........ Insurance is cheap!

Sources

...............................

...............................

...............................

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MISTAKES PEOPLE MAKE

WHILE BUYING A HEALT H PLAN

Health insurance has been getting a lot of attention lately. The sales of health

policies are rising not only in the metro cities where the awareness levels are

relatively higher but also in smaller towns and rural areas. People in India have

realised that the only way to fight the spiralling cost of health care and safeguard

them against critical illness is by buying a comprehensive health insurance plan.

Every day thousands of visitors search for health insurance plans on My Insurance

Club but most of them have no idea on how to pick one for themselves or their

family. Hence, we compiled a list of few things which you should avoid at the time

of buying a health plan

1. Hold back facts about your medical history – In their eagerness to get a health

policy, many individuals do not declare their medical history in the policy

application form. Some do this because they are aware that declaration of

condition / s (like diabetes, high/low blood pressure, etc.,) may result in rejection

of their application. And others skip it out of sheer laziness. Please note: any non-

disclosure of facts is considered incorrect by the insurance companies and they

may reject your claim.

2. Rely on employer-provided health plan – Several companies (employers) offer

group health cover to their employees. Due to this many individuals feel that

there is no need to buy a separate health insurance plan. Please understand that

the employer-provided group cover will terminate once you leave the job.

3. Choose co-pay – In an effort to reduce premiums, people sometimes

proactively opt for a co-pay facility. Co-pay means that during the event of a claim,

the policyholder will pay a certain percentage (for example 10%) of expenses

himself. The idea of a health insurance policy is to protect your own money as

much as possible. Plus by opting for co-pay, the discount in premium is not very

high.

4. Assume that all health plans are the same – Today, there is a wide array of

health policies available in the market such as the staple health plan, accident

policies, special cover for critical illness, etc. The benefits offered under each type

of policies are different so do not pick any plan off the shelf without reading about

its benefits in detail.

5. Expect your money back – For a lot of people, insurance still continues to be an

alternative to fixed deposits and mutual funds. People search for health plans

which will give them a part of premiums back on maturity. We should not look for

such features in health plans. The idea is not to save a few thousand rupees in

premium but to save an expense of lakhs of rupees if it occurs.

6. Overbuy – While there is low awareness of health insurance in most parts of

the country, there is a small set of population who are obsessed with health

insurance. They buy multiple health policies, higher coverage amount with extra

riders and end up spending a sizeable part of their income on health insurance.

Please stay away from overbuying insurance plans. The idea of insurance is to

create a backup and not splurge money in the name of protection.

benefits, diagnostics, etc. and it

s is a sharp rise of 5.81

Ignoring medical cover can

. Irrespective of your

ARE YOU COVERED ENOUGH

TO FIGHT MEDICAL INFLATION?

During my last visit to the hospital I realized how much medical attention we

need! This is one of the only costs that cannot be ignored, delayed or even

compromised. Are we equipped enough to pay for the healthcare expenses? If

not, then why are we delaying or compromising when it comes to transfer of risks

in the form of Health Insurance?

"It was unacceptable that almost 80% of the expenditure on healthcare by people

was met by personal, out of pocket payment. I am shocked to note that as many as

4 crore people of our country plunge into poverty each year due to expenses on

medical treatment."

- President Pranab Mukherjee had said, while addressing 40th convocation

function of All India Institute of Medical Sciences (AIIMS) in New Delhi.

One of the primary concerns of the nascent health industry in India is the low

penetration of insurance vis-à-vis medical inflation. Even if regular inflation is

about 7-8% p.a., medical inflation has over shot the figure by far. It is about 20%

while only 5% of healthcare expenses are paid by Insurance. The worrying fact is

that basic awareness of healthcare needs and insurance is still considered an

expense despite the fact that 95% of healthcare expenses are still borne out of

pocket!

Medical inflation includes hospitalization, OPD

increases due to the rising cost of treatments and medicines in our country along

with advanced medication and higher mortality. The average morality rate has

gone up to 70 years from 64.19 years in the last 3 years. Thi

in just 3 years. It simply means that the number of older people has increased in

our country and adequate healthcare provisions are missing for them. Thus,

supply to demand has reduced which has further helped the rise in cost.

Hence the fright of Medical Inflation has been a big concern. If you check a simple

hospitalization bill, you will realize what I am saying.

easily set one back by Rs. 8 to10 lakhs during any hospitalization. When your

near and dear ones are in need of the best medical services, the last thing you

want to worry about is how to incur the medical expenses

profession, caste or creed, each and every person needs adequate health

protection. Even if you can afford to pay the bills, why do you want to deplete

your savings at one go? Why not be a smart investor and transfer the risk of your

health by securing coverage and also getting additional tax rebate for doing the

same? If you think working hard is important, managing your portfolio, both

investments and health, are also of importance.

Points to consider:

Are you adequately covered for yourself and your family, beyond the

cover provided by office?

What have you planned for your healthcare requirements post-

retirement?

Are your parents covered?

Consider these points, reassess your health requirements and take adequ ate

coverage right now, instead of waiting till the need actually arises, when the

insurance company might not even extend the coverage!

The total deductions you can claim under Section 80D is as follows:

Description

Medical Insurance Premium

paid in respect of Total

Deduction

u/s 80D

Self, Spouse &

Dependent

Children

Parents

(whether

dependent

or not)

Insured is below the age of 65

years Rs. 15,000 Rs. 15,000 Rs. 30,000

Insured and his/her family is less

than 65 years of age and his/her

parents are senior citizens

Rs. 15,000 Rs. 20,000 Rs. 35,000

Insured and his/her parents have

attained age of 65 years Rs. 20,000 Rs. 20,000 Rs. 40,000

Invest in Jeevan Arogya Comprehensive family Insurance plan.

Traditional Mediclaim

Traditional Mediclaim:

Such Health Insurance plans are called "Indemnity based plans", and pay

the actual expenses on submission of original papers, of course subject to

terms and conditions of the policy.

Defined Benefit Products:

Also called Hospital Cash plans, pay defined benefits on no. of days the

insured customer is hospitalized. The newer products from LIC are more

advanced and cover all surgical benefits with a fixed compensation,

irrespective of whether your actual costs are low or high. Such products

pay claims on photocopy of bills also. Let’s take a live case and compare

the benefits vis-à-vis a premium. Let’s take an individual, Sanjay who is 32

years old and wants to buy Health Insurance. Here is how the medical

insurance products would compare with the premium.

Comparison of Defined Benefit Products with Traditional Mediclaim:

Comparison of a Claim made between Defined Benefit Health Insurance

Products and Mediclaim.

Let’s look at some live instances, so as to understand, how claims would be

differentially paid.

The ideas is to die young as late as possible

Lifetime physical ActivityWalk rather than ride

Climb the startsDo yard work

Aerobic ActivityAerobicsJogging

Biking

Active SportsAnd recreationTennisBasketballCanoeing

Exercise forFlexibility

Stretching

F- 3 to 7 days week I- StretchingT- 15-60 Sec. 1-3 Sets

F- 2 to 3 days weekI- Muscle OverloadT- 8-12 reps, 1-3 Sets

Rest orInactivity

Watching TVReading

Lev

el 4

Lev

el 1

Lev

el 2

Lev

el 3

I = Moderate T= 30 + Mins

I = Moderate to Vigorous T= 20 + Mins

Physical Activity Pyramid

They key to happiness is Sound Mind & Sound Body-Theodore Roosevelt

Human bones are 7 times strongerthan concrete.

Your Body On Walking

Ridiculously simple, astonishingly powerful,

scientifically proven by study after

study: sneaking in a few minutes a day can transform your health, body, and mind,

why are still sitting?

HEART: 3 to 60 minutes most days of theweek drastically lowers your riskof heart disease.

WEIGHT: A daily 1-hourwalk can cutyour risk of

obesity in half.

BONES : 4 hours a week

can reduce the risk

of hip fracturesby up to 43%.

BRAIN : Just 2 hours of walking a week can reduce your

risk of stroke by 30%

MEMORY: 40 minutes 3 times

a week protects the brain region

associated with planning & memory,

MOOD: 30 minutes a day can reduce symp-toms of depres-sion by 36%

HEALTH:logging 3,500steps a day lowers your risk of diabetes by 29%

LONGEVITY:75 minutes a week of brisk

walking can addalmost 2 years

to your

Walk…is the best exercise

‘Walk Away’ from arguments that lead you to nowhere but anger..

‘Walk Away’ from people who deliberately put you down.

‘Walk away’ from any thought that reduces your worth.

‘Walk away’ from failures that stifle your dreams.

The more you walk away form from things that poison your soul the happier your life would be.

Gift your self a walk towards Happiness & health every day each year.

Jeevan Arogya VS Mediclaim

JEEVAN AROGYA MEDICLAIM

CoversSelf+Spouse+Children+Parents+Parentsin Laws

Hospitalisation + Surgeries

Defined benefits irrespective of a actual exp

50% advance facility through quick cash

Original bills not mandatory. Photocopiesduly attested by same doctor will do

Claim under each HI Policy taken from LICis treated as separate claim for any hospitalisation /Surgery

Claim can be taken in addition to Department medicalSccheme / Mediclaim

Covers:Self+ Spouse + Children + Parents

+Medicinal Expenses

Reimbursement of actual exp

Cashless Facility

Original bills mandatory

Not Possible

Not Possible if Department asks for Original Bills

Terry Grossman is one of the new-age gurus of longevity. He shot into fame after penning a book on how `to live forever' with Ray Kurzweil, futurist and chief engineer at Google. They are confident that science is going to end death -people will live for centuries if not indefinitely, and that this is not some dream of the distant future but a certainty by the middle of this century. Grossman has been practising what he preaches at his clinic in Denver, US, and claims he feels youthful at 68. He was full of zing talking to Subodh Varma

Why do you say that we have reached a point after which lives will be longer and healthier?

In the year 1900, life expectancy was 47 years. By 2000, it had jumped to 72 years. In 2015, in some places like Japan, people's average life is 82 years. On an average four-five months are being added to life every year. Very soon, one year will be added for every year that passes. We are poised at a point when life expectancy will grow exponentially. Aubrey de Gray, the Cambridge biomedical and aging scientist, calls it the "longevity escape velocity" when life will be extended by periods larger than the time passed. This has happened because medical science is increasingly merging with information technology, which grows exponentially. By focusing new medical research on stopping the aging process, human life will be extended to centuries -and this will happen within decades.

But do we want to live for, say, 200 years in an old, diseased condition?

That's not desirable! The concept of `old age' keeps changing. A few decades back, 65-70 years was thought of as `old'. Now it is considered ̀ young old' as compared to 85 years, which is 'old old'. What is going to happen in the coming years is that youthful life will be extended. Eighty years will become the new 40. 'Old' people will have such healthy bodies that they will be able to go surfing or mountain climbing or do other activities associated with youth. I believe that in the next 10-12 years these dramatic changes will become more visible.

In my book TRANSCEND -Nine Steps To Living

Forever, written with Ray Kurzweil in 2009, we

describe the whole system. TRANSCEND

stands for: Talk with your doctor, Relaxation,

Assessment, Nutrition, Supplements, Calorie

reduction, Exercise, New Technologies,

Detoxification. The book explains how people

can take full advantage of the available

information to help eliminate their chances of

disease and to drastically slow down the aging

process. Note that when I say "Talk with your

doctor", I mean consult an anti-aging

specialist. That's because most doctors are

trained to detect and treat diseases, not

prevent them. Also, while doing an

"assessment" by getting various tests like

cholesterol or liver function done, I don't go by

just `good'. I want to see best or optimal

numbers. New research is constantly coming

out and technologies are constantly improving.

These changes also need to be taken on board.

In a few years, 80 will be the new 40’So, what do you prescribe for extending a healthy life?

All this sounds very expensive. Will people be able to afford it, especially in the Third World?

Everything is expensive when it is first introduced. An LCD TV or monitor was beyond reach earlier but now everybody has it. After a time lag, products become accessible. The same thing will happen with life extension technologies. Testing prices will come down, devices will become cheap. Already, I can download apps on my smartphone that can test blood sugar, hypertension or even take an ultrasound. Self-monitoring will become the norm. Meanwhile some other new expensive product will enter the market, but over time that too will get cheap. In the long run, the whole of humanity will benefit.

I pledge to quit Eating Junk Food.

I Pledge to quit Smoking.

I Pledge to Eat Less Butter.

I Pledge to not to take Work Home.

I Pledge to get less Stressed Out.

I Pledge to Laugh More.

I Pledge to Control my Diabeties.

I Pledge to Watch my Weight.

I Pledge to Take More Exercise.

I Pledge to Take up Yoga.

I Pledge to Start Meditation.

I Pledge to Keep My Cool in Traffic.

I Pledge to Pay my Health Insurance

Premium Regularly.

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Don't Say“There’s still time”

or“May be next time”

Because there’s alsothe Concept of “It’s too late”

Life Insurance Corporation of IndiaToll Free No. 1800 33 44 33Toll Free No. 1800 22 40 77

1251 For Policy Enquiry 24x7www.licindia.com

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