India spends roughly 3.9 % of GDP towards healthcare compared to 17% in USA. It is one of the lowest spenders in healthcare among the BRIC. 9 out of 10 persons in Indian do not have health insurance cover. Though the sector is growing at 16% CAGR, there is a dire need to ramp up the coverage of health insurance. Some reform measures have been introduced in 2013 to de-compartmentalize health insurance from other insurance and allowed them to tie with banks to penetrate rural sector.
Though privatized in 2000, the public sector insurance companies leads the market with 60% market share and the rest of share ties with private sector companies with ICICI Lombard leading it with 9.7 % market share. Indian middle class are yet to accept healthcare insurance as a necessary and they
Insurance Regulatory and Development Authority of India (Irdai) has released draft norms on health insurance where it has suggested discounts based on fitness and wellness criteria. The regulator has also called for establishing a separate channel to address the health-insurance-related claims and grievances of senior citizens. Irdai has also detailed its norms for 'combi products', which would be a combination of a life insurance policy and a health insurance policy. The regulator has said that clear disclosures should be made on the two partners offering the products. It also mandated a 'lead' insurer in these products.
Health Insurance Sector likely to get a third party administrator from the year FY2017. The Health Insurance TPA of India will provide the services of call centres, customer service and grievance management, pre-authorisation, and claim processing. It would be involved in providing network empanelment, verification and investigation and pre-policy health check-up. The firm would also provide services to support all types of health insurance policies - individual, family floater, group covers, mass schemes, indemnity, fixed benefit, among others. The TPA is set up as a venture of National Insurance Company, New India Assurance Company, United Insurance Company, Oriental Insurance Company, and General Insurance Corporation of India which will have 23.75% stake in the venture. TPA will reduce
Registry of Hospitals in Network of Insurers' (Rohini) portal is being launched to provide information like treatment facility, cost of treatment and cost of claims among others relating to the 35,000 hospitals which are registered by Irdai-promoted Insurance Information Bureau (IIB). It is an initiative of IRDA which going forward will help insurance companies and hospitals and all the insured under various health insurance schemes to get all relevant data at one place
Central government is planning to revamp its flagship health insurance scheme Rashtriya Swasthya Bima Yojana (RSBY), for below-poverty-line people (BPL). It will soon undergo a makeover by bringing ?disjointed? schemes under a single umbrella. The scheme, which proposes private-public partnerships to create a strong infrastructure will be widened to cover 8-10 crore BPL people with higher cash limits for treatment. MoU are likely to be entered with State governments which can also provide a top up. Apart from universal coverage and affordability, the scheme will also lay stress on preventive care, such as free check-ups once in three years for the age group vulnerable to cardiac diseases and diabetes.
Rajasthan government has launched "Swasthya Bima Yojana scheme" which provides health insurance to 70 million population of the state of Rajasthan. The beneficiary of the insurance scheme can seek benefits between Rs 30,000 and Rs 300,000 in empanelled private hospitals. They can avail treatment of Rs. 30,000 for general illness and for critical illness they can avail treatment upto Rs. 300,000. The state government has tied up with New India Insurance company with a condition that it cannot profit above 20% in the scheme.