Risk Management &

Insurance
Presented To : Mr.Ahsan Khalique
Presented By : Shabnam Zulfiqar
Roll no.
: AM552387

Topic:
Individual Health Insurance
Coverages in Pakistan

Health Insurance
O Health insurance: a type of insurance

offered by private insurance companies or

the government that covers health care
expenses incurred by policyholders for
necessary medical care
O Critical component of financial planning
Cost of providing health care is rising

Health Insurance
O Your health insurance decision is not

whether to obtain it, but which health plan

to purchase and how much coverage to
purchase
O Many options available

Private Health Insurance

O Private health insurance: health

insurance that can be purchased from

private insurance companies to provide
coverage for health care expenses
O Types of private health insurance
coverage
O Hospital insurance, physician insurance,

and surgical insurance

Private Health Insurance

O Options for purchasing private health

insurance
O Many employers offer health insurance as

part of benefit package

O Cost usually shared between employee and

employer
O Self-employed individuals must pay entire

cost of their health insurance

Private Health Insurance

O Private health care plans
O Indemnity plan: health insurance that

reimburses individuals for part or all of the

expenses they incur from health care
providers; individuals are free to decide
whether to seek care from a primary care
physician or a specialist

Private Health Insurance

O Managed health care plan: a health

insurance policy under which individuals

receive services from specific doctors or
hospitals that are part of the plan
O Health maintenance organization (HMO):

a health insurance plan that covers health

care services approved by doctors; a primary
care physician provided general health
services
and refers patients to a specialist as
necessary

Private Health Insurance

O Preferred provider organization (PPO):

a health insurance plan that allows

individuals to select a health care provider
and covers most of the fees for services
O Discount on charge arrangement: an

arrangement in which the preferred provider

organization agrees to pay a specific
percentage of the health care providers
charges
O Per diem rate arrangement: an arrangement

in which the preferred provider organization

pays the provider a specific sum per day a
patient is hospitalized

Private Health Insurance

Private Health Insurance

O Maintaining private health care insurance

coverage
O COBRA allows continuation of coverage

provided through an employers plan for 18

months
O HIPPA prohibits insurance companies from
denying health insurance coverage based
on applicants health status, medical
history, previous claims, or disability

Private Health Insurance

O Expenses not covered by private

insurance plans should be included in

your budget
O Flexible spending account: account

established by the employer for the

employee to use pretax income to pay for
medical expenses
O Funds cannot roll over into the next year

Long-Term Care Insurance

O Long-term care insurance: covers

expenses associated with long-term

health conditions that cause individuals to
need help with everyday tasks
O Provided by private insurance companies
O Covers care in a nursing home, assisted

living facility, or at home

O Premiums quite expensive

Long-Term Care Insurance

O Long-term care insurance provisions
O Eligibility to receive benefits
O Types of services
O Amount of coverage
O Elimination period to receive benefits
O Maximum period to receive benefits
O Continued coverage
O Inflation adjustment
O Stop-loss provision

Long-Term Care Insurance

O Other factors that affect long-term care

insurance premiums
O Age
O Health condition

O Reduce your cost of long-term care

insurance by shopping around and

comparing premiums

BISP Waseela-e-Sehat
O Improving access to quality health

services and reducing income loss from

catastrophic health shocks.
O BISP has launched the Health Insurance
Scheme through cashless Benazir Sehet
Card through State life Insurance
Corporation.

Benefits of Wsaeela-e-Sehat
O The insured family would be covered for

hospitalization resulting from illness or

injury with an annual maximum limit of Rs.
25,000 per family.
O Pre-existing diseases and all age groups
will be covered.
O All members of the family would be
covered.
O Diagnostic tests/procedures inclusive of
daycare surgery would be covered.

Conclusion
I conclude that there is no focus of
government to promote this
industry or provide the benefit to
public related to health insurance.

Recommendations
There is need of Government of
Pakistan planning and programs to
take initiate for promoting the
health insurance of public.
Private insurance companies plans
should be familiar to public.