Health and Disability

Ranking of the world's health systems WHO.

Rank Country

1 2 6 10 18 37 112 122

France Italy Singapore Japan UK USA India Pakistan

Definitions of health insurance

 

Insurance against loss due to ill health 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.

Definitions of health insurance



Insurance cover providing financial protection in the event of sickness or injury. Protection against the costs of hospital and medical care arising from an illness or injury (sometimes called Accident & Sickness Insurance).

Definitions of health insurance



Insurance providing for the payment of benefits as a result of sickness or injury. Includes various types of insurance, such as accident insurance, disability income replacement insurance, medical expense insurance, and accidental death and dismemberment ( Removal of limbs by cuttings) insurance .

Definitions of health insurance



Provides cover against loss from illness or bodily injury. Can pay for medicine, visits to the doctor, hospital stays, other medical expenses and loss of earnings. It depends on the conditions covered and the benefits and choices of treatment available on the policy.

Health and Disability



Healthcare Insurance Insurance is seen as a solution to the healthcare needs of the growing ageing population by governments, and as a growing commercial enterprise by insurers.

Health and Disability

The main drivers in the healthcare market is the ageing population. There is no Universal Health Care insurance system adopted among the countries. Different Countries have tried different models according to their knowledge .

Health Insurance Policies

Health Insurance Policies Long-term policies- generally provided by life assurance companies
  

Income protection insurance Critical illness insurance Long-term care insurance

Health Insurance Policies

Health Insurance Policies
Short-term policies - General insurance companies  Accident, sickness and unemployment insurance  Private medical insurance  Hospital cash plans

Income protection insurance

Income protection insurance is used to protect earned income in the event of long-term illness or disability. It is usually taken out to replace income that is lost and not replaced by either an employer or the state.

Income protection insurance

The income is paid after a deferred period, which may be one month, three months, six months or a year. Premiums Calculation :  Age at entry,  term of contract and the sex,

Income protection insurance

health and  occupation of the policyholder. Longer deferred periods reduce the premium.


Critical illness insurance

Critical illness insurance pays out a tax-free lump sum on diagnosis of one of a list of Life threatening conditions like cancer, heart Attack and stroke. Premium Calculation :  Age, Sex,  Amount of cover required and medical history.

Critical illness insurance

The term of the contract can be either life or a specified period. Two forms of Critical illness insurance :  Stand-alone basis Provide only protection and there is no savings element or surrender value.

Critical illness insurance

Additional benefit under a whole-life, term or endowment life policy. The sum assured will be paid on diagnosis of a specified critical illness or on death.


Critical illness insurance

There are no restrictions on the ways in which policyholders can spend their lump sum. They may decide to pay off outstanding debts, such as a mortgage, or use it to pay for adapting a house, specialist nursing care or a recuperative ( To be restored to health / strength) stay in a better climate.

Long-term care insurance

Long-term care insurance is designed to pay for some or all of the costs of long-term care required as a result of long-term illness or extreme old age. Although the provision of long-term care is typically associated with the elderly, younger people may require it because of an accident or some disabling illness.

Long-term care insurance

The policy pays a regular income to either the individual or a provider of care when the insured is unable to perform a specified number of activities of daily living (ADLs), for example, washing or dressing, without assistance from another person, or is suffering from cognitive or mental impairment.

Long-term care insurance

Long-term care policies fall into two categories:  Pre-funded plans A pre-funded policy is taken out before care is needed. It will pay out a monthly sum if Long term care is needed in the future. The policy is underwritten at outset, and is paid for by regular or single contributions.

Long-term care insurance

If no claim is made, or the insured dies or cancels the policy, there is usually no benefit payable or refund of contributions.  Immediate care plans Immediate care plans are arranged once the need for care has arisen, when the key issue is how long the insured will live.

Long-term care insurance

A single premium is paid to a life office, which then provides a regular monthly benefit for as long as the insured is alive, usually directly to the care provider. The amount of benefit depends on the life expectancy of the insured, and the poorer the health of the insured the greater the monthly benefit will be.

Long-term care insurance

A long term care insurance policy helps reduce the financial burden on families caring for elderly relatives. It allows individuals to retain their assets and home, which might otherwise have to be sold to pay for care fees. It allows a choice over the type and quality of care.

Short-term policies
Accident, Sickness and unemployment insurance Accident and sickness cover can be arranged separately or combined with redundancy (overabundant / excessive) cover in a single policy. Policies with the redundancy option are typically linked to mortgages.

Short-term policies
Main features :



The policies are renewable on an annual basis. Lump sum benefits are usually provided for death, loss of sight or loss of limbs, and permanent total disability. A weekly income is paid if the insured is unable to work through sickness or

Short-term policies
redundancy, usually for a maximum of two years. A common form of accident, sickness and unemployment insurance is mortgage payment protection insurance. This typically covers mortgage payments for a maximum of two

Short-term policies
years in the event of accident, sickness or redundancy, usually with a waiting period of either 30 or 60 days.

Short-term policies
Private medical insurance Private medical insurance provides cover for the cost of private medical treatment. Plans can be arranged on an individual basis, or by employers on a group basis for their employees.

Short-term policies
Types of Private medical plans : Budget plans with low costs and limits on the amount of cover for different types of treatment; Standard plans which cost more than budget plans but give wider cover; Comprehensive plans which are the most expensive but provide the greatest cover.

Short-term policies
This kind of insurance is primarily aimed at covering the cost of short-term, curable medical conditions. In general, it is not designed to cover the cost of long-term, incurable conditions (known as chronic illnesses) such as diabetes and Dementia (Insanity).

Short-term policies
This type of policy can enable you to get private medical treatment when you need it, with a consultant and in a hospital of your choice, with the insurer paying all or most of the cost.

Short-term policies
Hospital cash plans Hospital cash plans are designed to pay a fixed cash sum for each day spent in hospital. They are not a substitute for private medical insurance as the payments are typically not

Short-term policies
enough to cover the cost of private treatment. They can, however, contribute towards out-of Pocket expenses.

Types of Health Insurance Plans

Three Types of Health Insurance Plans:


Health Maintenance Organizations (HMOs), Participating Provider Options (PPOs) and Consumer Directed Health Plans (CDHPs).

Types of Health Insurance Plans

Health Maintenance Organizations (HMOs) An HMO is a type of health insurance plan that gives you access to certain doctors and hospitals, often called network or contracting doctors and hospitals (sometimes called "providers").

Types of Health Insurance Plans

HMO basics:  When you sign up, you select a primary care physician (PCP) from a network of doctors.  Your PCP is your first point of contact for most of your basic health care needs.  Women can also select an OB/GYN for obstetrical and gynecological care.

Types of Health Insurance Plans



If you need special tests or need to see a specialist, your PCP will give you a referral to see another doctor. HMO plans generally have lower up-front upcosts, or premiums, than other types of plans. They usually feature low deductibles or no deductible at all. A deductible is the amount you pay out-of-pocket before your plan kicks out-ofin.

Types of Health Insurance Plans



HMOs usually feature low copayments as well. Copayments are set amounts (usually a Rupees amount or a percentage) that you pay for care. An example of a copayment is Rs.200 for each office visit. HMO plans generally provide the highest level of coverage - meaning the lowest cost for you when you use doctors, hospitals and specialists that are in the network.

Types of Health Insurance Plans



If you seek care outside the network, your care may not be covered at all.

Types of Health Insurance Plans

Participating Provider Options (PPOs) PPOs often feature a network of doctors, specialists and hospitals; however, there are some key differences between the two types of plans.

Types of Health Insurance Plans

PPO basics:  With a PPO plan, you don't have to choose a primary care physician.  You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

Types of Health Insurance Plans

Key features:

PPO plan premiums are generally higher than HMO plans, which means you'll have to pay more up front.  When you receive care from a doctor or hospital that is in the network, your costs tend to be lower.


Types of Health Insurance Plans



When you receive care from a doctor or hospital outside the network your costs are likely to be higher, and, in some cases, your care may not be covered at all. PPO plans usually have a deductible. So, for example, if your PPO plan has a Rs.500 deductible, your coverage doesn't begin until you've paid

Types of Health Insurance Plans

out-ofout-of-pocket for the first Rs.500 of your own medical expenses. Preventive care services are not subject to the deductible.

Types of Health Insurance Plans

Consumer Directed Health Plans (CDHPs) often involve pairing a high deductible PPO plan with a tax-advantaged account, such as a Health taxSavings Accounts (HSA). For an individual to establish an HSA and contribute money to the account each year, he or she must be considered an HSA-eligible individual. HSA-

Types of Health Insurance Plans

Eligibility includes enrollment in an HSAHSAqualified high deductible health plan. Key features:  If the plan uses a PPO network, you don't have to choose a primary care physician.  You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

Types of Health Insurance Plans

The bottom line:  When a CDHP includes a high deductible health plan, premiums are often lower than other types of health plans because you are responsible for a greater share of your health care costs.  If the health plan is an HSA-qualified high HSAdeductible health plan, and you are an HSAHSAeligible individual,

Types of Health Insurance Plans

you may establish an HSA and make contributions to the account each year.  An HSA is a savings account that you can use to cover a wide range of qualified medical expenses. HSAs have special tax advantages and are regulated by the Treasury Department.

Healthcare issues in some Countries Japan The Japanese society is expected to age at a far greater rate than any other countries. Increase in ageing population without significant increase in population. population.

Healthcare issues in some Countries Percentage of National medical cost to National income will continue to grow. Public Long term care Insurance Provide long term care for the frail (weak) elderly in Institutions and Community.

Healthcare issues in some Countries



Singapore
3 M Program : Medisave, Medishield, Medifund. GOVT. began facilities development for the elderly people since 1996. In 2000, there were app. 1,700 hospital beds available.

Healthcare issues in some Countries

Demand Eldershield By 2010 Singapore aging population will be 24% appr. > Supply.

Healthcare issues in some Countries South Korea People aged 80 or over are the fastest growing segment in the population. It was only 0.2% in 1960, and was below 1% until 1996. It reached 1.1% in 2000, by 2050 the figure

Healthcare issues in some Countries

is projected at 12.6%. All Citizens are covered by the National Health Insurance and medical assistance Programs.

Healthcare issues in some Countries Australia

Medicare and Pharmaceutical Benefit scheme. Govt. encourage developments of facilities catering to the elderly. Australia enjoys lower cost of drugs than many other western countries.

Healthcare issues in some Countries

By 2010, 32.2% of population in Australia will be above 55 years old.