Escolar Documentos
Profissional Documentos
Cultura Documentos
ROLL NO-534
1) Introductory
2) Origin
3) Meaning & Definition
4) Why Health Insurance Is Must
5) Indian Scenario
6) What Are The Issues And Concerns
7) Licensing Of Health Insurance In India
8) Health Sector Financing
9) What Are The Opportunities And Challenges
10)
Need For Priorities
11)
Government Based System(CGHS) & (ESIS)
12)
Employer Managed System
13)
NGO System
14)
Market Based System
GIC Mediclaim Coverage
LIC Coverage
15)
Mediclaim
16)
Overseas Mediclaim
17)
MICRO Health Insurance
18)
Health Insurance For The Poor
19)
Healthcare Products
20)
Third Party Administrators
21)
Future Issues Relating to Health Insurance
22)
News Related To Health Insurance
23)
Conclusion
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INTRODUCTION
India is the first largest country in terms of purchasing power parity
and is considered one of the fastest emerging economics in the world.
However, its health status remains a major concern. Infant mortality
rate of India is as high as 54.6 while it is around 23 for China. Similarly
life expectancy at birth for India is around 64.7 while it is in the range
of 77.80 for many countries. Insurance generally comprises of life and
non-life (general) insurance. Health Insurance in India comes under
general insurance. The development of health insurance in India
therefore, has to be seen in the backdrop of the development of
insurance in general. Healthcare, with global revenue of over Rs.
2.75 trillion is the largest industry in the world. The nation of India with
a population of 1000 million experiences a vast inequity that exists sin
the healthcare industry with barely 3 percent of the population covered
by some form of health insurance, either social or private. Health
insurance schemes are increasingly recognized as preferable
mechanisms to finance health care provision. The option of insurance
seems to be promising alternatives as its pools and transfers risk of
unforeseeable health care costs for a pre-determined fixed premium.
We do not social security system, appropriate Health Insurance
Schemes
for
different
sections
of
the
society
particularly
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penetration being very low and health insurances share being minimal
in the existing situation, the vast majority of the populations are
outside the existing Health Insurance System. With the opening up of
the insurance market for private entry and the accompanying hype it is
being hoped that in the days to come, the teeming population of India
can look for health coverage from an array of insurance providers that
too at an affordable price. The present series on health and group
insurance therefore attempts to trace the significance of health
insurance and its basic tenets in preserving the economic value of the
lives of the citizens.
ORIGIN OF HEALTH INSURANCE
The concept of health insurance was proposed in 1964 by Hugh the
Elder chamberlen form the Peter Chamberlen family. In the late 19th
century, early health insurance was actually disability insurance, in the
sense that it covered only the cost of emergency care for injuries that
could led to a disability. This payment model continued until the start
of the 20th century in some jurisdictions (like California), where all laws
regulating health insurance actually referred to disability insurance.
Patients were expected to pay all other healthcare costs out of their
own packets, under what is known as the fee for-service business
model. During the middle to late 20 th century, traditional disability
insurance evolved into modern health insurance. It is not an easy task
to regulated health insurance. Some countries including the US had to
launch war-like operation to unearth large scale frauds. Malpractices
in health Insurance range from excessive billing to exaggerating
severity of hospital patient conditions.
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Scheme
Beneficiar
ies in lacs
253.
43.
5.
Employer
80.
based
Defense employees
66.
Schemes
Ex-Serviceman
75.
40.
60/80.
100.
8.
2.3
30.
Schemes
WHY HEALTH INSURANCE IS A MUST?
Health insurance has become a necessity today because it plays a
major role in health care. This is because one never knows when
illnesses may strike. And in such cases hospitalization and medication
expenses can be unaffordable. Health insurance can prove to be a
source of support by taking care of the financial burden of your family
may have to go through.
Advancement in science and technology has brought about a
revolutionary change in mans life. It has reduced mortality rates and
increased his life span but at the same time has given rise to a
number of other ills. Increasing pollution levels especially in metros,
stress and strain at workplace, cut throat competition taking its toll are
some of the harsh realities.
Pollution levels in certain areas are unimaginably high and the areas
are nothing short of gas chambers. An individual going to his place of
work has to spend long hours in queues, inhaling the vehicular
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INDIAN SCENARIO
In India, presently the health insurance exists primarily in the form of
Mediclaim policy offered to the individual or to any group, association or
corporate bodies. The government spending is less than 25 percent
against the average spending of 30-40 percent in other developing
countries. There is need for regulation for the self-funded health plans by
major employers who may not find insurance as a cost effective
alternative. According to WHO figures (2002), total health expenditures
represent 6.1% of Indias GDP, but most of this amount, representing
4.8% of GDP is the share of private expenditures and only 1.3% of
GDP is public expenditure. Of the 4.8% private expenditure, 98.5% are
out-of-pocket spending of users. In other words, 77.5% of total
expenditure for health care costs is paid by individuals or households
(WHO, 2005) and this huge expenditure does not pass through any
pooling mechanism. Access to health care in India is still low and with
only less than 1% of GDP allotted to public health, there is lack of
adequate health infrastructure.
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Health care insurance is one such alternative that covers the risk of
payment for health care. William C Hsiao (1992) of the Harvard
University undertook a comparative study of the three models and
concluded that "public financing and private delivery" of health care as
practiced in Canada is the best among the 3 models in terms of
performance, health outcome, public satisfaction and access to health.
There is however, a school of thought that doubts the suitability of this
model to Indian conditions on the grounds that:
i. The size of the population is far more than any of the countries
where it is being currently practiced efficiently.
ii. The level of the per capita income is far lower than in other
countries.
iii. The type of federal set up India has is different from the rest.
True, these apprehensions cannot simply be shunned off but one
redeeming feature of the Indian system is that it has the necessary
infrastructure - sizeable public hospitals, not-for-profit voluntary
organizations plus highly skilled professionals in different kinds of
medical services and decades of experience in managing insurance
business. What is therefore needed is a better link-up of these
available resources with the ordinary consumer at an affordable price.
With the opening up of the insurance market for private entry and the
accompanying hype it is being hoped that in the days to come, the
teeming population of India can look for health coverage from an array
of insurance providers that too at an affordable price. The common
negative factors which evolve after looking at various health coverage
phase are
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11
1. Quality of service when facilities are owned by the plan giver. ESIS,
CGHS is grossly inferior Reimbursement delays in case out of
pocket spending and or rejections of claims
2. Limitations of services Either monetary restriction on the amount
available per year or non-comprehensive care of certain pre-existing &
chronic ailments.
3. Inadequate information regarding health, ailment, procedures &
treatments, cost and outcome
4. Provider malpractices
5. Coatings for comprehensive total care
6. The Low Level of Medical Penetration in India
Health care spend in India is considerably lower than that in other countries..
Life expectancy
US
UK
77.4
78.3
72.6
71.4
72.5
64.0
providers and
(avg. # of years)
# of Physicians
2.7
1.9
1.7
1.2
1.7
0.4
availability of
physicians is one
care service
236
62
32
capital
Healthcare
13.2
8.4
5.5
7.5
5.0
5.3
spend (% of
GDP)
12
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Using central/state
revenue for health
Compulsory premium
contributors to health
Channeling loans, grants
etc. to healthcare
Payments to health are
providers for service
Premium contributions
towards health support
Tax-based and
out-of-pocket
expenses are direct
expenses related
outlays
Health Ins.
Involves a fund
pool for future
healthcare
Tax
funded
Public
Total health
Expenditure
Private
Social
Security
Externally
funded
Out-ofPocket
Private
Health Ins
Externally
sourced
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15
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20
originates from the Union Ministry of Health and Family Welfare and is
channeled to the state governments, which retain considerable
authority for the spending decisions. Over the years, the Central
Government have been the main source of funds for the primary
health care facilities, whereas the states bear the major responsibility
of recurrent costs, especially the costs of running hospitals. This
system has added to the overall inefficiency of public heath facilities.
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EMPLOYER-MANAGED SYSTEMS
Employer-managed health facilities and the reimbursement of
health expenses by employers are the other means of health
insurance in India. Generally, the public sector undertakings and big
industrial houses have their own dispensary and hospitals and provide
medicines, etc, across the counter, usually within the company
premises township. These include defence services, educational
institutions, particularly universities also provides medical services to
their employees.
In addition, there are various medical reimbursement plains offered by
employees for private medical expenses in the private sector including
commercial banks and autonomous institutions. Also, in some
organization we may find a self-insurance system known as medical
benefit or medical allowance scheme. Under this scheme, employees
incurring medical expenses are required to submit their claims to their
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G
IC Mediclaim Coverages
The GIC holds a major share in the market-based health insurance
segment. It introduced the standard Mediclaim health insurance
scheme in 1986, and become operational in 1987. This product was
later on modified in 1997 to allow for premium differentials for various
age group meant for both individuals and groups. As on date, the GIC
and its subsidiaries offer the following products:
23
Anyone in the age group of 5 to 80 years can take the policy. Children
in the age group below the age of 5 years can also be covered from
the age of 3 months onwards provided one or both of the parents are
covered concurrently. Higher limits are permitted of the policy is in
renewal for the preceding three years. Suitable for persons of any
nationality but treatment should be availed of within the country and
the claim is paid in Indian currency/foreign currency.
Salient Features
Provides cover, which takes care of medical expenses following
hospitalization from sudden illness or accident
Cover extends to pre-hospitalization and post-hospitalization for
periods of 30 days and 60 days respectively.
Domiciliary hospitalization is also covered
Benefits
Reimbursement of medical expenses
Discount in insurance premium is allowed on family package,
cumulative bonus and health check. In case of family package cover,
a single member can avail of the entire policy limits.
The premium paid by a cheque upto a maximum of Rs. 10,000 is
totally exempt from income tax.
Domiciliary Hospitalization
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24
The term means that a patient can be treated at home when he is not
in a fit condition to be moved to the hospital or where is no
accommodation in the specialist hospital provided
The treatment was for a period not less than 3 days.
The sub-limits of sum insured towards domiciliary hospitalization are
furnished
Exclusions
The facility is not available if any illness is contracted within 30 days
from the commencement of risk except in case of an accident.
Any pre-existing diseases
Treatment for contracts, benign prostatic hypertrophy, hydrocele,
congenital internal diseases, fistula in anus, piles sinusitis and related
disorders for 1st year of policy
AIDS or conditions of similar kind
Requirements
A completed proposal form. If the prosper is a Diabetic, a separate
questionnaire completed by the family physician.
A.2 BHAVISHYA AROGYA INSURANCE POLICY
Suitability
Bhavishya Arogya is a life term policy where medical benefits are
made available after retirement of the insured. Therefore, by paying
premiums during the earning period, one can make a provision for
medical benefits after retirement. Persons in the age group- of 25 to
55 years are eligible for this policy.
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Salient Features
The policy provides hospitalization benefits for
lifetime after
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26
Requirements
A completed proposal form
Proof of age is necessary as the payment of premium depends on the
age
A.3 JAN AROGYA BIMA POLICY
This policy was introduced in the year-1998. It is designed to provide
hospitalization insurance to poorer sections of the society.
The coverage is along the lines of the individual mediclaim policy
except that cumulative bonus and medical check up benefits are not
included.
The sum insured per insured person is restricted to Rs. 5000/-.
Premium up to Rs. 10000/- qualifies for tax benefit under Section 80D
of the Income Tax Act. Service tax is not applicable to the policy. The
premium payable as per the following table
Age of the person
Up to 45
46-55
years
Head of the family
70
100
Spouse
70
100
Dependent child up to 25 years
190
250
For family of 2+1 dependent children 190
250
For family of 2+2 dependent children 240
300
The policy is available to individuals and family members
56-65
66-70
120
120
290
290
340
by duly
140
140
330
330
380
27
I. Jeevan Asha
Features
Open ended scheme
Covers many surgical procedure
Fixed benefits for surgical treatment can be availed twice (subject
to conditions)
Exclusive Double/Triple accident benefit.
Option to switch over from existing Jeevan Asha plan
Suitable for
The Jeevan Asha II plan is apt for people who whose family history
tends to show hereditary lineage of maladies and afflictions that have
required major or minor surgery from time to time.
Special Features
Under the Jeevan Asha plan, the major surgical procedures covered
for are:
Nervous system (non-malignant causes)
Respiratory system
Cardiovascular system
Haemic and lymphatic system
Endocrine & Ocular system
28
Features
Cover the risk of four major ailments namely, Cancer (malignant),
Paralytic stroke resulting in permanent disability, renal failure of either
kidneys or Coronary artery diseases where by-pass surgery has been
done.
Suitable for:
The Asha Deep II (with profits) policy is best suited for people if they
anticipant or have a family history of serious diseases like Cancer,
Paralysis, Renal failure and Coronary disease.
Special Features
During the term of the policy, if the life assured is afflicted by any of
the major ailments listed above and the same is established as per
rules (in case of Coronary artery disease, the life assured must have
undergone the by-pass surgery), the policyholder will be eligible for
the following benefits, the policy is in force for the full sum assured.
Immediate payment of 50% of the sum assured
Payment of an amount equal to 10% of the sum assured, every year
commencing from the policy anniversary falling on or after the date of
affliction and ending with the policy anniversary preceding the date of
maturity or the date of death of the life assured whichever is earlier.
Payment of balance 50% of the sum assured and vested bonuses on
the date of maturity or on death of life assured, whichever is earlier.
The bonuses will be calculated on the full sum assured even though
50% of the sum assured would have been paid earlier
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A lien for a period of one year will be imposed on all policies on all
policies under this plan. If the life assured does not get afflicted by any
of the diseases mentioned above, the full sum assured and vested
bonuses will be paid on the date of maturity or on death of the life
assured, whichever is earlier.
Benefits
1. Survival Benefits
2. Sum Assured and vested Bonus on maturity.
Death Benefits
Natural: If the life assured is not afflicted by any of the specified
ailments, the legal heirs get the full Sum assured + accrued bonus
Accidental: Accidental benefits available to the life assured whether
afflicted or not afflicted by any of the specified ailments.
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30
MEDICLAIM - AT A GLANCE
The
Policy
basically
covers
reimbursement
of
expenses
of
Basic Cover
The insured person can claim reimbursement for the following
expenditures, provided they are reasonable and necessary incurred:
Room expenses
Nursing expenses
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31
Spouse
Dependent children
Dependent parents
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OVERSEAS MEDICLAIM
At a glance you need Videsh Yatra Mitra Policy if you are going
abroad on business or holiday. The benefits under policy include:
I. General Insurance Plan
Personal Accident Cover
Medical Expenses and Repatriation
Cover Loss of Checked in Baggage
Cover Delay of Checked in Baggage
Cover Loss of Passport
Personal Liability Cover
II. Special Insurance Plans for:
Corporate Frequent Travelers
Overseas Journey Business and holiday
What's more, while you pay the premium in Indian Rupees, the
claims(while abroad) are paid in foreign currency!
1. Personal Accident Cover
If the insured person suffers any bodily injury during the overseas trip
and such injury, within 12 months of its occurrence, is the sole cause
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Up to US$ 225 per dental service taken only for immediate relief of
toothache. Dental care rendered necessary as a result of an
accident that is covered, shall be reimbursed subject to the limit of
cover under Personal Accident.
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If the insured person dies abroad, the expenses incurred for the
preparation and air transportation of the remains to India or an
equivalent amount for their local burial or cremation.
Specific Conditions
Medical expenses that could have been postponed till the insured
returned to India will not be reimbursed. The attending physician
and the Medical Advisors shall decide which expenses can be and
which can't be delayed.
US$ 100 is the deductible amount and any expense below this
amount will have to be borne by the insured person. Further, it also
means that from every claim this amount will be deducted before
making settlement.
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No claim shall be paid for loss or theft of the passport if it was left
Specific Conditions:
US$ 200 is the deductible amount and any expense below this
paid.
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7. Hijack
The Insurance Company will pay up to a sum of US$ 300 (US$ 30 per
day). This sum will become payable by the Insurance Company, if the
insured is held hostage for more than 24 hours.
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BENEFIT
US$)
(in
REMARKS
Medical Expenses
500,000
Personal Accident
25,000
1,000
100
Loss of Passport
250
Deductible: US$ 30
Personal Liability
200,000
Loss
of
Checked
in
Checked
in
Baggage
Delay
of
Baggage
age. The age limit can be extended to 75 years at the option of the
Insurance Company and after such person undergoes a thorough
medical check up. The Medical Reports should be authorized by an
M.D. in Cardiology and should include, ECG Reading, fasting blood
sugar/Urine sugar & Treadmill test in case of medical history
Where the insured person is unable to present himself or herself for
the medical examination (when one is called for by the Insurance
Company), the limit of indemnity will be reduced to US$ 10,000. This
limit will be utilized only towards physician's services, hospital and
medical services and local emergency transportation. Further, the
insurance cover will be restricted to cover only illness or diseases
contracted abroad and not cover accidents. The medical certificate is
a must for persons above 60 years.
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REMARKS
Medical Expenses
Includes USA &
Canada
Excludes USA &
Canada
500,000
250,000
Personal Accident
25,000
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Hospital Benefit
Loss of Checked in
Baggage
1,000
Delay of Checked in
Baggage
100
Delay> 12 hrs
Loss of Passport
250 US$
Deductible: 30 US$
Personal Liability
200,000
Hijack
42
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YESHAVINI CO-OPERATIVE
SCHEME (UHIS)
HEALTH PROGRAMME
(MADHYA PRADESH)
(ANDHRA PRADESH)
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45
NGO/Private Trust
years old)
Rs.20,000
Premium: Rs. 475/Per Person/Per
year
Services provided by nodal
year.
TPA (MD India):Partner-Agent Model
referrals
Coverage (2006); 60,000.
SCHEMES
NO OF
BENEFIC.
YESHASVINI
DHARAMST.
SEWA
KARUNA
PREM
1,83,000
400,000
174,000
118,000
108,000
NAANI
AROGYA
INDORE
ASHWINI
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60,000
60,000
49,000
12,000
TYPE OF
SCHEME
TYPE OF
COVERA
GE
IN- HOUSE TER
P. AGENT
SEC.
P. AGENT
SEC.
P. AGENT
PER/SEC.
In- House
SEC.
TYPE OF TYPE OF
BENEFIT SUBSIDY
CASHL.
CASHL.
REIMB.
REIMB.
CASHL/
DIRECT
INDIRECT
IND/DIRECT
INDIRECT
In- House
REIMB.
PER+SEC CASHL.
IND/DIRECT
P. AGENT
P. AGENT
P. AGENT
+TER
SEC.
CASHL.
SEC.
CASHL.
PER/SEC. CASHL.
INDIRECT
DIRECT
IND/DIRECT
46
through
institutional
arrangements
with
insurance
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47
ISSUES
RELATING
TO
HEALTH
INSURANCE
POLICIES
Socio-Economic Environment
The socio-economic environment has a significant impact on the type
of health insurance policy that consumes will look to buy. If will also
have an impact on the claims patterns of consumers. For instance, in
a relatively poor society, product demand will be for products that
cover day-to-day basic medical care. This will tend to be products
which have high frequency of claims where the average claim sizes
are relatively low.
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IT Systems
The measurement and manipulation of data is of essential importance
in operating an effective health care management system. There is a
vast quantity of data that must be stored and manipulated for the
various aspects of health care management. In addition this data
should be readily available and easily updateable. In short the system
should be robust!
Investment Strategy
Due to the frequency and level of the contribution received for most
health insurance products, providers have large amounts of funds
that need to be invested in appropriate vehicles. Certain countries
(e.g. South Africa) have also introduced reserving requirements,
which will result in significant reserves building-up over time for health
Insurance products. This has introduced the additional complication of
matching assets and liabilities. This is an area where actuarial
judgement is essential.
Cross Subsidies
The issue of cross-subsidies is another item which needs to be
carefully considered by any insurer. There often tends to be crosssubsidies in health insurance policies and in particular in medical
expenses policy. Even when legislation does not force crosssubsidies, it is quite common for there to be cross-subsidies in health
Insurance products. The insurance company needs to examine the
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49
level of the cross-subsidies and ensure that the style of their products
is such that anti-selection will not result in abuse of these crosssubsidies.
Risk Management
The success of any health insurance policy is crucially dependent on
appropriate management of the underlying risks which can be best
attained by
Effective underwriting
effective claim control
Appropriate reserving
Internal operational control
AIDS
The challenges that faces health insurers is how to deal with AIDS
claims, and what product can be designed that meet the needs of
AIDS suffers. This is a challenge that has not, in any market, to my
knowledge, been fully addressed. In some Southern African
countries, insurance companies are offering certain anti-retroviral
treatments in order to extend the expected life span of their policy
holders. This is one area where health Care Management can be
used to delay the payment of insured benefits (normally Life
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50
Insurance) and also add the expected life of the insured, thus
benefiting all parities concerned.
Medical Savings Account:
One example of a new product introduced to relieve the risk of rising
costs is the introduction of medical Savings Account (MSA) as a
component of a Medical Expense Policy. The account holder, at each
ill health incident, has to take a conscious decision whether or not to
draw on savings and deplete his wealth. MSAs can be encouraged
fiscally by providing savers with tax breaks not available to savers for
other purposes. The funds in an MSA could be used to pay health
premiums, deductibles or other medical bills not covered by
insurance. An MSA minimizes moral hazard. There are two main
kinds. One is a short term scheme which can be used at the
discretion of the account holder for day-to-day expenses; the other is
long term, where the savings are intended to build up to a substantial
sum for either major expenditures or for old age.
Capitated Arrangements:
A further innovation in some progressive markets, including the South
African market is the use of a capitation arrangement for Medical
expense Policies. A capitation arrangement involves identifying
certain service providers usually doctors who will provide given
services to their patients. The services provided are usually doctors
consultations. The doctor is paid a fixed fee per policyholder under its
care. The doctor is then responsible for providing whatever care is
necessary to that patient. By linking up a provider network through a
capitation arrangement the risk of over servicing and hence higher
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players
setting
their
sights
on
it.
Deutsche
52
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53
Total premium
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54
FUNDING PATTERN
Release of funds:
1. The Central Govt. share of premium will be released to the ICICI
Lombard directly for coverage of weavers under the scheme in
installments.
2. Service Tax of 10.2% over the annual insurance premium of
Rs.1000/- will be borne by the Government of India
3. In the event the claims ratio including all related costs is below
70%, with the view to incentives the scheme, the surplus shall be
rolled over to the next policy period.
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The
organization
also
wants
to
increase
sickness
benefits,
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ICICI Lombard will tie up with neighborhood hospitals so that handheld machines that read these cards can be installed. Mr Prashad
said the card would reduce administrative hassles for the customer
and would eventually drive down distribution costs. If the experiment
works in Manipal, it may extend this service to other rural health and
motor insurance policyholders. ICICI Lombard would have to tie up
with garages in the case of motor insurance.
In rural areas
Collecting biometric information in rural areas is, however, ridden with
its own set of problems. "The fingerprints of people in the rural areas
are not very clear as they perform intense manual labour. So, we take
the impression of all the fingers and choose the best two prints of
each hand," he said. The card has the capacity to load as many as 15
applications and FINO is in talks with several other finance providers
and government agencies. So, besides cash withdrawal, deposits and
insurance premium payments, the urban and rural poor may also use
this card at the neighborhood kirana store and the post office. Among
banks, ICICI Bank has introduced biometric cards and Citibank has
set up biometric ATMs. Several PSU banks are also on the verge of
introducing similar technology for micro-finance customers.
CONCLUSION
The Government of India, in one of its economic survey reports, has
proclaimed that human development is the ultimate goal of India's
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