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Evolution of Health Insurance in India

The document provides an overview of the history and development of health insurance in India. Some key points include: health insurance began in India in 1923 with the Workman's Compensation Act and expanded in 1948 with the ESI Act; the Mudaliar Committee recommended a long-range health insurance policy for all in 1959-1961; the IRDA Act was passed in 1999 and the Insurance Amendment Act was passed in 2001; health insurance allows individuals to pool risks and provides protection against costs of medical care; there are various forms of health insurance like indemnity and cashless insurance in India.

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WasimAkram
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67 views22 pages

Evolution of Health Insurance in India

The document provides an overview of the history and development of health insurance in India. Some key points include: health insurance began in India in 1923 with the Workman's Compensation Act and expanded in 1948 with the ESI Act; the Mudaliar Committee recommended a long-range health insurance policy for all in 1959-1961; the IRDA Act was passed in 1999 and the Insurance Amendment Act was passed in 2001; health insurance allows individuals to pool risks and provides protection against costs of medical care; there are various forms of health insurance like indemnity and cashless insurance in India.

Uploaded by

WasimAkram
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Presented by :

Md. Wasim Akram (11400998)


Aman Gupta (11408412)
Apoorva Kumar Singh (11410106)
Mohit Boora (11411213)
History of Health Insurance in India

1923: Workmans compensation Act.


1948: ESI Act passed.
1952: First ESI hospital established.
Mudaliar Committee(1959-1961)
recommendations:
Long range health insurance policy for all.
Small fee for availing health services.
1999: IRDA act passed.
2001: Insurance amendment Act
WHAT IS HEALTH
INSURANCE
Health insuranceis a form of collectivism
by means of which an insured individual
pools his/her risk of incurring medical and
surgical expenses.
WHY WE NEED HEALTH
INSURANCE
To assure in making contingencies of health care
expenses.
To provide protection against financial loss by
unforeseen sickness.
To meet cost of good medical care.
To relieve anxiety & tension.
CHARACTERISTICS OF HEALTH
INSURANCE
It is contract between an insurance company
and an individual or his sponsor (e.g. an
employer).
The contract can be renewable annually or
monthly.
The type and amount of health care costs that
will be covered by the health insurance
company are specified in advance, in the
member contract or "Evidence of Coverage"
booklet.
FORMS OF HEALTH
INSURANCE
Indemnity Insurance: where the insurer
first pay to the hospital and claim is made.
E.g. Jeevan Asha II, Asha Deep II, Mediclaim.
Cashless Claim Facility: TPAs who bear the
expenses on behalf of insurance company.
Patients need not to pay directly as a rule
e.g. Bajaj Alliance.
CBHI (Community Based Health Insurance).
TYPES OF HEALTH
INSURANCE
Accidental Death and Dismemberment
Insurance
Total Permanent Disability Insurance

Disability Insurance

Long Term Care Insurance

Vision Insurance

Dental Insurance
CLAIMING PROCESS
Get admitted to any of the authorized hospitals in the
1 network
Fax the pre-authorization form to the insurance
2 company or TPA

3 Obtain itemized receipts, bills and claim forms

Make copies, review and then send to insurer for


4 settlement
BENEFITS OF HEALTH
INSURANCE
CASHLESS SERVICE TAX BENEFIT
Advantages

Early Prevention

Peace of Mind

Less Lost Time

Tax Benefits
Disadvantages

Cost

Lack of choices

Complicated rules

Limited access
Issues/Limitations
Limited coverage
Geographic spread in terms of health care facilities and
financing awareness is limited
Lack of universal schemes
Limitations in terms of coverage of illnesses as well as
treatment options
System leakages
Provider malpractices leading to over-charging or pre-
selection / selective recommendation
Moral hazard and Adverse selection
Claims ratios for some policies have been in the range of
120 - 130%
YOU

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