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Health Insurance Companies in India – A Comparative Study Pranav S., Post-Graduate Student, MBA - Insurance Management =================================================================== Language in India www.languageinindia.com ISSN 1930-2940 Vol. 13:4 April 2013 =================================================================== Abstract My research is aimed at understanding the Health Insurance sector in India and flagging issues relating to competition in this sector. This report provides a broad direction for India’s health sector in the coming years. In doing so, it describes India’s achievements with regard to the three key goals of health policy - improvement in health status, financial health protection and equity. The role of both public and private institution in provision of such services is studied in the overall context. The focus is to analyze the status of health in India, and is done by bringing together data and analysis from government documents, health economics and mainly from health insurance company websites and a host of other sources. The study mainly focusing on the health insurance sector in India, and the comparative study on different companies who providing health insurance, based on their products and plans. Introduction The health care system in India is characterized by multiple systems of medicine, mixed ownership patterns and different kinds of delivery structures. It is interesting to note that although compared to other countries in the Asian continent, Indians are heavy users of health care services (about 5% of GDP being spent on healthcare, 80 percent of which is private expenditure). Health insurance in India is not yet that popular. In fact, health care market is almost untouched, with only 3.4 to 3.5 million members covered. Health Insurance Heath insurance, which is being provided mainly by the general insurance companies, is a segment with great potential for growth because of greater health consciousness and increasing risk in the wake of faster phase of life, environmental pollution, etc. The increasing pollution levels are taking a toll in terms of the health of a large portion of the pollution, especially residents of metropolitan cities. These phenomena have made many people susceptible to

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

136

respiratory diseases of one kind or the other.

The Indian Healthcare Industry The Indian healthcare industry is expected to reach US$ 280 billion by 2020 on the back of increasing demand for specialized and quality healthcare facilities. Further, the hospital services market, which represents one of the most important segments of the Indian healthcare industry, is expected to be worth US$ 81.2 billion by 2015 Health Insurance – A Limited Market in India Health insurance in a narrow sense would be ‘an individual or group purchasing health care coverage in advance by paying a fee called premium. The health insurance market in India is very limited covering about 10% of the total population. Health insurance expenditure in India is roughly 6% of GDP, much higher than most other countries with the same level of economic development. Of that, 4.7% is private and the rest is public. In private insurance, buyers are willing to pay premium to an insurance company that pools people with similar risks and insures them for health expenses. The key distinction is that the premiums are set at a level, which provides a profit to third party and provider institutions. Premiums are based on an assessment of the risk status of the consumer (or of the group of employees) and the level of benefits provided, rather than as a proportion of the consumer’s income. In the public sector, the General Insurance Corporation (GIC) and its four subsidiary companies (National Insurance Corporation, New India Assurance Company, Oriental Insurance Company and United Insurance Company) and the Life Insurance Corporation (LIC) of India provide voluntary insurance schemes. Health Insurance Claim Settlement Health insurance claim settlement has been calculated using the following formula Health insurance claim settlement ratio = (total claims - claims rejected) % Table: 1 (Claim Settlement Ratio) Insurers Apollo Munich Bajaj Allianz

Claim Settlement Ratio (%) 76* 84

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

137

Bharti AXA Chola MS Future Generali HDFC ERGO ICICI Lombard IFFCO-Tokio Max Bupa Oriental Insurance Reliance General Royal Sundaram Star Health New India Assurance United India Assurance

65 62 79 73 65 46 65* 92 73 93 61* 89 78

*Stand alone health insurance companies The health insurance claim settlement ratio of the insurers in 2011 is given above. Companies Providing Health Insurance Product

Table: 2 General Insurance Companies

Life Insurance Companies

Health insurance

1

Bajaj Allianz General Insurance Co Ltd

Life Insurance Corporation of India

Appolo DVK Insurance Co. Ltd.

2

Bharti Axa General Insurance Co. Ltd.

Aviva Life Insurance

Max-Bupa Health Insurance Co Ltd

3

Cholamandlam MS General Insurance Co. Ltd

Birla Sun Life Insurance

Religare Health Insurance Company Limited

4

Future Generali Indua Insurance

Bajaj Allianz Life Insurance Co Ltd

Star Health and Allied Insurance Co. Ltd.

5

HDFC Ergo Genral Insurance Co Ltd ICICI Lombard General Insurance Co. Ltd. IFFCO Tokio General Insurance Co. Ltd.

Bharti AXA Life Insurance Co Ltd Future Generali India Life Insurance Company Limited HDFC Standard Life Insurance Company Ltd.

6 7

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

138

8

National Insurance Co Ltd

9

Reliance General Insurance Co. Ltd.

10

Max Life Insurance Co. Ltd.

13

Shriram General Insurance Company Limited Royal Sundaram Alliance Insurance Co. Ltd TATA AIG General Insurance Co. Ltd. The New India Assurance Co. Ltd.

14

The Oriental Insurance Co. Ltd.

15

United India Insurance Co. Ltd. Super Top Up

Star Union Dai-ichi Life Insurance Co. Ltd. TATA AIA Life Insurance Co. Ltd.

16

Universal Sompo General Insurance Co. Ltd.

11 12

ICICI Prudential Life Insurance Co. Ltd IDBI Fortis Life Insurance Co, Ltd.

MetLife India Insurance Co. Ltd. Reliance Life Insurance Co. Ltd SBI Life Insurance Co. Ltd.

Types of Health Insurance Plans Table 3

Bajaj Allianz General Insurance Co Ltd

Individual Health Insurance Plan

Family Floater Health Insurance Plan

Critical Care Health Insurance Plan

 





Health Guard Hospital Cash





Bharti Axa General Insurance Co. Ltd.



Smart Health Individual Policy

 

Family Floater Health Guard Insta Insurei Family Floater Policy for Rs 1 Lacs Star Package

Smart Health  Essential Insurance Policy Smart Health High Deductibles

Critical Illness

Group Health Insurance Plan  Group Health Guard 

Group Critical Illness

Smart Health

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

139



Insurance Policy Smart Health Insurance Policy.



Family Health.

Cholamandlam MS General Insurance Co. Ltd Future Generali India Insurance Co.Ltd. HDFC Ergo Genral Insurance Co Ltd ICICI Lombard General Insurance Co. Ltd.



Individual Health



Health Suraksha



Health Suraksha 

Health Suraksha



Critical Illness





Health Advantage Plus



Family Floater Health Insurance



Critical Care



IFFCO Tokio General Insurance Co. Ltd. National Insurance Co Ltd



Individual Medishield



Swasthya Kavach



Mediclaim Policy



Parivar – Mediclaim for Family Star National Swasthya Bima Policy BOI National Swasthya Bima



Critical Illness Policy



Reliance  Critical Illness Policy

 

Reliance General Insurance Co. Ltd.



Individual Mediclaim



Reliance Health Wise Policy

Royal Sundaram Insurance Co. Ltd.



Health Shield Individual Insurance



Health Insurance for Individuals and Family Health Shield Online





Group Health



Group Health Policy Group Health Insurance Group Mediclaim Insurance Policy

 Critical Illness Policy

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

Reliance Group Mediclaim Insurance Policy

140

Tata AIG General Insurance Co Ltd



Maharaksha



The New India Assurance Co. Ltd. The Oriental Insurance Co. Ltd.



Mediclaim



Individual Mediclaim Policy



United India Insurance Co. Ltd. Universal Sompo General Insurance Co. Ltd.



Mediclaim Policy





Individual Health



Health Care Plus Policy

Life Insurance Corporation of India



Health Protection Plus Health Plus

Aviva Life Insurance Bajaj Allianz Life Insurance Co Ltd Bharti AXA Life Insurance Co Ltd HDFC Standard Life Insurance Company Ltd.





 

Happy Family floater Health Insurance/Policy Wording Family Medicare Policy India

Aviva Life Shield Plus Family Care First Easy Health



Aapat Suraksha Bima Policy



Aviva Health Plus



Swasthya Sanjeevani HDFC Critical Care Plan HDFC Surgicare Plan

 

ICICI Prudential Life Insurance Co. Ltd. Max Life Insurance Co. Ltd.

Criticare



Health Saver, Medi Assure



Crisis Cover



Life Line Healthy Family Plan



LifeLine Wellness Plan

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study



Group Multi Guard



Group Mediclaim Policy



Mediclaim Policy



Group Health Insurance Policy

141

 



MetLife India Insurance Co. Ltd. SBI Life Insurance Co. Ltd.

Met Health Care



Met Health Care



SBI Health Product Group Schedule of Critical Illness





TATA AIA Life Insurance Co. Ltd.



Apollo Munich Insurance Co Ltd



Easy Health Individual

Star Health and Allied Insurance Co. Ltd.

  

Medi Classic Medi Premier True Value

LifeLineSafety Net Plan Lifetime Wellness Plus Plan

Life Health Investor Life Health Protector 



Family Health Optima.



Group Health Insurance

Star Criticare Plus

Individual Health Insurance Plan Individual Health Insurance Plan is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Individual Medical Insurance Policy is a policy where each of the insured members is entitled to the entire amount separately. The Individual medical insurance Policy is great for older families and when the health risk is more. There are no age restrictions on the maximum age for the members for renewable. You can avail the benefits of Loading and Discounts until the policy lapses. Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study 142

Family Floater Health Insurance Plan Family floater means cover for family. It is same as insurance for family. The family could include two members or more. According to the number of family the premium amount will increase. Critical Care Health Insurance Plan Critical Care or critical illness is an insurance product, where the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed in the insurance policy. The policy may also be structured to pay out regular income and the payout may also be on the policyholder undergoing a surgical procedure. Group Health Insurance Plan Group Health Insurance Plan is an insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the major benefits offered by many employers. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group. Group health insurance plans usually cost less for participants than individual plans that offer the same benefits. This is because the risk is spread over the entire group, rather than one person. Conclusion Everyone should be covered by some form of health insurance. People are always vulnerable to injury and illnesses from their everyday activities. Whether it is an individual plan or employeror government-sponsored coverage, having health insurance is better than not having it at all. Millions of Americans are uninsured in part due to high premium costs. Many are forced to pay these high health costs out of pocket, which can create more problems medically and financially. Indian Health insurance or medical insurance sector has been growing, since the country's economic reforms. The reason why mediclaim insurance, has grown is that it ensures good medical care from reliable health care institutions. With numerous companies offering health insurance and with a variety of health insurance plans on the offer it’s hard to decide which plan you should go for. This is the study for finding which plan fits your needs the best. This competitive market means that you will need to compare policies to find the best health insurance policies or the best medical insurance plans.

================================================================== References Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

143

1. Ajay Mahal, Bibek Debroy & Laveesh Bhandari (2010) India Health Report, BS Books, New delhi 2. IRDA Annual Report 2011-2012 3. P.S. Palande, R.S. Shah & M.L Lunawat (2003) Insurance in India- Changing Policies and emerging opportunities, Response Books, New Delhi 4. www.ibef.org/industry/healthcare-india.aspx 5. www.wikipedia.org ================================================================== Pranav S., Post Graduate Student MBA - Insurance Management Pondicherry University – Karaikal Campus Karaikal 609605 Union Territory of Puducherry India [email protected]

Language in India www.languageinindia.com ISSN 1930-2940 13:4 April 2013 C. Subburaman, Ph.D. (Ed.) Health and Medical Care Services: Claims on National Resources Pranav S., Post-Graduate Student, MBA - Insurance Management Health Insurance Companies in India – A Comparative Study

144

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Health Insurance Companies in India – A - Language in India

Health Insurance Companies in India – A Comparative Study Pranav S., Post-Graduate Student, MBA - Insurance Management ===============================...

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