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TERM PAPER OF
BASIC OF PERSONAL
FINANCE
(OE175)
TOPIC: - HEALTH INSURANCE
SUBMITTED TO;-
MS. JASPREET KAUR
SUBMITTED BY : -
PRITI SINGH
REG.NO. 3440070133
B.TECH –BIOTECH (MBA)
ROLL NO. OE17511
ACKNOWLEDGEMENT
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I , priti hereby take the advantage to thank my teacher, Ms. JASPREET KAUR
for assigning me such a wonderful topic for my term paper& extending meconsistent help, support & guiding throughout the project.
Also, I will like to thank my friends for aiding me with the requisite materials &
information for my project.
My immeasurable gratitude to my roommates & my parents cannot be expressed
in words for the support they have provided.
PRITI SINGH
TABLE OF CONTENT
INTRODUCTION…………………..3
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HISTROY…………………………..3-4
WORKING…………………………4-5
POLICES…………………………..5-7
COMPANIES...…………........................7-24
• ICICI LOMARD
• BAJAJ ALLIANZ LIFE INSURANCE
• THE NEW INDIA ASSURANCE COMPANY LIMITED
• NEW INDIA INSURANCE LTD
NEW POLICY………………………24-26
CONCULSION……………………….26
REFRENCES…………………………27
INTRODUCTION
Health insurance like other forms of insurance is a form of collectivism by means of which
people collectively pool their risk, in this case the risk of incurring medical expenses. The
collective is usually publicly owned or else is organized on a non-profit basis for the members of
the pool, though in some countries health insurance pools may also be managed by for-profit
companies. It is sometimes used more broadly to include insurance covering disability or long-
term nursing or custodial care needs. It may be provided through a government-sponsored social
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insurance program, or from private insurance companies. It may be purchased on a group basis
(e.g., by a firm to cover its employees) or purchased by an individual. In each case, the covered
groups or individuals pay premiums or taxes to help protect themselves from unexpected
healthcare expenses. Similar benefits paying for medical expenses may also be provided through
social welfare programs funded by the government.
By estimating the overall risk of healthcare expenses, a routine finance structure (such as a
monthly premium or annual tax) can be developed, ensuring that money is available to pay for
the healthcare benefits specified in the insurance agreement. The benefit is administered by a
central organization such as a government agency, private business, or not-for-profit entity.
HISTORY AND EVOLUTION
The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the
Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available,
which operated much like modern disability insurance. This payment model continued until the
start of the 20th century in some jurisdictions (like California), where all laws regulating health
insurance actually referred to disability insurance.
Accident insurance was first offered in the United States by the Franklin Health Assurance
Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries
arising from railroad and steamboat accidents. Sixty organizations were offering accident
insurance in the U.S. by 1866, but the industry consolidated rapidly soon thereafter. While there
were earlier experiments, the origins of sickness coverage in the U.S. effectively date from
1890. The first employer-sponsored group disability policy was issued in 1911.
Before the development of medical expense insurance, patients were expected to pay all other
health care costs out of their own pockets, under what is known as the fee-for-service business
model. During the middle to late 20th century, traditional disability insurance evolved into
modern health insurance programs. Today, most comprehensive private health insurance
programs cover the cost of routine, preventive, and emergency health care procedures, and most
prescription drugs, but this is not always the case.
Hospital and medical expense policies were introduced during the first half of the 20th century.
During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis,
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eventually leading to the development of Blue Cross organizations. The predecessors of today's
Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s
and on during World War II.
WORKING
A health insurance policy is a contract between an insurance company and an individual or his
sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and
amount of health care costs that will be covered by the health insurance company are specified
in advance, in the member contract or "Evidence of Coverage" booklet. The individual insured
person's obligations may take several forms:-
• PREMIUM: The amount the policy-holder or his sponsor (e.g. an employer) pays to the
health plan each month to purchase health coverage.
• DEDUCTIBLE: The amount that the insured must pay out-of-pocket before the health
insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per
year, before any of their health care is covered by the health insurer. It may take several doctor's
visits or prescription refills before the insured person reaches the deductible and the insurance
company starts to pay for care.
• CO-PAYMENT: The amount that the insured person must pay out of pocket before thehealth insurer pays for a particular visit or service. For example, an insured person might pay a
$45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each
time a particular service is obtained.
• COINSURANCE: Instead of, or in addition to, paying a fixed amount up front (a co-
payment), the co-insurance is a percentage of the total cost that insured person may also pay. For
example, the member might have to pay 20% of the cost of a surgery over and above a co-
payment, while the insurance company pays the other 80%. If there is an upper limit on
coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the
actual costs of the services they obtain.
• EXCLUSIONS: Not all services are covered. The insured person is generally expected
to pay the full cost of non-covered services out of their own pocket.
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• COVERAGE LIMITS: Some health insurance policies only pay for health care up to a
certain dollar amount. The insured person may be expected to pay any charges in excess of the
health plan's maximum payment for a specific service. In addition, some insurance company
schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop
payment when they reach the benefit maximum, and the policy-holder must pay all remaining
costs.
• OUT-OF-POCKET MAXIMUMS: Similar to coverage limits, except that in this case,
the insured person's payment obligation ends when they reach the out-of-pocket maximum, and
the health company pays all further covered costs. Out-of-pocket maximums can be limited to a
specific benefit category (such as prescription drugs) or can apply to all coverage provided
during a specific benefit year.
• CAPITATION: An amount paid by an insurer to a health care provider, for which the
provider agrees to treat all members of the insurer..
• PRIOR AUTHORIZATION: A certification or authorization that an insurer provides
prior to medical service occurring. Obtaining an authorization means that the insurer is obligated
to pay for the service, assuming it matches what was authorized. Many smaller, routine services
do not require authorization.
TYPES OF HEALTH POLICY
1. GROUP HEALTH INSURANCE POLICY is an insurance cover applied for by the
employer, with Insurance Company. The employer would usually have to pay only a part
of the premium (unlike earlier when 100% employee benefits were prevalent) of the
group medical insurance policy.
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2. SMALL AND LARGE BUSINESS GROUP HEALTH INSURANCE QUOTES,
and, as an Employer, What are the Benefits of Providing Group Medical Insurance
Policies:
• It is a well known fact that an employee values a group health insurance cover and its
benefits. It is viewed by the employee as the second best thing next to monetary
compensation, and gives the employer the added advantage of being able to employ and
retain the best in the business.
• Additionally, a group health insurance policy also offers your employees and yourself a
special bonanza in the form of tax incentives. For instance, as an employer you could
reduce payroll taxes, by offering your employees group health insurance as part of a
whole compensation package, thereby deducting 100% of the premiums that you would
have had to pay on a qualifying group health insurance plan..
1. BASIC HEALTH INSURANCE QUOTE
The Basic Health Insurance Plan was specially designed to function as an inexpensive (limited
benefit) alternative to the major group health insurance covers which are very expensive. This
can be comprised of an "any size group" and its outstanding features include:
• Hospitalisation and surgery benefits
• Medical Emergency Room benefits
• An option of either a single cover or a family coverage
• Visits/Consultations at a doctor's office of your choice
• Affordability
• Accessibility-to qualify for this Plan, there is no necessity to undergo physical exams,
and neither are medical questions asked as a pre-qualifier. For those members who are
eligible; this medical insurance cover is "guaranteed issue."
1. TYPES OF GROUP HEALTH INSURANCE PLANS
Group Health Insurance Plans are broadly split into indemnity plans (traditional indemnity plan,
an FFS or Fee for Service Plan, and more prevalent in the east coast) and managed care plans
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(very popular in western USA), both different from each other in approach.The outstanding
differences between the indemnity and managed care plans are in sectors concerning:
• Out -of-pocket expenses for covered medical services,
• Choice of medical providers and hospitals, and
• How medical bills are paid.
In an indemnity plan, you will have a wider choice of hospitals and medical/healthcare providers
(this includes specialists like a cardiologist).In a managed care plan, you will incur less
paperwork and out-of-pocket expenses.
1. FEE FOR SERVICE PLAN
In these plans, the insured patient is examined by a doctor chosen by him, and the medical professional receives a fee for each service given to the insured patient. The fee- for -service
health insurance claim is filed either by the patient or the medical provider.
COMPANIES
ICIC LOMBARD
ICICI Lombard General Insurance Company Limited is a 74:26 joint venture between ICICI
Bank Limited , India's second largest bank with $79 billion in assets and Fairfax Financial
Holdings Limited, a Canada based $26 billion diversified financial services company engaged in
general insurance, reinsurance, insurance claims management and investment management.
ICICI Lombard is the largest private sector general insurance company in India with a Gross
Written Premium (GWP) of Rs. 3345 million for the year ended March 31, 2008.
ICICI Lombard General Insurance has been conferred the 'Customer and Brand Loyalty award
in the 'Insurance Sector - Non-Life' at the 2nd Loyalty awards, 2009. It was awarded the
‘General Insurance Company of the Year’ at the 11th Asia Insurance Industry Awards. The
company also won the 'NDTV Profit Business Leadership Award 2007' and was adjudged as the
most Customer Responsive Company in the Insurance category at the Economic Times Avaya
Global Connect Customer Responsiveness Award 2006. It has the Gold Shield for "Excellence
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in Financial Reporting" by the ICAI (Institute of Chartered Accountants of India) for the year
ended March 31, 2006.
Advantages
• A single premium health policy that covers hospitalisation expenses of entire family.
• Cashless Hospitalisation at 3500+ network hospitals.
• Income Tax Benefits on premiums paid under Section 80 D** of Income Tax Act,
1961.
• Medical Insurance for Sum Insured of Rs. 2 lacs, 3 lacs or 4 lacs
• No medical check up to the age of 55.
• Also covers hospitalization activities arising out of terrorist activities
PRODUCTS
1. HEALTH PLUS ADVANTAGE
This is a very good and beneficial plan introduce by the ICICI Lombard with floter facility. A
person can save tax as well as get tax benefit against their investment.
Advantage:-
1. FLOATER COVER :- Anyone out of the 2 adults insured can avail of either covers
under Health Advantage Plus; Floater provides a common cover for both members
.
2.NO MEDICAL
CHECK - UP
No health check-up up to the age of 55 years (age as on last
birthday)
3.CASHLESS
HOSPITALIZATION Simply use our 'Health Advantage Plus' ID card at
any of the empanelled 3500+ hospitals and avail of
cashless service, a boon for those times when you
need finance the most. This benefit is only for
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hospitalisation claims.
4.MAXIMUMTAX
BENEFIT You can avail a full utilisation of tax benefit on up to
Rs. 15,000/- (Rs. 20,000 for Senior Citizens) as
premium paid under Section 80D of the Income Tax
Act,1961. This will save up to Rs. 4635/- ^ in your
tax liability in one years.
For the first time in India,a person can avail of an insurance cover for orthopedic, maternity,
dental, pharmacy, general practitioner and other medical expenses incurred up to the sum
insured on OPD basis.• The following OPD expenses are covered:
RooM
• Boarding Expenses as charged by the Hospital
• Nursing Expenses
• Expenses related to Dental Treatment
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables,
Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy,Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids,
Dental treatment charges, Ambulance charges
.
DISADVANTAGES
• We can lodge a claim only once during the Period of Insurance, i.e. 90 days after
commencement of policy and up to 30 days after expiry of the Period of Insurance.
• Any illness / disease / injury pre-existing disease before the inception of the policy.
1. INDIVIDU AL PERSONAL ACCIDENT INSURANCE
It is the insurance plan introduce by the ICICI Lombard to ensure personal safety for us.
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Individual Personal Accident Insurance Policy provides immediate coverage on policy
issuance. This policy covers you against Accidental Death & Permanent Total Disablement
(PTD) on account of an accident. Customised coverage that offers choices in sum insured.
The insurance cover is available in options of Rs. 3 Lakhs, 5 Lakhs, 10 Lakhs or 20 Lakhs.
The Policy Covers:- Individual Personal Accident Insurance pays our nominee the sum
insured chosen, in case an accident occurs during the policy period resulting in the insured's:
• Death
Permanent Total Disability - Individual Personal Accident Insurance pays compensation
against the permanent and total loss of limbs, sight etc., (including on account of terrorism or
acts of terrorism) due to an accident.
A person can get the following during period of insurance.
Loss of use/Actual loss by
physical separation of
Percentage of Capital Sum
Insured*
Sight of both eyes 100%
Both hands 100%
Both feet 100%
One hand and one foot 100%
One eye and one hand or one
foot
100%
Sight of one eye 50%
One hand or one foot 50%
ADVANTAGES
• Covers against Accidental Death - Permanent Total Disablement (PTD) on account of an
accident.
• Immediate cover on policy issuance
• Choose among Sum insured options of Rs. 3, 5, 10 and 20 Lakhs
• Covers claims arising out of Terrorism or acts of Terrorism
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• No health check-up required for policy issuance
• Renewable till the age of 70 years
Easy Claim Process with minimal documentation
DISADVANTAGE
The Company shall not be liable under this policy for:
• Death, injury or disablement of Insured Person;
(a) whilst engaging in aviation or ballooning, or whilst mounting into, or
dismounting from or travelling in any balloon or aircraft other than as a passenger
(fare-paying or otherwise) in any duly licensed standard type of aircraft anywhere
in the world.
(b) directly or indirectly caused by venereal disease or insanity;
(c) arising or resulting from the Insured committing any breach of the law with
criminal intent.
.
BAJAJ ALLIANZ LIFE INSURANCE
Bajaj Allianz General Insurance Company Limited or Bajaj Allianz Insurance is a joint
venture between two of the most reputed names in the world of insurance - Bajaj Finserv
Limited and Allianz SE. Both of the names are known for their strength, expertise and
stability in the insurance sector. While Bajaj Finserv Limited holds the 74% of the paid
up capital of Rs. 110 crore, Allianz SE holds the remaining 26%. It can be added here
that Bajaj Finserv Limited has very recently demerged from Bajaj Auto Limited.
Bajaj Allianz Insurance started its journey on May 2, 2001 when it received the
certificate of Registration from Insurance Regulatory and Development Authority
(IRDA) for conducting General Insurance business in India including Health Insurance.
As on the end of March 2009, the income of Bajaj Allianz Insurance went up to Rs. 2,866
crore with a growth of 11% over the previous year. It also registered a net profit of Rs. 95
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crore, highest by any private insurer, in the last financial year.
PRODUCTS
1. HEALTH GUARD POLICY
It covers expenses arise during the period of illines of insured person.
Advantage
Health Guard policy takes care of your hospitalization expenses & also offers a
wide coverage of pre & post hospitalization expenses.
Room rent limit General 'No Limit'
Room rent limit ICU 'No Limit';
Medical OT charges 'No Limit'
Doctor fee limit: 'No Limit'
The member has cashless facility at over 2400 hospitals across India
The member can opt for hospitals besides the empanelled ones, in which the
expenses incurred by him shall be reimbursed within 14 working days from
submission of all documents.
Pre and post - hospitalization expenses covers relevant medical expenses incurred
60 days prior to and 90 days after hospitalization.
Cumulative bonus of 5 % is added to your sum assured for every claim free year.
Family discount of 10 % is applicable.
Covers ambulance charges in an emergency subject to limit of Rs. 1000 /-
No tests required up to 45 years up to SI 10 lacs*
10% co- payment applicable if treatment taken in non-network hospitals. Waiver
of co-payment is available on payment of additional premium
Pre-existing diseases covered after 4 years continuous renewal with Bajaj Allianz
Family discount of 10% is applicable
DISADVANTAGE
• No floater facility.
• No Expenses related to Dental Treatment is available.
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• NON allopathic tereatment is not incurred inthis policy and no pregenancy related
decisive is covered.
• Pre illness expenses covered after four year of successful completiton of policy.
The period is too long.
1. SILVER HEALTH POLICY
It is a policy introduced by the bajaj alliance for the people of age year of mor than46
years.
As the age of an individual increases the health care costs increase & become a burden on
the individual. The senior citizens have to pay out the hard earned savings to meet the
expenses. Bajaj Allianz’s Silver Health plan is exclusively designed for the senior
citizens, which covers medical expenses incurred during hospitalization period so this is
a very good policy introduced by the bajaj.
ADVANTAGE
This policy is very good for the senior citizen because the medical treatment is expensive
for the people for this age group.
• Pre-existing diseases covered from the second year of the policy.
• A flat benefit of 3% of admissible hospitalization expenses are paid towards pre
& post hospitalization expenses.
• Cashless facility : With Silver Health plan, the member has access to cashless
facility at various network of over 2400 hospitals across India (subject to exclusions and
conditions)
• If admission in non-network hospitals the expenses incurred would be reimbursed
within 14 days from the submission of all documents.
• 20% of co-payment of the admissible claim to be paid by the member if treatment
is taken in a hospital other than a network hospital.
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• Waiver of co-payment is available on payment of additional premium.
Cumulative bonus of 5 % added to your sum assured for every claim free year.
• Health Check up at the end of continuous four claim free years.
• Family discount of 5 % is applicable.
Income tax benefit on the premium paid as per section 80-D of the Income Tax Act as
per existing IT law.
• Cumulative bonus of 5 % added to your sum assured for every claim free year.
• Health Check up at the end of continuous four claim free years.
• Income tax benefit on the premium paid as per section 80-D of the Income TaxAct as per existing IT law.
DISADVANTAGE
Pre existing desises are not covered before two years of policy taken.
• 20% of co-payment of the admissible claim to be paid by the member if treatment
is taken in a hospital other than a network hospital.
• No allopathic treatment is not included.
• No dental treatment charges are included.
• No floater facility is available.
NEW INDIA ASSURANCE COMPANY LIMITED
There are two types of health policies being offered by The New India Assurance
Company Ltd for the year 2009-10 as follows:-
1. UNIVERSAL HEALTH INSURANCE SCHEME
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2. JAN AROGYA BIMA POLICY
1. UNIVERSAL HEALTH INSURANCE SCHEME - SALIENT
FEATURES
Medical Reimbursement
The policy provides reimbursement of hospitalization expenses upto Rs.30,000/- to an
individual /family, subject to the following sub-limits:-
A. (i) Room, Boarding expenses upto Rs.150/- per day
(ii) If admitted in ICU upto Rs.300/- per day
B. Surgeon, Anesthetist, Consultant, specialists fees, Nursing expenses upto
Rs.4,500/- per illness/ injury
C. Anesthesia, Blood, Oxygen, OT charges, Medicines, Diagnostic material & X-Ray,
Dialysis, Radiotherapy, Chemotherapy, Cost of pacemaker, Artificial limb, etc
upto Rs. 4,500/- per illness/ injury
D. Total expenses incurred for any one illness upto Rs. 15,000/-
Personal Accident Cover
Coverage for Death of the Earning Head of the family (as named in the schedule) due to
accident: Rs. 25,000/-.
Disability Cover
If the earning head of the family is hospitalized due to an accident / illness a
compensation of Rs.50/- per day will be paid per day of hospitalization up to a maximum
of 15 days after a waiting period of 3 days.
For purpose of this POLICY HOSPITAL means:
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• Any Hospital/ Nursing home registered with the local authorities and under the
supervision of a registered and qualified Medical practitioner.
• Hospital/ Nursing Home run by Government.
• Enlisted hospitals run by NGOS / Trusts / selected private hospitals with fixed schedule
of CHARGES.
• It should have minimum 15 beds (10 in case of class 'C' cities having a population lest
than 5 lakhs) with fully equipped OT, fully qualified nursing staff round the clock and
fully qualified doctor should be in charge round the clock.
• Hospitalization should be for a minimum period of 24 hrs. However this time limit is
not applied to some specific treatments and also where due to technological advancement
hospitalization for 24 hrs may not be required.
OTHERS FEATURES
• Any One Illness - Will be deemed to mean continuous period of illness and it includes
relapse within 60 days from the date of last consultation with the hospital.
• Age Limitations - This Policy covers people between the age of 3 months to 70 years.
• Family - Means earning head, spouse and up to maximum of three dependent children.
Dependent parents can also be included.
• Floater Basis - The benefit of family will operate on floater basis i.e. the total
reimbursement of Rs.30,000/- can be availed of individually or collectively by members
of the family.
Premium
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For an individual Rs. 300/- per annum
For a family up to 5 (including the first 3 children) Rs. 450/- per annum
For a family up to 7 (including the first 3 children and dependent parents) Rs. 600/- per annum
Premium Subsidy for BPL Families
For families below the poverty line the Government will provide a premium subsidy of
Rs.100/- per family.
2. JAN AROGYA BIMA POLICY
Features
This policy is designed to provide cheap medical insurance to poorer sections of society.
Premium up to Rs.10000/- qualifies for tax benefit under Sec 80D of the Income Tax
Act. Service tax is not applicable to the policy.
Scope
The coverage is along the lines of individual mediclaim policy except that cumulative
bonus and medical checkup benefits are not included. The Sum Insured per insured
person is restricted to Rs 5000/-.
Eligibility
The policy is available to individuals and family members. The age limit is 5 to 70 years.Children between the age of 3 months and 5 years can be covered provided one or both
parents are covered concurrently.
Major Exclusions
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Financial Institutions, Automobile Manufacturers, NGOs and State Governments for
marketing of its Insurance services.
POLICIES OFFERED:
• Personal Line Insurance – insurance of person and property would include
Personal Accident, Mediclaim, Critical Illness, Amartya Siksha Yojana , Motor
Policy - Two Wheelers, Householders Policy, Niwas Yojana , Personal Liability,
Professional Indemnity for a Doctor / Lawyer and others.
• Rural Line Insurance – insurance policies devised for the rural people and weaker
section of urban society like Cattle / Livestock Insurance, Brackish Water Prawn
Insurance, Sericulture Insurance, Horticulture/Plantation Insurance, Kisan
Agriculture Pumpset Insurance and others.
• Industrial Line Insurance – these insurances covers various risks faced by the
industry and are of two types, Project Insurance like Erection All Risk Insurance
and Contractor's All Risk Insurance and Operational Insurance like Fire policy,
Machinery Insurance policy, Electronic Equipment Insurance policy and
Consequential Loss (Fire) policy.
Commercial Line Insurance – the company offers different options to protect thecommercial organizations against the loss of or damage to property and liability arising
out of an action or inaction in the course of the commercial activity
Top of Form
http://w w w .medi National Insuranc National Insuranc This article gives National Insuranc
Bottom of Form
Features of Products and Services
Family Floater Health Insurance Policy wherein entire family will be covered under
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single Sum Insured.
Premium Chart
Up to 35 years
Sum
Insured
Self
Spouse1st
Child
2nd
Child
2
Adult
s +
2
Kids
2 Adults +
1 Kid(Rs.) 25 % 20 % 20 %
2,00,000/- 2469/- 617/- 494/- 494/- 4074/-
3580/-
2,50,000/- 2956/- 739/- 591/- 591/-4877/
-4286/-
3,00,000/- 3444/- 861/- 689/- 689/-5683/
-4994/-
3,50,000/- 3870/- 968/- 774/- 774/-6386/
-5612/-
4,00,000/- 4297/- 1074/- 859/- 859/-7089/
-
6230/-
4,50,000/- 4723/- 1181/- 945/- 945/-7794/
-6849/-
5,00,000/- 5151/- 1288/- 1030/- 1030/-8499/
-7469/-
NEW POLICY
JEEVAN
This is the policy which has the unique feature of both illness expenses as well as
accidental insurance. It also covers the medical expenses for the outdoor patent.
SALIENT FEATURE
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The policy is available in two forms.
Only illness Expenses is Paid by the company.
Illness as well as Accidental claim is covered by the company.
If a person is taken only illness policy then they have to payRs.1200 as a premum per month.
BENEFIT
Person can get medical expenses with room charges as well as ambulance charges.It cover pre illness desires like castrates, dental etc.
NO critical pre illness desires is covered under this policy.
Only 50% medical expenses is bear by the company.
Only one time expenses is covered by the company for the pre illness diseases.
Pregnancy related diseases are fully covered by the Company.
Floater facility is available for the family of four people i.e. husband, wife and two
spouse.
If insured person cannot avail the facility of insurance then 5% of the total amount is paid
to the concerned person after 7 year of successful completion of policy.
If person continue the policy for 20 years then he can get 3% of total premium amount
after 20 years. For the person of age more than 55 years and up to 70 years can get the
medical checkup expenses once in a year.
Policy Covers:- Covers medical expenses incurred as an inpatient during hospitalization
for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines,
diagnostic tests, etc 30 days pre-hospitalization
• 60 days post-hospitalization
• Pre-existing diseases shall be covered after 2 years of continuous renewal with the
company
• Coverage against Swine Flu / H1N1 influenza in case of hospitalisation~
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• Following technologically advanced treatments that do not need 24-hour
hospitalization* but are covered under this policy are::
○ Cataract
○ Dilatation and curettage
○ Cardiac Catheterization
○ Lithotripsy (Kidney Stone removal)
○ Chemotherapy
○ Tonsillectomy
○ Radiotherapy
○ Eye Surgery
FEATURES
PREMIUM is paid monthly for Rs.1800. Person who takes this policy can avail the
benefit of accidental claim also.
ACCIDENTAL CLAIM COVERS:-
Loss of use/Actual loss by
physical separation of
Percentage of Capital Sum
Insured*
Sight of both eyes 100%
Both hands 100%
Both feet 100%
One hand and one foot 100%
One eye and one hand or one
foot
100%
Sight of one eye 50%
One hand or one foot 50%
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ILLNESS CLAIM COVERS:- Covers medical expenses incurred as an inpatient during
hospitalization for more than 24 hours, including room charges, doctor’s / surgeon’s fee,
medicines, diagnostic tests, etc 30 days pre-hospitalization
• 60 days post-hospitalization
• Pre-existing diseases shall be covered after 2 years of continuous renewal with the
company
• Coverage against Swine Flu / H1N1 influenza in case of hospitalization~
• Following technologically advanced treatments that do not need 24-hour
HOSPITALIZATION* but are covered under this policy are::
○ Cataract
○ Dilatation and curettage
○ Cardiac Catheterization
○ Lithotripsy (Kidney Stone removal)
○ Chemotherapy
○ Tonsillectomy
○
Radiotherapy
○ Eye Surgery
BENEFIT
Person can get medical expenses with room charges as well as ambulance charges.
It covers pre illness disease like castrates, dental etc.
NO critical pre illness disease is covered under this policy.
Only 50% medical expenses is bear by the company.
Only one time expenses is covered by the company for the pre illness diseasePregnancy related disease is fully covered by the Company.
Floater facility is available for the family of four people i.e. husband, wife and two
spouse.
If insured person cannot avail the facility of insurance then 5% of the total amount is paid
to the concerned person after 7 year of successful completion of policy.
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If person continued the policy for 20 years then he can get 3% of total premium amount
after 20 years.
For the person of age more than 55 years and up to 70 years can get the medical checkup
expenses once in a year.
Note:- No Medical Checkup required for the age of up to 55 years.
CONCLUSION
Health systems are complex and fluid entities working at multiple levels; there are no
simple solutions. For the development of equitable and effective health systems,
researchers need to embrace two inter-linked challenges. Firstly, in a context where the
links between poverty, marginalization and (ill) health are so compelling, there is an
urgent need to mainstream an equity or pro-poor approach throughout the research cycle.
In operational research, pro-poor indicators are essential to ensure that equity
considerations do not evaporate, but are central to analysis, dissemination and scale-up.
Secondly researchers need to build partnerships on many fronts: multi-disciplinary
partnerships to ensure that their research does justice to the holistic and complex nature
of health systems; partnerships for capacity building to promote demand, delivery and
uptake of research; and partnerships with the broader research, policy and practice
constituency, from communities to service providers to policy makers, to ensure the
timeliness and relevance of the research agenda and a receptive research-policy-practice
interface. There is no magic formula for these partnerships, as they will need to reflect
different, often fast-moving, institutional contexts, the interplay between vertical and
horizontal approaches to health in specific countries, and particular research foci. The
levels of engagement demanded by these partnerships will take time, energy, skills and
resources. "Methods for partnership development" is a new component for the evolving
health systems research paradigm. We need a global research culture that values andfunds these new levels of engagement from multiple sources including governments,
foundations, and charities.
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REFERENCES
• http://www.nia25.com/
• http://en.wikipedia.org/wiki/ICICI_Lombard
• http://www.icicilombard.com/app/ilom-en/default.aspx
• http://www.icicilombard.com/app/ilom-en/personalproducts/Health/Health-
Advantage.aspx
• http://www.bajajallianzlife.co.in/
• http://www.bajajallianzlife.co.in/category-detail.asp?id=8
• www.newindia.co.in
• http://www.health-policy-systems.com/content/7/1/26
• http://www.medindia.net/patients/insurance/national-insurance-company-
limited-parivar.
• http://www.medindia.net/patients/insurance/national-insurance-company-limited-star-
national-swasthya-bima.htm
http://www.insureurhealth.com/health-insurance-articles/health-insurance-types.htm