1. Health Insurance
Challenges & Opportunities

2. What is Health
Insurance?
Health Insurance covers
your medical expenses
due to diseases and
accidents
Health Insurance is a
contract between an
individual/group and the
insurer
The policy provides
specific health cover for a
particular premium

3. Reasons for Health
Problems
Fast Lifestyle
Diseases common in
children
Food Habits
Lack of Exercise
Mental Stress & Strain
Pollution
New Types of Diseases
Expect the unexpected
like Accidents .

4. Rising Health Care
Costs - Reasons
Speciality health care
Investigative type of
treatment
Hospital infrastructure
Medical equipment
Cost of living/Inflation
Rising drug prices
Super speciality doctors
Defensive Medical
practice

5. Why is health
insurance essential?
Unaffordable health care
No basic public health
services
Increasing life
expectancy
Increasing percentage of
the elderly persons
Health is wealth
Good news – Health
insurance is affordable

6. Health Insurance
Market in India
Fastest growing segment
(avg. 20% growth)
Growth:
Expected By 2015: 30000
Cr.
24companies offering
health insurance
100+ types of medical
insurance policies
Potential market: Semi-
urban areas

7. Health Care
Scenario in India
Health care expenditure
is 6% of GDP
Govt. spending
< 25% as against
30%-40% in other
countries
Only a small section
of the population is
covered

8. Health Insurance –
Role of Hospitals
In Kerala, people are
conscious of health care;
but mostly unaware of
health insurance
Hospitals are the right
place for creating
awareness of health
insurance
Enough time for patients
and relatives to study
various types of policies
and their benefits

9. Issues & Challenges
for Insurance
companies
Limited Influence over
healthcare delivery
mechanism
High claim ratio – Around
140%
Low level of consumer
awareness
Limited product
development
Limited knowledge for
staff/Agents

10. Issues & Challenges:
Healthcare providers
Pricing demands from
Insurance companies
Lack of proper
communication between
TPAs and Hospitals
Delay in Settlement of Claims
Lack of Training support from
Insurers as well as TPAs
Pre existing diseases
disputes between consumer
and TPAs
Different Insurance
Companies – different
policies, terms etc

11. Expectations from
Hospitals
No overcharging for insured
patients
No fraudulent medical
certification
Pre-existing diseases &
treatment education
No mis-handling of patients
in front office
Classification of hospitals &
transparency
Economical treatment for
poor / BPL patients
No unwanted investigations,
treatments, delays
No manipulation of records
Ex: [Alcoholic accidents and
into Road accidents]

12. Insurance
Education
Health Insurance–different
types
Proposal fillings
Premium calculation
Income Tax benefits
Cashless/Reimbursement
Group/family discounts
Policy comparisons
Claims process
Prompt reimbursements

13. Recommended
Policies
Individual Policies
Family Floater Policies
Group Policies (customized)
Senior citizen Plans
Critical Illness Policies
Surgical benefit policy
Hospital Daily Cash Policies
Super Top up Policies
Students Policies
Micro & social security Schemes

14. Health Insurance
Promotion
Health Insurance
Posters/ Banners etc
Simple Health insurance
leaflets in Malayalam
Insurance Help Desk
Policy details,
comparisons, premium
charts, claim procedure
Documentation
assistance

15. Benefits to the
public
Developing insurance
awareness
Selection of suitable
insurance policies
No immediate cash outgo
thanks to cashless facility
Tension free claim
settlement process

16. Encash the
opportunity
Developed Countries –
100% health insured
India Emerging Economy
– Untapped Market
Kerala - Health conscious
people
Kerala – Low awareness
of Health Insurance
Be a part of social
development through
promoting health
insurance

17. Thank You
Prepared by
Viswanathan Odatt
Director
Aims Insurance Broking