...amount of health coverage is the Indemnity Plan. Indemnity type of health insurances indemnifies the beneficiary from financial costs associated with health care. The main aspect of indemnity health insurance was coverage for illness not necessarily for prevention or wellness. The insurance company would decide the maximum amount of billing charges and the provider was able to bill the beneficiary anything the insurance did not pay for. In some cases, the insurance company would pay the beneficiary and the beneficiary would have the responsibility of paying the provider. On the other side of the spectrum is Health Maintenance Organizations. Health Maintenance Organization is a type of managed care organizations that provides a form of health insurance coverage that is fulfilled in hospitals, doctors, and other providers under contract. HMO is basically having the beneficiary pay for their coverage in advance rather than paying for each health services. Initially, the beneficiary would have to pay a price of a monthly premium and then HMO will offer a range of benefits from preventive care to full coverage. The main difference between HMO and PPO is the freedom of choice. HMO allows you to see doctors only within the HMO’s network but with PPO you can choose to see any doctor you wish but the coverage will result in higher out-of-pocket costs like copays and coinsurance. In the middle, Preferred Provider Organizations (PPO) are contracted between employer health benefit plans...
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...Pre-launch Survey Report of Insurance Awareness Campaign SPONSORED BY Insurance Regulatory and Development Authority © National Council of Applied Economic Research, 2011 All rights reserved, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publisher. Published by Jatinder S. Bedi, Secretary & Head, Operations, for and on behalf of the National Council of Applied Economic Research, Parisila Bhawan, 11, Indraprastha Estate, New Delhi–110 002 Printed at M/s. Multiplexus (India), Delhi. Email: multiplexusindia@gmail.com Study Team Project Leader Anushree Sinha Core Research Team Rajesh Jaiswal Barun Deb Pal Kalicharan Shukla Consultant Ramamani Sundar Geetha Natesh Technical Support Sadhana Singh Contents List of Tables List of Annexure Tables Foreword Preface Acknowledgements Chapter 1: Background 1.1 Concept of Insurance 1.2 Importance of Insurance 1.3 Origin of Insurance 1.4 Origin and Development of Insurance in India 1.5 Important Developments in the History of Indian Insurance Business 1.6 Insurance Scenario in India and Other Countries 1.7 Insurance Penetration and Density in India 1.8 Why Awareness is Important Chapter 2: Methodology 2.1 Coverage 2.2 Sample Design 2.3 Selection of the Rural Sample 2.4 Selection of the Urban Sample Chapter 3: Socio-Economic...
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...than some of my peers. Having a family I feel makes it that much more important because you have more than just yourself to look after for years to come. I think I would love to discuss how important it is to have great health insurance coverage. It might be a hard thing to talk to them about but I feel like through my personal experiences and hardships I could get them to relate to me. If I would had have health insurance I would not had to file for bankruptcy years ago. Health issues can really can add up quickly and put someone in a hole financially. I feel that one of the most important steps for adults to understand is how they can work towards saving for retirement. There are so many ways that someone can plan towards a retirement, cutting expenses is one way that I have learned in this chapter. I have found just by cutting a few daily habits such as going to starbucks every morning and replacing that with having coffee at my house can save so much. If you can find multiple things to save on each week while putting that money into a savings or a safe mutual fund it can add up quickly. Another topic I feel that is important is all of the different types of insurances that are provided for every aspect in life. I learned about so many different insurances that I had no clue on that I am going to use in my future. Through out this chapter I have made some changes for my financial planning as each week goes by. One...
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...the three types of health insurance in the U.S. The three main types of insurance in the United States include the Individual Health Insurance, Group Insurance and State Sponsored Insurance. The Individual Health Insurance policies allow the policy holder to hold health coverage on themselves, their spouse and dependants. It is usually more expensive that other insurances offered however. This type of insurance is tax deductable. With this type of insurance you are able to choose the coverage needed for your lifestyle. As long as the policy holder pays the premiums due they do not run the risk of prices going up as in group health insurance where the employer has the ability to pick and choose what coverage’s they are willing to use on their plans offered to the employees. The Group Insurance is offered to employees at a rate the employer chose. The insured can choose coverage for themselves or for family coverage. The benefits can include a lesser cost insurance since the employer pays a portion of the costs, better coverage in health care needs and the insured and their family members will not be excluded due to preexisting conditions. The last of the three is the State Sponsored Insurance which includes Medicare and Medicaid coverage for low income families and senior citizens. This coverage is usually a free insurance or low cost that covers 100% of health care needs and medications. Describe the three methods for categorizing of health insurance in the U.S. Indemnity...
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...to seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; • Medicare alludes to a federal health insurance program that covers individuals...
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...seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; * Medicare alludes to a federal health insurance program that covers individuals...
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...Health Insurance Guide Health Insurance Guide * What is health insurance? * How does health insurance work? * What are the different kinds of health insurance? * Individual mediclaim policy * Floater Policy * Critical illness policy * Overseas mediclaim policy * Student medical insurance * Tax saver * So, what kind of coverage can I get? * Accidental death benefit * Permanent and total disability cover * E opinion rider * Children's education allowance * How much does health insurance cost? * The no of people to be covered * Amount of coverage needed * Age of the oldest family member who is proposed to be covered * Can I get tax benefits with health insurance? * Are there any alternatives to health insurance? * Critical illness benefit * Hospital cash benefit * Things to watch out for What is Health Insurance ? Health Insurance also known as Mediclaim in India provides you the cover against the medical care costs arising from disease or accidental injuries. Health insurance is a crucial financial product that every individual must have irrespective of their age. It allows you to focus on getting the best treatment without bothering about the financial costs of the same. Depending on the terms of the health insurance policy it covers all or part of the medical costs of treating the disease or injury including doctor's...
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...Why do we need the health insurance industry? Need for health insurance The health insurance industry (XLV) mainly provides a risk management tool for an individual. People cannot predict the extent and timing of their future healthcare expenses. By paying regularly for health insurance, people can get protection against financial losses resulting from high health care expenses. It also enables them to better manage their cash flows as most health insurance plans specify the maximum amount an individual will need to pay in excess of the charge paid for buying the insurance, in a calendar year. Risk pooling According to study by the Congressional Research Service, the top 5% of the total population accounted for about 50% of the health expenses in 2011 and 2012. This uneven distribution of spending forms the basis of risk pooling, where people contribute an amount of money, at least equal to the per capita cost of medical services, expected to be used by the group of insured people. Risk pooling in insurance is essentially a cross-subsidy paid by low-risk members to high-risk members of the insurance plan. The above diagram shows that the performance of healthcare system or the efficiency of health insurance and effectiveness of risk pooling increases as the size of the group increases. However, the benefit of reduced risk resulting from the increasing size of the insured population reduces as the size increases a certain optimal size, S*. As size increases, the probability...
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...Health Insurance- Blessing for people with busy life The word insurance truly mentions security. Security against life, health, family,vehicle,homes, shops,etc. In earlier years, there was no need to this kind of thing for the protection. I am talking about days of our grandfathers or may be even before that. The life was so great and slow, nothing to worry about any future, would involve in their daily occupational jobs like farming and living life in their own way. But it is said that nothing is permanent. The time has change now. Today we live in a much advance world. The change is faster than time. The daily routine got so much fix that we cant even take out some time to enjoy. People work in office as well as in home too. Social life is like getting extinct from their life. No time to eat even hygienic food on time. Just grabs some cafeteria served items and forget about its effects. As “no time” kind of thing ruling our life. We almost neglect our health and when any weird kind of stuff happens! Doctor is the second word that comes in our mind. First is the expense if the condition got severe. We can’t change this situation, neither can we escape from it. We have to work, look at our family and their future, about your dreams, and so to earn this, we have to get a job that offers salary far from your expectation but if salary is well then the work load will also be high. In fulfilling your daily task, you forget about your health! So it’s better to have an insurance...
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...HEALTH Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners. HEALTH CARE SCENARIO Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line. Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country. CG: Central Government PH: Primary Health MCH: Maternal and Child Health. • Access to health care service providers and availability of physicians is one part of the...
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...Adam Thompson Bryant & Stratton Research and Writing II - ENGL 250 – 551 Dr. Sharma July 26, 2014 Insurance is a two-way legal agreement between the insurer and the customer. The customer, which may be an individual, business, or other entity, agrees to pay the premiums as required, in exchange for monetary protection from the insurer for any possible substantial loss. Customers usually obtain insurance, not to cover the trivial incidents of life or business, but to cover the potential significant losses which could be a financial hardship for them. The premiums of all customers of the insurance company are pooled together. The insurance applies statistical analysis to determine the chance that a particular event might occur to one of their customers. From this analysis they can determine the premiums which must be collected and the claims. Insurance is a very important part of modern life and business. Three health insurance companies: Healthspan, Anthem Blue Cross Blue Shield and Apex. Breaking down plans and talking about what they cover, how much they cost and where they are accepted and attempt to answer the age old question “Is people’s healthcare better depending on how much one pays?” All these packages are based on someone who makes $25,000 per year and only looking to cover just them. The prices also change depending on when they want their insurance to start and if they have to prorate for the previous month and also if the clients are a tobacco user or not...
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...After a year of prepare Maryland health insurance exchange system collapsed in the same day when it was launched. In this case of Maryland Insurance Online site no clear chain of command contributes to the disaster. There were three main leaders in the project: Maryland Health Secretary, Human Resources Secretary and Exchange leader, however, lacking of clear leadership these three leaders together actually couldn’t make decisions efficiently. Therefore, in the leadership team no clear internal understanding could help to set the project a direction. They fight against each other and therefore not only waste time but negatively affect their lower level staff in morale, trust etc. A second reason that account for the failure is inadequate vertical and lateral communication and coordination. In the top three-people leadership team there was no clear communication between each other. Thus they couldn’t actively support and participate in achieving a direction for the project progress. Vertically, as we know within the exchange the leader kept jostling with the project manager for day-to-day control. It shows a lack of communication, trust and coordination, because the leader actually didn’t support the manager’s daily work. Laterally, poor communication existed among the contractors hired to build the website. After a period of work, dispute actually became a major distraction for the project. Lack of human resources is another major reason. When started the exchange team...
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...have a better and secured future, in this direction life insurance services have its own value in terms of minimizing risks and uncertainties. Indian economy is developing and having huge middleclass, Societal Class and salaried persons. Their money value for current needs and future desires helps in generating the reason behind holding a policy. Insurance: in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss. An insurer: is a company selling the insurance; an insured Policyholder: is the person or entity buying the insurance. The insurance rate: is a factor used to determine the amount to be charged for ascertain amount of insurance coverage, called the premium . | HEALTH INSURANCE The term Health Insurance is used to describe a form of insurance that pays for medical expenses. It is used more broadly to include insurance that covers disability or long-term nursing or custodial care needs. In simple words, if you are covered under Health Insurance, you pay some amount of premium every year to an insurance company and if you have an accident or if you have to undergo an operation or a surgery, the insurance company will pay for the medical expenses. HISTORY ...
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...BASIC HEALTH INSURANCE KNOWLEDGE What is health insurance? Health insurance is a mechanism whereby the community finances healthcare in an equitable manner. All the members in the community contribute a small amount towards an insurance fund, which is then used to meet the specific healthcare costs of the contributors. Usually the contribution and the benefits are limited for a period of one year. Why Health Insurance? Medical expenses are sky high these days. An appointment with a doctor might churn out big bucks. The elaborate medical treatment medical expenses could eat into your savings meant for the future. Health insurance policy kicks in to ensure that you get the required treatment and your pocket is still under control. Having health insurance is important because the coverage helps people get timely medical care and improve lives and health. It covers the risk of financial difficulties in the event of long illness. The awareness has been enormous in the last couple of years. This must have been in response to the series of uncertainties people have observed in recent times like the terror attacks. BENEFITS: Benefit depends on the policy you choose and the coverage it provides. Here is a list of basic coverage provided by most of the health policies. 1. It helps securing a better future by paying a fraction as an expense today called the premium. 2. It reduces saving huge amount of financial losses...
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...Health Insurance Basics: Key Words and Phrases You Need to Know Shopping for insurance can be confusing, but the new health care law makes it easier to understand. This simple guide will help you make smarter choices for you and your family. KEY WORDS AND PHRASES What You Pay There are different costs associated with health insurance. When choosing a plan, it is important to take into account all of the costs for each plan. Premium The money you pay the insurance company to buy the plan. You usually pay this monthly or every pay period. If you get coverage through your job, your employer may also pay a part of the premium. Deductible $ The amount you have to pay for your $ health care each year before your $ insurance starts paying for care. Similar to car insurance, many health plans require you to pay a certain amount “out of pocket” before their coverage kicks in. For example, if your deductible is $300, you have to pay the first $300 of your medical costs yourself before the insurance starts paying. In some plans, the deductible applies only to services that you get outside their “provider network.” Also, some plans have a separate deductible for prescription medications. Usually, the deductible does not apply to preventive services. KEY WORDS AND PHRASES What You Pay Copay/Co-insurance The money that you may have to pay “out of pocket” for each service you receive. This could include an office visit with a doctor...
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