Resumo de Health Insurance

Health Insurancemedical expenses are easier to bar with innovative schemesHave you ever had to pay through your nose for an angioplasty your ailing father had to undergo? Or expecting your first child, but cannot revel as you are concerned about the exorbitant cost of a caesarian delivery? Health care costs have sky rocketed like nobody?s business. A simple surgery, like appendicitis, could cost you anything from Rs. 15,000 to Rs. 30,000., depending on the hospital. For a bypass surgery, be prepared to shell out Rs. 2 lakh at least. Many hospitals across the country offer top- end facilities. Moreover, the fees of specialists are very high. These factors contribute to burning a hole in your pocket.Though the insurance industry has revamped itself over the last decade, an area that remains largely untapped is the health insurance. A study showed that 50% of the average Indian?s annual expenditure is spent on health care. Forty per cent of those hospitalized have had to borrow money or sell their assets to meet medical expenses.There is an increased awareness about health insurance among the middle income class as well as senior executives today. The major benefit of the health insurance is that, apart from managing sudden expenses in case of medical exigencies, they also get income tax benefits on the premiums paid as per section 80 D of the IT act. Third Party Administrator (TPA)A welcome development in the health insurance sector is the emergence of third party administrator (TPA) or health care management organizations. During medical emergencies, going through the motions of paying bills and lodging claims is a traumatic experience. This is where the TPA steps in. Licensed by the Insurance Regulatory and Development Authority, TPAs are nodal agencies operating between the insurer and the service provider, namely hospitals and nursing homes. There are 20 licensed TPAs in our country.The basic function of the TPA is claim management and back office support to the insurance company. When a person buys a medical insurance policy, the insurance company passes on his details to the TPA, which issues a photo identity card to the member. Cashless service can be availed at select hospitals by those who opt for the provider claim. In the case of member reimbursement claims, the bills have to be paid before a claim is lodged for reimbursement.Family Health Plant (FHPL) Family Health Plant (FHPL) part of the Apollo group, offers Third Party Administrator (TPA) service backed by an insurance company as well as for self funded schemes. Under the self funded scheme, FHPL creates a fund from money collected from its members. TPAs also value add their services. Some TPAs work out arrangements with hospitals to offer special rates to their clients. Some TPAs have a 365 day call centre that provides information about hospitals, ailments, explains whether the claim will be honored, etc.Apollo, which has been granted a TPA license, is forging ties with Allianz Bajaj and Prudential ICICI and has already tied up with LIC (Life Insurance Co operation) and GIC. Other prominent players in the field are Paramount Health Care and TTK Health Care.Health insurance companies do not cover certain ailments, known as ?exclusion?. Some exclusions are diseases the person had at the time of proposing the insurance or an illness that commences in the first thirty days of the policy?s inception. During the first year of the policy, treatment for certain ailments is not covered.While the core products are the same, companies package their offers with attractive frills. Cholamandalam reimburses medical expenses incurred sixty days prior to hospitalisation, which, they claim, is the longest time period offered by any such policy. You get cash fee hospitalisation in more than 1,400 hospitals in India. The policy pays for medical expenses related to the hospitalisation up to 90 days after discharge. Over 130 minor surgeries that require less than twenty four hours hospitalisation are also covered.Royal SundaramRoyal Sundaram offers Health Shield for the insured, the spouse, children and dependent parents. There is a family discount for ten per cent. You can access your families medical history and information about hospitals, illnesses and medicines online. ING VyasaING Vyasa, a TPA has a comprehensive lifestyle protection plan called conquering life. Its critical illness cover - upto fifty per cent of the sum assured - is offered up to a maximum of Rs. 20 lakh to those diagnosed with any one of ten specified critical illnesses. ICICI Lombard offers a critical insurance plan that provides cover against specific illnesses.TATA AIGSTATA AIGS health first provides a lump sum alliance, irrespective of the actual medical expenses. United India s medi claim covers both pre hospitalisation ( upto 30 days) and post hospitalisation (for sixty days) expenses. It recently launched the medi care policy - with less premium and restricted hospitalisation benefits - to help the lower - middle class.New India AssuranceIn January 2004, New India Assurance announced the health plus medical expenses policy for individuals and corporate clients. It covers reimbursement of hospitalisation expenses only and allows for treatment abroad on payment of additional premium.

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