Fundamentals of Health Insurance in India
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Fundamentals of Health Insurance in India

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Questions and Answers

What is a distinguishing feature of Star Health and Allied Insurance?

  • Limited treatment availability
  • Direct payment to doctors only
  • No maximum-entry age limit (correct)
  • Claims-based loading

    • Which innovative health insurance plan is targeted at individuals aged 60 to 75?

  • Star senior citizens
  • Star healthy living
  • Star cardiac care
  • Star citizen red carpet (correct)

    • What is a key benefit of the cashless service offered by Star Health?

  • No hospital stays required
  • Immediate reimbursement process
  • No need for prior authorization
  • No TPA intervention necessary (correct)

    • Which of the following is NOT typically covered by health insurance plans as described?

    <p>Routine annual check-ups</p> Signup and view all the answers

    Which feature enhances the attractiveness of health insurance plans by allowing additional coverage?

    <p>Add-on benefits</p> Signup and view all the answers

    What is one of the main functions of health insurance?

    <p>Cover the cost of medical care</p> Signup and view all the answers

    What does Star cardiac care specifically address?

    <p>Health insurance needs of heart patients</p> Signup and view all the answers

    Which of the following statements is true regarding the COVID-19 situation in relation to health insurance?

    <p>Adequate health insurance is crucial during unexpected medical crises.</p> Signup and view all the answers

    Which company is known for offering innovative health insurance plans and quick cashless authorization?

    <p>Apollo Munich Health Insurance Co.Ltd.</p> Signup and view all the answers

    What is the sum insured limit for the West Bengal Health Scheme?

    <p>Rs 1 lakh</p> Signup and view all the answers

    What unique feature does Apollo Munich Health Insurance Co.Ltd. provide in its claim settlement process?

    <p>Cashless authorization within 2 hours</p> Signup and view all the answers

    Which of the following is NOT a stand-alone health insurance company mentioned?

    <p>Liberty Videocon General Insurance</p> Signup and view all the answers

    Who can benefit from the Yeshasvini Health Insurance Scheme?

    <p>Farmers associated with a co-operative society</p> Signup and view all the answers

    Which company partners with Fortis Hospitals to strengthen its claim servicing?

    <p>Religare Health Insurance Co.Ltd.</p> Signup and view all the answers

    What is a unique feature of the Mahatma Jyotiba Phule Jan Arogya Yojana?

    <p>It offers immediate claims for specified illnesses</p> Signup and view all the answers

    Which of the following is covered under the Mukhyamantri Amrutam Yojana?

    <p>Family floater health insurance up to Rs 3 lakh</p> Signup and view all the answers

    Which company formed a joint venture with the UK-based Bupa Finance PLC?

    <p>MAX Bupa Health Insurance Co.Ltd.</p> Signup and view all the answers

    What aspect strengthens the brand of MAX Bupa Health Insurance Co.Ltd.?

    <p>Local expertise of Max India and global healthcare experience of Bupa</p> Signup and view all the answers

    What type of illnesses does the Karunya Health Scheme cover?

    <p>Chronic illnesses such as Cancer and Kidney disease</p> Signup and view all the answers

    How does enrollment in the Yeshasvini Health Insurance Scheme occur?

    <p>Via co-operative societies</p> Signup and view all the answers

    What distinguishes Religare Health Insurance Co.Ltd. in the market?

    <p>It is backed by Fortis Hospitals.</p> Signup and view all the answers

    Which group of individuals is targeted by the Mukhyamantri Amrutam Yojana?

    <p>The poor and below poverty line individuals</p> Signup and view all the answers

    In which year was Religare Health Insurance Co.Ltd. established?

    <p>2012</p> Signup and view all the answers

    What financial benefit does the Mahatma Jyotiba Phule Jan Arogya Yojana provide?

    <p>Family health cover up to Rs 1.5 lakh</p> Signup and view all the answers

    Study Notes

    Fundamentals of Health Insurance

    • Health insurance is a contract between two parties: the insurer and the insured.
    • The insured pays a specific amount to the insurer for a guaranteed return, protecting against loss.
    • The insurer promises to cover losses caused by unforeseen circumstances.

    Scope of Medical Insurance in India

    • Modern insurance originated in the Great Fire of London 1666.
    • Nicholas Barbon established the first fire insurance company.

    First Insurance Company

    • The Friendly Society was the first US insurance company established in 1735 in Charleston, South Carolina.
    • Solomon Huebner is recognized as the "father of insurance education".

    History of Insurance in India

    • Oriental Life Insurance Company, established in 1818, was the first Indian life insurance company that catered to Europeans.
    • The pre-independence era in India saw discrimination with higher premiums for Indians.
    • Bombay Mutual Life Assurance Society, established in 1870, covered Indian lives at normal rates.

    Regulation of Indian Insurance Companies

    • The Life Insurance Companies Act and the Provident Fund Act of 1912 regulated insurance business.
    • The industry consisted of two state insurers: Life Insurers (LIC) and General Insurers (GIC).
    • In 1972, the General Insurance Business (Nationalisation) Act nationalized general insurance with effect from 1 January 1973.

    5 Major Types of Insurance

    • Life insurance
    • Health insurance
    • Fire insurance
    • Marine insurance
    • Vehicle insurance

    Government Non-Profit Sector Insurance

    • Several government-sponsored insurance schemes exist in India, targeting different categories of people.
    • Some examples include schemes for the poor, farmers, employed, and pensioners. Specific schemes mentioned include Ayushman Bharat, Pradhan Mantri Suraksha Bima Yojana, Aam Aadmi Bima Yojana, Central Government Health Scheme, Janshree Bima Yojana, and others.

    Regulatory Body for Insurance Sector - IRDA/IRDAI

    • IRDAI, the Insurance Regulatory and Development Authority of India, is a government body responsible for regulating and developing the insurance industry in India.
    • IRDAI was founded in 1999 and is headquartered in Hyderabad.

    Public Sector Insurance Companies

    • National Insurance Co. Ltd.
    • New India Assurance Co. Ltd.
    • Oriental Insurance Co. Ltd.
    • United India Insurance Co. Ltd.

    Private Companies

    • A list of private insurance companies are provided.

    TPA

    • Third-Party Administrator (TPA) is an intermediary that assists in the claim settlement process in health insurance.
    • Family Health Plan Insurance TPA Limited (FHPL) is a notable TPA in India.

    Cashless Claims

    • Members must provide required documents, including photo ID proof, to initiate cashless claims at approved network hospitals.

    Reimbursement Claims

    • Members must notify the TPA (FHPL) within 24 hours of hospitalization if it is a non-network claim.

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    Fundamentals of Health Insurance PDF

    Description

    This quiz covers the essential concepts of health insurance, including its history and significance in India. Learn about the first insurance companies and key figures who shaped the industry. Test your knowledge on how health insurance protects individuals from unforeseen losses.

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