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8/6/2019 Imra Slides

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HEALTH INSURANCEHEALTH INSURANCE

Presented By:-

Bhagirathi Das

Debabrata Dash

Mousam PattnaikSanujeet Mohanty

Sandeep Mishra


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PRESENTATION PLANPRESENTATION PLANINTRODUCTION

HEALTHINSURANCE MARKET PRIORTOLIBERALISATION

HEALTHINSURANCE MARKETINTHELIBERALISED MARKET

LAWAND REGULATIONS

INITITATIVESOF

FEW

STAKEHOL

DER

SWAYFORWARD


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INTRODUCTIONINTRODUCTIONPROVIDING QUALITYHEALTHCAREA CONCERN

GOVERNMENTROLEINHEALTHCARE

HEALTH CAREFINANCING INSURANCEAS ANOPTION


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HEALTH INSURANCE MARKETHEALTH INSURANCE MARKET

PRIOR TO LIBERALISATIONPRIOR TO LIBERALISATION

PRE-NATIONALISATION :

Hospitalisation and Sickness Insurance

POSTNATIONALISATION:

Prior to 1986

1986: Introduction of Mediclaim


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HEALTH INSURANCE IN THEHEALTH INSURANCE IN THE

LIBERALISED MARKETLIBERALISED MARKET

Growth in Health Insurance premium

Product Development

Customer Service

Market share


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LAW AND REGULATIONSLAW AND REGULATIONSHealth Insurance defined

Priority in licensing

Other relevant regulations:

IRDA Protection of policyholders interests, 2002

IRDAAdvertisements and DisclosuresRegulations, 2002

IRDAThird Party Administrators- Health ServicesRegulations, 2001

File & Use procedure


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HEALTH INSURANCE:HEALTH INSURANCE:

ISSUES AND CONCERNSISSUES AND CONCERNSADVERSE SELECTION

MORAL HAZARD

HIGH PAYOUTS

SELF-FUNDEDHEALTHINSURANCE


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INITIATIVESINITIATIVES

PRIVATE INSURERS KEEN TO DEVELOPHEALTH POLICY: PORTFOLIO

DEVELOPED NEW PRODUCTS

INCREASED THEIR MARKET SHARE

LIFE INSURERS HAVE SHOWN INCREASEDINTEREST


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INITIATIVES contdINITIATIVES contdINTRODUCTION OF GOVT. FUNDED HEALTHINSURANCE FOR POOR

STATE GOVTS. INTRODUCING SCHEMES FORPOOR IN PANCHAYAT ANDVILLAGE LEVELS

INCREASED GOVT. SPENDING TO STRENGTHENPRIMARY HEALTHCARE FACILITY INSELECTED STATES.

PRELIMINARY STUDY BEING HELD FOREVOLVING HEATH INSURANCE SCHEME FOR

URBAN AND RURAL POOR.


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INITIATIVES contdINITIATIVES contdMORE TPAs LICENSED AND EXISTING TPAsSTRENGTHENED THEIR OPERATIONS

EMERGENCE OF COMMUNITY AND GROUPINSURANCE

INVOLVEMENT OF NGOs AND MICRO FINANCEINSTITUTIONS


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RECOMMENDATIONS OF SUB-

COMMITTEESSubSub--group on Health Insurance Datagroup on Health Insurance Data

1)Collection of existing data

2)Collection of future data in standardized formats

3)Training of personnel

SubSub--group on Product Innovation ( & definition of pregroup on Product Innovation ( & definition of pre--existing diseaseexisting disease)

Distinction made between pre-existing disease and

condition and common definitions recommendedMedical Savings Accounts recommended

Creation of a pool for covering senior citizens

Committee to study insurance cover for common man inrural area


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RECOMMENDATIONS OFRECOMMENDATIONS OF

SUBSUB--COMMITTEEScontd,COMMITTEEScontd,Sub-group on registration of stand-alone HealthInsurers

1) Minimum Required Capital ofRs.50 Croresrecommended

2) Foreign Direct Investment of 51% suggested

3) Adoption ofRisk Based Capital proposed

4) Besides health, it was recommended thatcompanies be allowed to write Personal Accidentand Travel Insurance


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WAY FORWARDWAY FORWARDInsurers to collect correct data,develop newproducts price properly, improve u/w and claimsmanagement

Explore possibilities of setting up pure healthinsurance company with JV partners

Insurers TPAs Data Warehouse to have commonIT framework to facilitate easy data transfer

Govt. to evolve National health scheme forcommon man in urban and rural area andSr.citizen and terminally ill


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WAY FORWARD.contd,WAY FORWARD.contd,

Support health Insurance scheme for populationbelow poverty line.

Foster Public private partnership

Providers to be more disciplined, bringstandardization.

Govt. to regulate the healthcare providers


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THANK YOUTHANK YOU

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