Presentation By Dr. Rajesh Kumar Attri, Deputy General Manager National Insurance Company Ltd. Pune Regional Office 4 th May, 2012

Transcription

1 Presentation By Dr. Rajesh Kumar Attri, Deputy General Manager National Insurance Company Ltd. Pune Regional Office 4 th May, 2012

2 HEALTH INSURANCE Financial security and protection to the insured person in case of hospitalization and/or domiciliary hospitalization arising out of 1. Illnesses/Diseases 2. Accidents TWO METHODS OF PAYMENT 1. Reimbursement 2. Cashless

3 PRINCIPLES OF INSURANCE Insurance is a mechanism where the losses of a few are shared through contribution by many. It is based on the basic principles of insurance 1. Utmost Good Faith- Proposal form 2. Insurable Interest The legal right to insure 3. Indemnity Reimbursement subject to the limits agreed in the policy

4 Population Global population, 700 crs India, 130 crs, 1.64% growth 17.5% of world population in India 2 nd largest in world China, largest, 19.4% of globe,, 0.53% growth USA, 3 rd, 4.5% of globe, 0.70% growth Globe growth 1.30%

5 THE HEALTH PORTFOLIO General Insurance Industry Premium- Rs crores Health Premium Incl Social Sector- Rs crores (22%) Incurred Claims Ratio 101% Loss Including Management Expenses 30%

6 POINTS TO PONDER Our Life Expectancy has risen from 36 years in 1951 to 67 years today. Health Insurance is a necessity rather than an option HEALTH PORTFOLIO IS THE FASTEST GROWING BUT LOSS MAKING PORTFOLIO

7 Health insurance schemes Voluntary health insurance schemes Employer-based schemes Insurance offered by NGOs Community based health insurance (Self Help Groups, Bidi Workers, Mine Workers, Unorganized labor like Construction workers etc) Government run schemes (ESIS, CGHS) Health Insurance Companies

8 Spending India spends about 4.9% of GDP on Health Care

9 Insurance Central Government schemes State government schemes Insurance companies

10 Insurance Companies Life Insurance Non-life insurance

11 LIST OF GENERAL INSURANCE COMPANIES Bajaj Allianz Bharti AXA General Insurance Cholamandalam MS Future Generali India Insurance HDFC ERGO General Insurance ICICI Lombard IFFCO Tokio L & T General Insurance

12 LIST OF GENERAL INSURANCE COMPANIES (contd) National Insurance Co Ltd New India Assurance Co Ltd Oriental Insurance Co Ltd Raheja QBE General Insurance Reliance General Insurance ECGC Agricultural Insurance Co. Ltd.

13 LIST OF GENERAL INSURANCE COMPANIES (contd) Royal Sundaram SBI General Insurance Shriram General Insurance Tata AIG General United India Insurance Co Ltd Universal Sompo General Insurance

14 Standalone health insurance Companies Apollo Munich Health Insurance Max Bupa Health Insurance Star Health Insurance Religare Insurance Company

15 VARIETY OF COVERS IN GENERAL BRANCH Individual Health Policies Group Health Policies Family Floaters Students Health covers Senior Citizens covers Overseas Health Covers Critical Illness cover Tailor Made Group Health Covers Specially designed covers for Bank Tie Ups Special policies for the social sector like UHIS, RSBY, RGJAY

16 INDIVIDUAL MEDICLAIM POLICY Individuals from the age of 18 till 59 can take this cover. Sum Insured ranges between to 5 lacs. Can be increased subsequently upto 10 lacs Hospitalisation expenses arising due to disease and illness is covered. Pre-existing diseases covered from the fifth year onwards after 4 claim free year.

17 GROUP MEDICLAIM POLICY Pre-Defined Groups/ Association/Institution/Corporate body like Employer Employee, subscribers to common facility like Account holders of banks, Credit Card holders etc. Maternity Extension allowed with 10% loading in premium and benefits upto Rs /-

18 PARIVAR MEDICLAIM INSURANCE A Family Floater cover Self, Spouse and 2 Children upto 25 years. Age band 3 months to 60 years One illness upto 50% of Sum Insured SI from Rs. 2 lacs to Rs. 5 lacs. In multiples of Rs

19 VIDYARTHI MEDICLAIM FOR STUDENTS Age Group from 3 to 25 years. Three Sections, Section I covers hospitalization of the student, Section II covers PA to Parents and Section III covers PA to the Student. Sum Insured under Sec I ranges from Rs to Rs. 2 lacs, Sec II will be twice Sec I and Sec III is restricted to Rs

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21 VARISHTA MEDICLAIM FOR SENIOR CITIZENS Individuals above the age of 60 upto 80 years Sum Insured of Rs. 1 lac for hospitalization and Rs. 2 lacs for Critical Illness or dreaded diseases cover. (Cancr, stroke, Multiple schlerosis,coronary Artery Surgery, Renal failure, Major Organ Transplant and optional covers are Paralysis and blindness)

22 OVERSEAS HEALTH INSURANCE Specialy designed to protect persons travelling overseas for business, holiday, studies or employment when sponsored or posted by Indian employer. Emergency health expenses incurred to relieve immediate pain and to save life Apart from illnesses and diseases, covers accident, loss of checked baggage, delay of checked baggage, loss of passport and personal liability during travelling abroad.

23 CIRITICAL ILLNESS INSURANCE Benefit policy targeting age group from 18 to 60 years. Covers eight dreaded diseases (Cancer, Stroke, multiple sclerosis, major organ transplant, paralysis, blindness, renal failure and coronary artery surgery) Person is given the sum insured in the event of inception or manifestation of the disease and survival of 30 days thereof. No claim is payable for the first 90 days.

24 SOCIAL SCHEMES UHIS: Sum insured of Rs /- per family with a per sickness limit of Rs /- Premium is shared by the Central Government for persons below poverty line. Rajiv Gandhi Jan Arogya Bima: Scheme introduced by Maharastra Government (Operated by National Insurance ) Sum Insured per family is Rs Rastriya Swasthya Bima Yojana

25 Some important features. Pre-existing exclusions. Waiting period of 30 days 1 st /2 nd year exclusions. Free Health check up after 4 continuous claim free years. Cumulative Bonus

26 GLARING TRUTHS Health Premium grew from 774 crs (Out of crs overall) in 2000 to crores (Out of crs overall ) in 2012 It was a meagre 6% of the GDPI in 2000 and has reached the figure of 23% of the GDPI in the year It will very soon cross the Motor portfolio, which is the major contributor to the GDPI

27 WHY IS THIS PORTFOLIO LOSS PRONE Improper Underwriting Management Policies are not taken by persons who should. Proposers in higher age bracket and prone to sickness. Thus there is an adverse Selection against Insurers Hospitals charges are not Regulated Failure of rural schemes due to mismanagement; Benefits do not reach the target beneficiaries, due to many reasons ; eg lack of awareness, exorbitant medical expenses etc.

28 THE REMEDY: TOWARDS PROFESSIONAL UNDERWRITING Have a more scientific method of rating proposals. Lower the age, lesser the premium Lower premium for non-smokers and non-drinkers Lifestyle discount like Gym members etc. Active grievance redressal system

29 THE REMEDY: TOWARDS PROFESSIONAL UNDERWRITING Medical Underwriting, Recruitment of Medical Professionals to assist in underwriting Targeting the young world Creating proper awareness, Product improvement and development etc. Redefining the need of health insurance, by inspiring the youth to take covers. This can be achieved through Publicity in the print and visual media, seminars and conferences, Interaction with the insuring public, the hospitals, the Third Party Administrators etc. INSPIRING THE YOUTH TO EARN WHILE THEY EARN. Insurance Agency is the best method of earning while learning. MAKING HEALTH INSURANCE VIABLE AND A WIN WIN SITUATION FOR BOTH THE INSURED AND THE INSURERS

30 OPPORTUNITIES/STRATEGIES MEDICAL PROFESSIONALS FOR UNDERWRITING AND CLAIMS ASSISTANCE INSURANCE AGENCY TO SELL HEALTH INSURANCE PRODUCT DEVELOPMENT TO ENCOMPASS WORLDWIDE HEALTH COVER

31 Medical Tourism Indian medical tourism that was valued at US$350 million in 2006, is estimated to grow into a US$2 billion industry by 2012 Medical Tourism has a great potential for development of Health Insurance Health cover should be considered for NRIs.

32 CONCLUSION Insurance Awareness and Feasibility should reach the levels of Western Countries. It is a long way to go but we shall achieve.

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