Wednesday, June 15, 2022

When Health Insurance Started In India

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Oriental Health Insurance Company

Insurance In India | History of Health Insurance In India

The Oriental Insurance company was founded in 1947 and since then, it is offering multiple health insurance products and laying down a smooth system for the better convenience of customers. The company has its head office located at New Delhi along with 29 regional offices and nearly 1800+ operating offices in various cities across the country. It also conducts overseas operations in Nepal, Kuwait and Dubai. Oriental offers different types of insurance covers to cater to the needs of both the urban and rural population of India.

Healthcare System In India

Learn about the healthcare system in India and how it works

India has a vast health care system, but there remain many differences in quality between rural and urban areasas well as between public and private health care. Despite this, India is a popular destination for medicaltourists, given the relatively low costs and high quality of its private hospitals. International students inIndia should expect to rely on private hospitals for advanced medical care.

Studying in India offers a number of health challenges that students from developed countries may be unused to,so it is important to know how the health care system in India operates in the event you need it. Health care inIndia is a vast system and can be much like the rest of the country: full of complexity and paradoxes.

Factors That Frustrate The Growth Of Private Sector Health Insurance

There are certain factors that have curtailed the growth of private health insurance in the past and are likely to have an influence in the near future.

  • Lack of awareness in promoting health insurance to the general public at large

  • Non-availability of reliable data and epidemiological information on the disease pattern and treatment cost that is requited for designing health insurance product specifications

  • Risk of adverse selection of people with pre-existing ailments and unhealthy persons opt for the coverage

  • Morale and morale hazard have had a negative implication on the insurance business

  • Lack of actuarial data for the development of new product

  • Lack of technically skilled manpower that has sound knowledge in the research and development activities associated with medical aspects of the health insurance and well-trained staff to meet the expectations of the clients

  • Lack of cooperation and coordination with health care providers regarding processing and settlement of claims

  • Lack of neutral bodies to carry out Accreditation and Categorization of health care providers.

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    How To Get Claims Faster

    • The Star Health website contains a list of network hospitals, including Agreed network hospitals.
    • Search from the network list from our website and locate the nearest network hospital to your residence.
    • For planned surgery, approach the hospital prior to the date of admission who will send the completed pre-authorization form.
    • In the pre-authorization form, you are required to furnish your contact number.
    • If details are not complete, approval of the authorization request may be delayed.

    How Is My Health Premium Calculated

    Health care spending in India

    Following are the key determinants for computing the premium amount for your chosen HealthInsurance Plan or Mediclaim Policy.

    Sum Assured

    The sum assured or health cover you opt for, determines the premium amount for yourhealth plan. You should select the adequate sum assured, keeping medical inflationin mind so that you get the enough cover for your medical conditions. Higher sumassured attracts a higher premium.


    If you buy a health plan at a young age , you will becharged with the lesser premium rates than those aged 40+ years. People at a youngerage are less likely to face critical health issues, and thus, your insurer willcharge the lesser premium.

    Type of Plan

    The individual health plan has a lower premium than the family floater health plan.The number of insured covered under a single policy results to increase in premium.Under a Family Floater Policy, the insurance company provides cover for each memberof your family who is insured under the health plan and so, the premium is alsorelatively higher than individual health policy.

    Pre-existing Condition

    If you have any pre-existing health condition, your insurance company will charge apremium at a higher rate. It is recommended to inform about your pre-existingcondition to the insurer while buying the health plan, so you can easily get theclaim afterward.

    Personal Health

    Claim Free Years

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    Here Are Our Health Insurance Plans:

  • Diabetes Safe Health Insurance Plan
    Diabetes is among one of the most common disorders with a huge number of 50.9 million people, driving India to the second position of the most affected country in the world, says Diabetes Foundation of India in a recent survey. A sedentary lifestyle, usage of tobacco, unhealthy food habits are the factors that stands foremost leading to diabetes, according to WHO.
    Star Diabetes Safe Health Insurance Plans offers coverage for regular in-patient hospitalization due to illness/accidents and diabetes complications arising out of Type 1/Type 2 . This is a specialized plan designed for people already with a history of diabetes. The plan covers diabetic complications and all other illnesses that require 24 hours of hospitalization on both individual and family floater basis.
    Know more
  • Super Surplus Top-Up Health Insurance Plan
    During the pandemic, even the best coverage is not sufficient. The Super Surplus Health Insurance Plan is a top-up plan that will cover medical costs, over and above a threshold limit. The plan is designed to cover exorbitant medical expenses with affordable premiums up to 1 crore sum insured. The Super Surplus Top-Up plan is available both on an individual and floater basis that can cover your family too.
    Know more
  • How Does Universal Health Coverage Work

    The constitution of India obliges the government to ensure the right to health for all.1 Each state is required to provide free universal access to health care services. However, health care in India has been chronically underfunded.

    Historically, there have been several government-funded health insurance schemes intended to improve coverage for specific population groups, with variations across states. One important scheme aimed at reducing financial catastrophe and vulnerability for lower-income populations is the National Health Insurance Program , launched in 2008. As of 2016, some 41 million families were enrolled in RSBY.2 However, evidence indicates that the scheme has not significantly reduced out-of-pocket spending. It is now being subsumed under the PM-JAY.

    With ineffective public insurance schemes and the low uptake of commercial insurance, only around 37 percent of the population were covered by any form of health coverage in 20172018.3 Further systemic barriers to access include long wait times in hospitals, the perceived low quality of public health services, and substantial workforce and infrastructure shortfalls.4

    Role of government: Responsibility for the governance, financing, and operation of the health system is divided between the central and state governments.

    In 2014, the government established the federal Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. It develops and promotes research in alternative medicine practices.

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    Pricing Hurdles In Out

    According to recent reports, some insurers have bought out-patient cover under cashless scheme for those hospitals that are linked with that particular insurance company. However, many believe that it would take a while before OPD cover becomes common as a product category in private health insurance. Some companies extend OP cover under cashless scheme by payment of some additional premiums. Claim management would not be an easy task if OP becomes a full-fledged offering under health insurance. This is because there are frequent visits to a physician in case of OP cover whereas hospitalization is not a frequent event and leads to one-time claim settlement. Some other issues like absence of a national brand in the OP space be it dental, eye or even diagnostic, controlling frauds in matters pertaining in billing and uniformity in service for claims assessment and payment are hurdles in regularizing the OP cover.

    Claim Settlement Process In Health Insurance Plans

    Beneficial Insights on Health Insurance Policy in India

    Under health insurance plans, you can make a claim in two ways, i.e. cashless claim and a reimbursement claim. A cashless claim is when you do not pay anything at the hospital for the treatment availed. Whereas in reimbursement claim, you will be first required to pay for the treatment taken, at the hospital, and the insurance company pays to you later. The claim processes for them are mentioned below:

    Cashless Claim

    To make a cashless claim, you will be required to follow the steps given below:

    Reimbursement Claim

    To avail reimbursement treatment, you must follow the steps given below:

    • Inform the insurance company within the stipulated time, in case of hospitalisation. You can also connect directly with the insurance company via email.
    • Avail the required treatment at the hospital if your policy covers you for the same. Collect all the medical test reports, discharge summary, medical invoices, and other relevant documents from the hospital to share to the insurance provider.
    • Submit the claim documents along with required medical documents to the insurance provider.

    You will be required to submit the following documents to the insurance company in case of reimbursement claim:

  • Valid ID proof
  • Medical practioners advising letter for hospitalisation
  • Original hospital bills and discharge certificate signed by the medical practitioner
  • Medical practioners prescription for consultation, medicine, and medical tests
  • Original pharmacy bills
  • First Information Report , in a police case
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    Bharti Axa Health Insurance Company

    Bharti AXA General Insurance Company was incorporated in 2008. The company is a joint venture between Bharti Enterprises of India, a pivotal Indian business group, and the AXA group of Europe, a world leader in financial protection. It has a PAN India presence through 135 branches and offers a variety of insurance solutions, including motor and two-wheeler, health and critical illness, property and student, individual and family travel and crop insurance. Bharti AXA is the first general insurance company that carries dual certifications of ISO 27001:2005 & ISO 9001:2008 within the first year of its operations.

    Know More About – Bharti Axa Health Insurance

    Health Insurance In India: Need For Managed Care Expertise

    The American Journal of Managed Care

    India’s emerging health insurance sector faces significant operational challenges that managed care models can help to address.

    Health insurers in India currently face many challenges, including poor consumer awareness, strict regulations, and inefficient business practices. They operate under a combination of stifling administrative costs and high medical expense ratios which have ensured that insurers operate under steep losses. External factors and internal factors have forced the health insurance industry into a regressive spiral. To overcome these challenges, health insurers need to innovate in their product offerings and tighten their existing processes and cost structures. But as a long-term strategy, it is imperative that health insurers deploy managed care concepts, which will go a long way toward addressing the systemic issues in the current operational models of health plans.


    Managed care firms can play a key role in India’s emerging health insurance sector and help strengthen the country’s overall healthcare effectiveness.

    • The health insurance industry in India today is loss making and does not use any managed care techniques.
    • Simple and innovative managed care techniques can go a long way toward addressing many of the industry challenges.
    • Because there is a need for expertise on policy formulation at the industry level, US managed care firms have the opportunity to play a key role in this emerging sector.

    Figure 1

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    Health Insurance In Indian History:

    In India, mention of health insurance can be found in the writings of Manusmrithi, Kautilya and Yajnavalkya. They have discussed the importance and the ways in which resources were used to help people. These writings reveal resources were pooled and shared among citizens during natural calamities like famine, epidemic or a flood.

    We also find traces of health insurance during British Imperial rule. Some form of insurance can be traced during the early British rule in the form of carriers contract and marine trade loans.

    Health insurance in India took off under the British. In the year 1818, life insurance business was set up in India. Oriental life insurance Company was established in Calcutta under the British leadership. However, the venture did not succeed and the company closed in 1834.

    In 1829 another life insurance company named the Madras Equitable began offering life insurance services in the Madras Presidency.

    This era was mainly dominated by foreign insurance companies because of the British rule in India. In the post-colonial era, the Indian Life Insurance act was passed , to end unfair trade practices, abolish principal agencies and nationalize insurance business in India.

    Why Should I Buy Health Insurance

    Top 6 Best Health Insurance Companies In India Indianable

    Here are some top reasons why you should buy a Health Insurance Policy.

    Hectic Lifestyle

    Nowadays, people are busy in their day-to-day life and typically, they dont havetime to look after their health concerns. The hectic lifestyle makes the body sufferfrom high levels of stress that can lead to serious health issues. In case you needmedical treatment, you should be covered by health insurance.

    Rising Medical Costs

    The medical treatments are becoming unbelievably expensive. 75% of Indian households arepaying medical bills out of their pocket. Innovation and development in the medicalarena have resulted in the cure for the majority of life-threatening illnesses.Treatment for such critical diseases carries enormous medical costs and thus are notaffordable to the common people. Treatment in private hospitals will cost you to theextent which will bring a quake in your financial stability.

    Effective Financial Planning

    Anybody may fall ill, and several medical treatments, especially a critical illnesscan obstruct you in achieving your financial goals. If you are not covered bymedical insurance, you need to pay the huge medical bills with money kept formeeting other financial objectives like buying a car or a new home. If you are theonly income earning member of the family, it becomes imperative to get yourself ahealth insurance at the earliest.

    Peace of Mind Guaranteed

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    What Has Been Your Biggest Setback So Far

    We are too early in our journey so this is a hard question. What were trying to accomplish is very difficult but very important, so there will, no doubt, be challenges coming our way.

    But we have an exceptional team with us who is ready to take these challenges head on. We are also fortunate enough to be backed by some of the most exceptional investors in the world including Khosla Ventures, Founders Fund , Lachy Groom and other investors and operators including Nikesh Arora , Kunal Shah Nithin Kamath Tom Stafford .

    What Is Not Included In My Health Plan

    Following are the conditions/exclusions that are not included in your Health Plan.

    Pre-existing conditions: Any illness that had symptoms or received medical treatment during3 months after commencement of the first policy.

    First 30 days: You cant claim for the first 30 days from the commencement of the healthpolicy. Accident injury claims, however, dont require a waiting period.

    First year of cover: During the first year of your policy, some specific illnesses are notcovered include Cataract, Hydrocele, Hysterectomy, Fistula in anus, Benign prostatichypertrophy, Sinusitis, and Congenital Internal diseases.

    Cost of contact lenses, hearing aids, and specs.

    Cost of contact lenses, hearing aids, and specs.

    Convalescence, congenital external defects, the use of intoxicating drugs / alcohol,intentional self-injury, general debility, expenses for diagnostic tests related to thedisease for which the insured has not been hospitalized.

    Pregnancy or childbirth related treatments.

    Naturopathy treatment.

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    Oope And Financial Protection

    The mean OOPE for utilizing hospital-care in private sector was many times larger than in public sector. This was true for the PFHI-enrolled and also for the non-enrolled in PFHI . The mean OOPE was similar for the PMJAY-enrolled and for the non-enrolled in PMJAY.

    Table 5 Descriptive findings on OOPE and CHE25 under different PFHI schemes

    Median OOPE in the private sector was many times greater than in public sector . According to descriptive findings, median OOPE in private hospitals for the PMJAY-enrolled was 17% lower than for the non-enrolled in PMJAY.

    What Are Health Insurance Plans

    Roadmap of Health Insurance in India [Digitization in Health Insurance Industry]

    A health insurance plan is a contract between the insurance company and the policyholder in which the insurer offers financial coverage for the healthcare expenses as mentioned in the policy document, for a specific period of time, as chosen by the insured. In India, there are a variety of health insurance plans that offer different features and coverage benefits.

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    Health Insurance Perspective In India

    Left with no stone unturned, the health insurance sector gaining popularity in India. At present, health insurance is one of the emerging sectors in India. Different stakeholders of this ecosystem, such as private health insurance companies, IRDAI, and other entities, are thriving each day to come up with the best health insurance policy for every citizen. Indians become the most active and engaged customers when it comes to health insurance. After pandemic, buying cashless health insurance online is a new normal. This increasing attention and awareness are due to rising medical inflation, advancements in medical sciences, pandemic, and critical illnesses. The availability of health insurance covers for senior citizens, maternity, and children, also popularizing medical insurance. Thus, the Indian Health insurance market has come up with lucrative growth avenues and opportunities for companies and customers.

    About Care Health Insurance

    About Care Health Insurance

    CHI is a specialized health insurer offering health insurance services to employees of corporates, individual customers, and for financial inclusion as well. With its operating philosophy being based on the principal tenet of consumer-centricity, the company has consistently invested in the effective application of technology to deliver excellence in customer servicing, product innovation, and value-for-money services.

    Copyright. Care Health Insurance

    Copyright. Care Health Insurance

    Understanding And Awareness Of Public Regarding Insurance

    Recent reports suggest that public awareness and understanding of health insurance in India is poor. However, general public awareness of health insurance in Kerala and in some other parts in India is increasing as a result of the efforts of private health insurance agents. Lack of necessary education and culture are perceived as barriers due to which people have difficulties in managing money and health and difficulty in learning this new technology. Poor and less educated people residing in both the rural and urban areas, consult private practitioners more than government practitioners and spend about twice as much on treatment from them than from government practitioners. This thing has led to the deepening of poverty in both rural and urban areas, pushing the millions of people into poverty each year. According to recent surveys and field works carried out in India, understanding of the entitled benefits and privileges remains confusing not only to the poor and illiterate people but also to the educated middle class citizens. This could be due to promotional languages of the insurance sellers that is difficult to understand for the general public belonging to different educational backgrounds.

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