m Requirement of people over 45

m Getting claim is difficult

m Money goes waste when young
m Benefit hospitals then holders
m Uncertainty about benefits
mRising medical costs
mSharing of health related risk
muncertain hospital bills
mExpensive/quality health care services
mFamily health insurance
mTax benefit
mProductivity of workforce
mRemoves some of the burden from the state
mKeeping pace with the customer needs while achieving
profitability
m RDA- regulator
m nsurance companies
m Customers

m Government

m TPAs

m NGOs/MFs

m Health provider
 Total Expenditure On Health As % Of Gross Domestic Product

15.30%
16.00%
14.00%
12.00% 10.00%
8.70%
10.00% 8.20%

% 8.00%
4.60%
6.00% 3.60%
4.00%
2.00%
0.00%
AUSTRALIA CANADA CHINA INDIA UNITED KINDOM USA
m Regulator/Government
º Enhance customer awareness
º Enhance client confidence - real value benefits in the event of a claim
º Effective supervision
º Compulsory percentage of total business towards health
º Compulsory savings towards health
º Tax incentives to employers for promoting group health coverage

m nsurer
º Clients confidence - warrantable claim will be paid out in a reasonable time
frame
º New clients have to be reached
º Value for money
º Design products as per clients needs
º Product transparency
º Cost efficiency
º affordability
º Wellness programmes
m Committee to formulate regulations

m Pure health insurance products

m Allowing the formation of an stand alone health insurance

company

m Standalone health insurance companies

m Renewability

m Senior citizens
( _ack of Data
( Moral Hazard/Adverse Selection
( Complex nature of the product
( Medical nflation
( New treatments
( Unnecessary treatments
( Difficulty in pricing
( Government provision of health care
( _ong term nature
( Changing life style
( Mis-selling/fraud««
( nsurer
º Designing a less complex products
º Transparency in the product features
º Clarity in policy terms, conditions & exclusions
º Efficient back-office support for underwriting and
claims processing
º Higher Reinsurance
º Need for quicker services. Eg: Toll free no.s, cashless,
quick response
º Expense analysis on a regular basis
º Product innovation
º Efficient training of sales force
m Policyholder
º Pay attention to policy conditions
º Read the exclusions and limitations very carefully
º Compare premium costs, deductibles, co-payments
º Take an informed decision

m TPA
º Proper infrastructure
º Speedy claim settlement process
º _ess paper work
m Regulator/Government
º Come out with health insurance regulations
º Centralized data base for health insurance experience
statistics
º Provider rating
º Cap on renewal premiums
º Ensure that a decent portfolio of health coverage represent
the rural sector
º Guard against ill effects of privatization
º Further tax incentives
º Compulsory savings towards health care
º Should emphasize the need to employ a
aa

 in
various aspects of life and non-life businesses
m Health nsurance - potential
to become a Rs.25000
crores industry by 2012.

m No. of Elderly People in

the Developing World will
TRP_E in 25yrs. (WHO)

m n ndia, the no. of people

above 60 yrs is about 8%
today, with that no.
expected to hit 21% by
2025. (Asia nsurance
Review)
m O
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