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No one should have to choose between medicine and other necessities. No one should have to use the emergency room every time a child gets sick. And no one should have to live in constant fear that a medical problem will become a financial crisis.
- Brad Henry |
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INDIA STANDS 145TH AMONG 190 COUNTRIES IN HEALTHCARE ACCESS AND QUALITY
Dated 23.05.2018 : Media reported today that India is ranked 145th among 195 countries studied by an international organization for healthcare and access . Report said that standing of India is much behind neighbouring countries like China ,Bangaladesh , Bhutan and Srilanka . However it is better than that of Pakistan , Nepal and Afghanistan .
Report also noted that the healthcare access in India has improved in last 25 years ( 1990 to 2016 ) from an index of 24.7 to 41.2 . In India , it is noted that states like Kerala and Goa has better healthcare access compared with national average while states of Uttar Pradesh , Assam are lagging behind .
We observe that access of healthcare has improved in India in last 15 years with improved medical facility and many states offering free healthcare or health insurance to the citizens at affordable prices . Case in point is Yashaswani in Karnataka . We have improved our medical facilities in many urban centers and such facilities are attracting many overseas patients on account of affordability compared with their own countries . But sadly such facilities are still not affordable to many Indians of middle class and poorer section . Unless one has sufficient insurance , many may not afford the medical facility they need .
Dated 23.05.2018 : Media reported today that India is ranked 145th among 195 countries studied by an international organization for healthcare and access . Report said that standing of India is much behind neighbouring countries like China ,Bangaladesh , Bhutan and Srilanka . However it is better than that of Pakistan , Nepal and Afghanistan .
Report also noted that the healthcare access in India has improved in last 25 years ( 1990 to 2016 ) from an index of 24.7 to 41.2 . In India , it is noted that states like Kerala and Goa has better healthcare access compared with national average while states of Uttar Pradesh , Assam are lagging behind .
We observe that access of healthcare has improved in India in last 15 years with improved medical facility and many states offering free healthcare or health insurance to the citizens at affordable prices . Case in point is Yashaswani in Karnataka . We have improved our medical facilities in many urban centers and such facilities are attracting many overseas patients on account of affordability compared with their own countries . But sadly such facilities are still not affordable to many Indians of middle class and poorer section . Unless one has sufficient insurance , many may not afford the medical facility they need .
FORTIS INCIDENCE - AN EYE OPENER
Dated 22.11.2017 : Newspapers / media reported that a girl named Ms Adya who was admitted to Fortis Hospital - Gurugram by her father Mr Jayant Singh recently for complications from dengue fever was billed by the hospital for more than Rs 16 lakhs for a treatment given for 15 days in ICU of the hospital . It is also reported that girl didn't survive in spite of costly medical treatment she got . Though the father had insurance for Rs 10 lakhs , he has to make arrangement for additional payment for the bill . It is reported that Haryana government will investigate the matter with regard to allegations of excess charges . The hospital authorities maintained that the entire treatment and billing was as per protocol .
As the news spread in the media , the eyes of media and public opened up on the prohibitive cost of private health care in India . We could hear debate ranging over various matters related to health care system in India . We analysed that major concerns raised were with following aspects of the health care .
1. Quality of public sector hospitals
2. Cost of private sector hospitals and a need to regulate them .
3. Ethics of corporate hospitals run on commercial mode and of doctors .
4. Role of governments in controlling hospitals
5. Regulations like KPME Act , though which Karnataka government is trying to regulate private hospitals .
The above aspects are very relevant these days and require deep debates and action by governments , doctors and hospitals . Collective action by governments , medical associations , hospitals and doctors may help the common man getting medical attention in a cost effective way . However ,as for as we are concerned , we individually have to take appropriate steps to safeguard ourselves against unforeseen medical calamity that may happen and the result of the same on our lives including financial disaster . While medical calamity make us lose our beloved ones , financial mess that may create may ruin the lives of living members of the family . We may take precautions in our daily life to save ourselves from health problems by changing our life style . But we may have to fight against accidents and unexpected diseases . Further we may have to ensure ourselves financially secure for any need in such situations . Some of the points below may be worth noting :
1. We are more and more dependent on private hospitals and doctors these days .
2. The cost of private health care is going up day by day . Take example of Fortis - Rs 16 lakhs for 15 days of treatment .
There is no guarantee that future costs will not increase .
3. We require either sufficient funds ear-marked for our medical contingencies or health insurance to cover our family .
4. The heath insurance we had taken 5 years ago for a"' LARGE " amount may or may not become sufficient now and may become very small part of expenses in future . Hence we may need our own additional funds for meeting expenses .
5. We may not have choice to select hospitals in emergencies as the patient has to be immediately rushed to a nearby hospital . Costs may be prohibitive there .
6 . Many hospitals do not share the cost aspect of treatment .
7 . At the end we may have to face a not so affordable large bill .
While paying for medical emergencies from our own funds or borrowed funds may cripple our finances , buying a health insurance policy may be more prudent . With tax rebate under section 80d of Income Tax act , it becomes more attractive . However before buying insurance , we need to assess our own family status , our income and affordability of paying premium by us . For full guide how to buy insurance cover , visit TIPS FOR BUYING HEALTH INSURANCE at the end of the page below .
Dated 22.11.2017 : Newspapers / media reported that a girl named Ms Adya who was admitted to Fortis Hospital - Gurugram by her father Mr Jayant Singh recently for complications from dengue fever was billed by the hospital for more than Rs 16 lakhs for a treatment given for 15 days in ICU of the hospital . It is also reported that girl didn't survive in spite of costly medical treatment she got . Though the father had insurance for Rs 10 lakhs , he has to make arrangement for additional payment for the bill . It is reported that Haryana government will investigate the matter with regard to allegations of excess charges . The hospital authorities maintained that the entire treatment and billing was as per protocol .
As the news spread in the media , the eyes of media and public opened up on the prohibitive cost of private health care in India . We could hear debate ranging over various matters related to health care system in India . We analysed that major concerns raised were with following aspects of the health care .
1. Quality of public sector hospitals
2. Cost of private sector hospitals and a need to regulate them .
3. Ethics of corporate hospitals run on commercial mode and of doctors .
4. Role of governments in controlling hospitals
5. Regulations like KPME Act , though which Karnataka government is trying to regulate private hospitals .
The above aspects are very relevant these days and require deep debates and action by governments , doctors and hospitals . Collective action by governments , medical associations , hospitals and doctors may help the common man getting medical attention in a cost effective way . However ,as for as we are concerned , we individually have to take appropriate steps to safeguard ourselves against unforeseen medical calamity that may happen and the result of the same on our lives including financial disaster . While medical calamity make us lose our beloved ones , financial mess that may create may ruin the lives of living members of the family . We may take precautions in our daily life to save ourselves from health problems by changing our life style . But we may have to fight against accidents and unexpected diseases . Further we may have to ensure ourselves financially secure for any need in such situations . Some of the points below may be worth noting :
1. We are more and more dependent on private hospitals and doctors these days .
2. The cost of private health care is going up day by day . Take example of Fortis - Rs 16 lakhs for 15 days of treatment .
There is no guarantee that future costs will not increase .
3. We require either sufficient funds ear-marked for our medical contingencies or health insurance to cover our family .
4. The heath insurance we had taken 5 years ago for a"' LARGE " amount may or may not become sufficient now and may become very small part of expenses in future . Hence we may need our own additional funds for meeting expenses .
5. We may not have choice to select hospitals in emergencies as the patient has to be immediately rushed to a nearby hospital . Costs may be prohibitive there .
6 . Many hospitals do not share the cost aspect of treatment .
7 . At the end we may have to face a not so affordable large bill .
While paying for medical emergencies from our own funds or borrowed funds may cripple our finances , buying a health insurance policy may be more prudent . With tax rebate under section 80d of Income Tax act , it becomes more attractive . However before buying insurance , we need to assess our own family status , our income and affordability of paying premium by us . For full guide how to buy insurance cover , visit TIPS FOR BUYING HEALTH INSURANCE at the end of the page below .
From a recent report of Sample Survey Office , it is revealed that 80 percent of Indians , who mainly rely up on private health care , do not have any medical insurance . The government has brought only about 12 % of population under health protection schemes like Rashtriya Swasthya Bima Yojana . In the absence of health insurance , 75 % of Indians use their hard earned savings while 18% have to borrow . In order to escape from financial gloom in the events of medical emergencies , one has to definitely require some form of Health insurance .
HEALTH INSURANCE - Basics
A Health Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
A Health Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
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Additional Benefits and other Riders
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
Exclusions
The following are generally excluded under health policies:
a. All pre-existing diseases
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prostatic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER HEALTH INSURANCE
In India, as per Section 80D of the Income Tax Act, a deduction is allowed in respect of the health insurance premium paid for up to Rs. 25,000 p.a when you buy health insurance in India for your family. For a senior citizen , deduction allowed is up to Rs 50,000 from the financial year 2018-19
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
Exclusions
The following are generally excluded under health policies:
a. All pre-existing diseases
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prostatic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER HEALTH INSURANCE
In India, as per Section 80D of the Income Tax Act, a deduction is allowed in respect of the health insurance premium paid for up to Rs. 25,000 p.a when you buy health insurance in India for your family. For a senior citizen , deduction allowed is up to Rs 50,000 from the financial year 2018-19
ISSUERS OF HEALTH INSURANCE POLICIES
Health Insurance policies are issued by specialised Health Insurance companies , Life Insurors as well as General Insurors .
To get the list and visit their websites , Click Here
TIPS FOR BUYING HEALTH INSURANCE
1. Various Insurance companies offer health Insurance Policies . But the terms , diseases covered and premiums vary . Hence first write down your needs like whether you have parents & children to be covered , Medical history of your family members , and the amount of coverage you require . Please remember the medical costs are increasing year after year and what looks like suffice today may not cover fraction of your requirement after 5 years . Hence keep cushion while having the amount fixed .
2. You check the hospitals in your city , especially which are convenient to you , are covered under cashless facility by TPA .
3. Compare the premiums from three or four insurance companies for the least . and you can find huge variation from company to company and chose the one which suits your budget and requirements .
4. Floaters policies covering all the members of your family are cheaper than taking individual policies and hence get a policy which can cover your family members .
5. Check whether premiums are kept at the same level as offered for at least for few years . Otherwise every year you will have to pay higher demanded premiums .
6. Check up to what your age the policy will cover . There are policies which cover up o maximum age of 80 years . Otherwise at the ripe age when you require insurance , umbrella of insurance would be removed .
7. Check towards the conditions on pre -existing diseases . Lesser period will be better .
8. If you have already covered by a health insurance policy taken by yourself or your employer and if you feel the amount covered is not sufficient , you may go in for a Top up Health Insurance or Super top up health insurance which will cover you beyond the amount covered by your initial policy .
9. Health Insurance policies get income tax rebates under SEC 80D . For details , CLICK HERE
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INSURANCE LIFE INSURANCE VEHICLE INSURANCE HOUSEHOLD INSURANCE
SMALL FINANCE BANKS PAYMENT BANKS UNIFIED PAYMENT INTERFACE BHARAT BILL PAYMENT SYSTEM
BHIM APP AADHAR