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Health insurance in India is a growing segment of India's economy. The Indian health system is
one of the largest in the world, with the number of people it concerns: nearly 1.3 billion potential
beneficiaries. The health industry in India has rapidly become one of the most important sectors in
the country in terms of income and job creation. In 2018, one hundred million Indian households
(500 million people) do not benefit from health coverage. In 2011, 3.9%[1] of India's gross domestic
product was spent in the health sector. According to the World Health Organization (WHO), this is
among the lowest of the BRICS (Brazil, Russia, India, China, South Africa) economies. Policies are
available that offer both individual and family cover. Out of this 3.9%, health insurance accounts for
5-10% of expenditure, employers account for around 9% while personal expenditure amounts to an
astounding 82%.[2] In the year 2016, the NSSO released the report “Key Indicators of Social
Consumption in India: Health” based on its 71st round of surveys. The survey carried out in the year
2014 found out that, more than 80% of Indians are not covered under any health insurance plan, and
only 18% (government funded 12%) of the urban population and 14% (government funded 13%) of
the rural population was covered under any form of health insurance.[3]
For the financial year 2014-15, Health Insurance premium was ₹20,440.
Contents
1Presentation
2History
3Structure and organisation
4Types of policies
o 4.1The main publicly funded health insurance schemes
4.1.1Plans funded by central government
4.1.2Federally funded schemes
5Key aspects of health insurance
o 5.1Payment options
o 5.2Cost and duration
6Tax benefits
7References
Presentation[edit]
The health situation and the provision of services vary considerably from one State to another.
Although public health services in principle provide free basic health care to all, the care provided by
most state health systems suffers from inadequate resources and poor management. As a result,
the majority of the population turns to private health services that offer more expensive care and of
very unequal quality.
In India, the health system mixes public and private providers. Public health facilities - local clinics
providing basic care, regional hospitals, national hospitals - are funded by the federal states and the
federal state and managed by the state authorities.
Public health services differ greatly from one federated state to another. In some states such
as Tamil Nadu or Kerala, public health facilities play their role as the first stage of the care journey,
but, outside of these few states, the public sector does not reach the goal to provide the basic health
needs of the population.
India's public health expenditures are lower than those of other middle-income countries. In 2012,
they accounted for 4% of GDP, which is half as much as in China with 5.1%. In terms of public
health spending per capita, India ranks 184th out of 191 countries in 2012. Patients' remaining costs
represent about 58% of the total.[4] The remaining costs borne by the patient represent an increasing
share of the household budget, from 5% of this budget in 2000 to over 11% in 2004-2005.[5] On
average, the remaining costs of poor households as a result of hospitalization accounted for 140% of
their annual income in rural areas and 90% in urban areas.
This financial burden has been one of the main reasons for the introduction of health insurance
covering the hospital costs of the poorest.
History[edit]
Launched in 1986,[6] the health insurance industry has grown significantly mainly due to liberalization
of economy and general awareness. According to the World Bank, by 2010, more than 25%[7] of
India's population had access to some form of health insurance. There are standalone health
insurers along with government sponsored health insurance providers. Until recently, to improve the
awareness and reduce the procrastination for buying health insurance, the General Insurance
Corporation of India and the Insurance Regulatory and Development Authority (IRDA) had
launched[8] an awareness campaign for all segments of the population.
Launched in 2007, the National Health Insurance Program (Rashtriya Swasthya Bima Yojana-
RSBY) is led by the Ministry of Health and was adopted by 29 states in 2014. It is funded 75% by the
government and 25% by the states. The worker and 4 of his dependents benefit from health
insurance if they are not covered by any system and live below the poverty line. RSBY beneficiaries
are required to pay an annual registration fee of INR 30 for hospital coverage up to INR 30,000 per
year per family.
September 25th, 2018, the Indian government announced the launch of a new health insurance for
the poorest citizens. Indian Prime Minister, Narendra Modi announced that the new system is
expected to reach more than 500 million people and is called "Modicare". The reform is still in
progress and aims to install universal social security in the country.
Types of policies[edit]
Health insurance in India typically pays for only inpatient hospitalization and for treatment at
hospitals in India. Outpatient services were not payable under health policies in India. The first
health policies in India were Mediclaim Policies. In Year 2000, Government of India liberalized
insurance and allowed private players into the insurance sector. The advent of private insurers in
India saw the introduction of many innovative products like family floater plans, top-up plans, critical
illness plans, hospital cash and top up policies.
The health insurance sector hovers around 10% in density calculations. One of the main reasons for
the low penetration and coverage of health insurance is the lack of competition in the sector. IRDA
which is responsible for insurance policies in India can create health circles, similar to telecom
circles to promote competition.[9]
In principle, government health services are available to all citizens under the tax-financed public
system. In practice, bottlenecks in accessing such services compel households to seek private care,
resulting in high out-of-pocket payments.
Health insurance plans in India today can be broadly classified into these categories:
Hospitalization
Hospitalization plans are indemnity plans that pay cost of
hospitalization and medical costs of the insured subject to the
sum insured. The sum insured can be applied on a per member
basis in case of individual health policies or on a floater basis in
case of family floater policies. In case of floater policies the sum
insured can be utilized by any of the members insured under the
plan. These policies do not normally pay any cash benefit. In
addition to hospitalization benefits, specific policies may offer a
number of additional benefits like maternity and newborn
coverage, day care procedures for specific procedures, pre- and
post-hospitalization care, domiciliary benefits where patients
cannot be moved to a hospital, daily cash, and convalescence.
There is another type of hospitalization policy called a top-up
policy. Top up policies have a high deductible typically set a
level of existing cover. This policy is targeted at people who
have some amount of insurance from their employer. If the
employer provided cover is not enough people can supplement
their cover with the top-up policy. However, this is subject to
deduction on every claim reported for every member on the final
amount payable.
Disease specific
special plans:
Some companies offer specially designed disease specific plans
like Dengue Care. These are designed keeping in mind the
growing occurrence of viral diseases like Dengue in India which
has become a cause of concern and thus provide assistance
based on medical needs, behavioural and lifestyle factors
associated with such conditions. These plans aim to help
customers manage their unexpected health expenses better and
at a very minimal cost.
The main
publicly
funded health
insurance
schemes[edit]
Plans funded by
central
government[edit]
ESI scheme:
This scheme
covers
organized
private sector
workers,
which is about
55 million
people.
Central
Government
Insurance
Scheme: This
scheme
covers central
government
agents and
retirees, i.e.
about 3
million people.
RSBY: this
scheme
covers
families below
the poverty
line of about
40 million
families.
Federally funded
schemes[edit]
Andhra
Pradesh: This
scheme
covers
families below
the poverty
line or with
annual
income below
INR 75,000. It
represents 70
million
beneficiaries.
Tamil Nadu:
This scheme
finances
families below
the poverty
line or with
annual
income below
INR 72,000,
which
represents
about 40
million
beneficiaries.
Karnataka:
this scheme
covers
members of
rural
cooperatives,
more than 3
million people.
Key aspects
of health
insurance[ed
it]
Payment
options[edit]
Direct
Payment or
Cashless
Facility:
Under this
facility, the
person does
not need to
pay the
hospital as
the insurer
pays directly
to the
hospital.
Under the
cashless
scheme, the
policyholder
and all those
who are
mentioned in
the policy can
undertake
treatment
from those
hospitals
approved by
the insurer.
Reimbursem
ent at the
end of the
hospital stay:
After staying
for the
duration of the
treatment, the
patient can
take a
reimbursemen
t from the
insurer for the
treatment that
is covered
under the
policy
undertaken.
Cost and
duration[edit]
Policy price
range:
Insurance
companies
offer health
insurance
from a sum
insured
of ₹5000/-
[10]
for micro-
insurance
policies to a
higher sum
insured of ₹50
lacs and
above. The
common
insurance
policies for
health
insurance are
usually
available
from ₹1 lac
to ₹5 lacs.
Duration:
Health
insurance
policies
offered by
non-life
insurance
companies
usually last for
a period of
one year. Life
insurance
companies
offer policies
for a period of
several years.
Tax
benefits[edit]
Under Section
80D of the
Income-tax
Act the insured
person who takes
out the policy can
claim for tax
deductions.[11]
₹25,000 for self,
spouse and
dependent
children.
₹50,000/- for
parents.
References[
edit]
1. ^ "WHO
South-East
Asia
Region:
India
statistics
summary
(2002 -
present)".
World
Health
Organizati
on.
Retrieved
13
January 20
14.
2. ^ http://ww
w.cppr.in/a
rticle/healt
h-
insurance-
and-
telecom-
markets-a-
comparativ
e-study/
3. ^ Ambrish
Singh .
Current
Situation of
Health
Care
Coverage
in India,
ISPOR,
News
Across
Asia,
Volume 5
Number 1
April–July
2016.
Available
at: https://
www.ispor.
org/consort
iums/asia/
NewsAcro
ssAsia_Sp
ring2016.p
df
4. ^ "Études
économiqu
es de
l'OCDE :
Inde
2007". Étu
des
économiqu
es de
l'OCDE :
Inde.
2008-11-
26. doi:10.
1787/eco_
surveys-
ind-2007-
fr. ISSN 22
23-5108.
5. ^ Ladusing
h,
Laishram;
Pandey,
Anamika
(2013-05-
23). "High
inpatient
care cost
of dying in
India". Jour
nal of
Public
Health. 21
(5): 435–
443. doi:10
.1007/s103
89-013-
0572-
9. ISSN 09
43-1853.
6. ^ "4 factors
that
impacted
health
insurance
industry in
2013". Fin
ancial
Express.
30
December
2013.
Retrieved
13
January 20
14.
7. ^ "Govern
ment-
Sponsored
Health
Insurance
in India:
Are You
Covered?".
World
Bank.
Retrieved
13
January 20
14.
8. ^ "4 factors
that
impacted
health
insurance
industry in
2013". Fin
ancial
Express.
30
December
2013.
Retrieved
13
January 20
14.
9. ^ http://ww
w.cppr.in/a
rticle/healt
h-
insurance-
and-
telecom-
markets-a-
comparativ
e-study/
10. ^ "Handbo
ok on
Health
Insurance"
(PDF).
Insurance
Regulatory
and
Developm
ent
Authority.
Retrieved
13
January 20
14.
11. ^ "Section
80D
provides
tax
benefits for
mediclaim
premium".
Live Mint.
24 June
2013.
Retrieved
13
January 20
14.
Categories:
Health insurance
in India
1986
establishments in
India
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