Brief Information about Health Insurance

-

General Insurance:

Broadly, General insurance is divided into 3 Categories i.e.
1.   Personal Insurance
2.   Liability Insurance
3.   Property Insurance
Personal Insurance has 2 major aspects i.e.
1.   Mediclaim Policies
2.   Personal Accident Policies



Follow us on LinkedIn : Actuary Sense
Follow me on LinkedIn: Kamal Sardana

 Mediclaim Policies:
 Introduced in India in 1981. They offer Health insurance and can be issued as Individual policies or as a Group Policy.

Health Insurance:
·        It is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.
·        A Health Insurance policy reimburses the insured for medical and surgical expenses arising from illness or injury that leads to hospitalization



Inclusions: Following expenses are reimbursed
1.   Nursing expenses, Anaesthesia and other specialist doctor Fees.
2.   Operation theatre, Room and Boarding Charges
3.   Treatment in a Hospital which has to be
·        Registered
·        Has an Operation theatre
·        Has atleast 15 Patient Beds (10 for C class Cities)
4.   Requirement is that Patient should be admitted for atleast 24 hrs but this condition not applicable in case of – “Dialysis, Chemotherapy, Dental Surgery etc”.
5.   Medical Expenses 30 days prior to and 60 days after hospitalization are also paid provided incurred for same ailment for which he is hospitalized.
Exclusions: Following Expenses are excluded from the Policy:
1.   War and Nuclear Perils
2.   Pre-existing Disease, AIDS, Hearing Aids and Spectacles
3.   Certain ailments are excluded for the first 30 days from the start of policy and some ailments are excluded for the first year such as Cataract, Hernia, Piles as they take time to develop.

Notes:
1.   These Policies can be issued in age group 5-80 years. However Children can covered between 3 months and 5 years too if one of the parents have taken a Mediclaim policy.
2.   Principle of Contribution Shall Apply.
3.   Policy can be cancelled by 30 days Notice. If cancelled by insurer, refund is made on Prorate basis. If cancelled by insured, refund is based on Short period basis.

Deductions by Government:
Persons Covered
Exemption Limit
Check-up Exemption
Total
Self, spouse and children
Rs. 25000
Rs.5000
Rs.30000
Self and family + parents
Rs.25000+25000=50000
Rs.5000
Rs.55000
Self and family+ senior citizen Parents
Rs.25000+30000=55000
Rs.5000
Rs.60000
Self (senior citizen) and family and Parents (senior citizen)
Rs.30000+30000=60000
Rs.5000
Rs65000




Follow us on LinkedIn : Actuary Sense
Follow me on LinkedIn: Kamal Sardana

Comments

Post a Comment

Popular posts from this blog

Term structure of interest Rates : Theories Explained

-
Image
Follow us on LinkedIn : Actuary Sense
Follow me : Kamal Sardana


Term Structure of Interest Rates: The term structure of interest rates, also called the yield curve, is a graph that plots the yields of similar-quality bonds against their maturities, from shortest to longest
Important Notes: ·The graph that plots coupon rates against a range of maturities -- that graph is called the spot curve. ·The graph that plots yields against a range of maturities – that graph is called the Yield curve. So, what is the difference between coupon rates and yield rates? - Yield rate is the interest earned by the buyer on the bond purchased, and is expressed as a percentage of the total investment. Coupon rate is the amount of interest derived every year, expressed as a percentage of the bond’s face value.Yield rate and coupon rate are directly correlated. The higher the rate of coupon bonds, the higher the yield rate.
As you know that the interest rate will not remain same as the markets are dynamic and const…
Read more

NPV vs IRR : Which is better and Why

-
Image
Follow us on LinkedIn : Actuary Sense Follow me on LinkedIn: Kamal Sardana

NPV: popularly known as Net present value. This is the difference between the present value of cash inflows and cash outflows. ·If you are investing in certain investments or projects if it produces positive NPV or NPV>0 then you can accept that project. ·And in case of negative NPV or NPV<0, you should not accept the project. Now there are some advantages and disadvantages: Advantages: 1.It helps you to maximize your wealth as it will show your returns greater than its cost of capital or not. 2.It takes into consideration both before & after cash flow over the life span of a project. 3.It considers all discount rates that may exist at different point of time while discounting back our cashflows. Disadvantages: 1.Calculating Appropriate discount rate is difficult. 2.It will not give accurate decision if two or more projects are of unequal life. 3.It doesn’t provide accurate answer at what period of time you will a…
Read more

Pension Plans: DB vs DC

-
Image
Follow us on LinkedIn: Actuary Sense
Follow me on LinkedIN: Kamal Sardana



 Broadly there are three sources of Retirement Income:    1.Government Programs (such as Social Security Benefits)    2.Employer Programs (such as Pensions)    3.Personal Savings
     1.Governmental Programs: Under this program, there are Social security Benefits (Social Security benefits are paid out monthly to retired workers and their spouses who have, during their working years, paid into the Social Security system) Medicare and Medicaid. Difference between Medicare and Medicaid is that, Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income
       2.Employer Contributions: For example: Defined Contribution plans, Defined Benefits plan etc. which we will discussed shortly.

        3.Personal Savings: such as Personal investments.
Now Let’s …
Read more