Core Healthcare Insurance Products

Chapter 3

Core Healthcare Insurance Products

Three Core Insurance Products are: Private Medical Insurance-Peace of Mind, Policy issue by General insurer, Renewable Annually. Health Cash Plans, Dental Insurance & Capitation (Payment per Capita) Plans.

Core Healthcare Insurance Products

Private Medical Insurance (PMI) NHS Covers Life threatening emergencies or for the relief of Chronic Conditions. PMI pay the cost of Secondary acute Care received Outside NHS. Family, Individuals, Groups of Employees, member of a Club or Affinity Groups may arrange this product.

Private Medical Insurance (PMI)

P. Medical Insurance Can Enable People: Avoid Having to Wait for Treatment, Medical treatment for themselves and Dependent on suitable time, Private Room Facility than Hospital Ward, Avoiding Treatment in Mixed Sex Ward, Private Treatment in the own selected Hospital,

Private Medical Insurance (PMI)

Choice of a specialist Consultant. PMI Can be Cancelled in case of : Non payment of premium, Death of Policyholder, Policyholder moves abroad, Fraud Misrepresentation of a material fact / facts.

Private Medical Insurance (PMI)

Hospital BandsInsurers bands hospital accommodation According to the Cost of the services and the treatment. Most PMI policies specify bands of hospital accommodation under the Policy terms & Conditions.

Private Medical Insurance (PMI)

Highest band Expensive accommodation. Bandings of hospitals depends upon Insurers (mostly 3 -5 bands are available). Banding doesnt determine the quality of medical care provided. Policyholder will contribute if he/she select the highest band hospital for treatment.

Private Medical Insurance (PMI)

Personal PMI Products Individuals purchase for their own or dependents benefits. Categories of Personal PMI Policies : Comprehensive, Standard, Budget and , International.

Private Medical Insurance (PMI)

How to Purchase an individual PMI Policy? Observe the following: Scale or Band of Hospital accommodation, The annual limits of benefit applicable to a particular type of treatment, Any non-standard Exclusion imposed by the insurer.

Private Medical Insurance (PMI)

Comprehensive Policies Widest, Most expensive Cover - Purchased by People of large Disposable income. Benefits of Comprehensive Policies: Hospitals Charges and Specialist Fees, Out Patient Benefits, Other Costs & Benefits.

Private Medical Insurance (PMI)

Hospitals Charges covers : Accommodation & Nursing, Operating theater facilities, Surgical drugs & dressings, Prosthesis ( surgical implanted device in a part of body). Day Case treatment - No overnight stay in hospital,

Private Medical Insurance (PMI)

Some Complementary or Alternative Therapies - Acupuncture, homeopathy. Specialist Fees Covers : Surgeons & Anaesthetists Fee. Classification of Surgical Procedure: Complex Major operation (CMO), Major Plus, Major, Intermediate &, Minor.

Private Medical Insurance (PMI)

Out Patient benefits Include: Pathology (Blood & Urine test), Radiology (X-rays / Body Scans), Physiotherapy and, Consultations.

Private Medical Insurance (PMI)

Other Costs & Benefits : Treatment for mental & Addictive illness Drugs & Alcohol excluded, Overseas cover-Cost of Repatriation in Emergency, Alternative or Complementary medicine, Dental treatment up to a stated limit,

Private Medical Insurance (PMI)

Cost of Eye care-up to a a stated limit, Cash benefit free treatment by NHS, Cash Payment for each night spent in hospital, Cost of a guest room Parents with Insured child, Home Nursing Facilities, Use of a Pvt. Ambulance.

Private Medical Insurance (PMI)

Standard Policies low premium, lower band hospitals. Standard Policies are Similar to Comprehensive Policies with some exceptions of certain benefits such as : Cash Benefits, Out patient benefits.

Private Medical Insurance (PMI)

Budget Policies Lowest Premium & People Purchase according to their needs. Out patient benefits is totally excluded or ver limited. Budget Policies are Divided into following: 6 / 12 week Policies Limited Benefit Policies.

Private Medical Insurance (PMI)

Group PMI Employer purchase PMI for their Employee for their loyalty or financial implication for the business. 3 Categories of Group PMI: Small Group Schemes, Large Group Schemes, Voluntary Schemes.

Private Medical Insurance (PMI)

Small Group Schemes: Scheme for less than 50 members, Low premium & Family member can join the group, Cover all employees with in a given Category and Beneficial for small business.

Private Medical Insurance (PMI)

Large Group Schemes: Schemes for 50 or more Members, Mostly, no exclusion for Pre existing Conditions, Premiums are based on Claims Experience, Cover all employees with in a clearly defined given category, Premium is paid in full by the employer, Family members can be added at a discount.

Private Medical Insurance (PMI)

Voluntary Schemes: Scheme is sponsored by the Employer / organization / association but premium is paid by Employees. Discount is offered to each member according to the size &/or Claim experience.

Private Medical Insurance (PMI)

Benefit Structure of group PMI: Only cover acute, non emergency medical Conditions. Fiercest competition in the market. Tailor-made policies according to the requirement of the organization. Finance & HR Department - Involved in designing of Group Insurance Policy.

Private Medical Insurance (PMI)

Improved customer services due to Competition. Prompt & sympathetic handling of PMI Claims. Well trained staff to deal with customer Enquiries.

Private Medical Insurance (PMI)

Supplementary Group benefits Insurers have introduced Employee Assistance / Support Program for Employees for confidential councelling service for a range of issues, including : Debts & Financial Worries,

Private Medical Insurance (PMI)

Family & Domestic difficulties, Mental & addictive illnesses, including drug abuse, Legal Advice and, Any general concerns an employee may have about their health, lifestyle or job.

Private Medical Insurance (PMI)

Occupational Health Audits insurers & other organizations offer an occupational health audit to a companys Employees. Health & lifestyle Questionnaires, Specific check-ups, Advice on Diet & fitness.

Private Medical Insurance (PMI)

Table of Benefits is provided for claims and cover provided under the contract. It is provided because of commercial reasons long term chronic conditions are not covered.

Private Medical Insurance (PMI)

Policy Excess Excess decreases the Premium amount Customer pays the excess amount in the event of the claim.

HEALTH CASH PLANS

Innovative Market. 3 / 6 month initial period during which claim may not be made. Fast claim payment with minimal checking. Plans are mostly sold directly. Small market share of intermediaries.

HEALTH CASH PLANS

Before NHS Voluntary groups Funded the Local Hospitals. Subscribers (Mostly breadwinner) entitled for Healthcare. Advent of NHS Reduce the value of these benefits and new benefits were developed.

HEALTH CASH PLANS

Most Valuable Benefits are: Dental Cost Half yearly Check ups & other Treatments, Specialist treatment such as Bridge work, Optical Costs Eye tests, Cost of Spectacles & Contact lenses.

HEALTH CASH PLANS

Other Benefits may Include : Consultation Specialist or Consultant following Referral from a GP, A Cash Payment Each Night or Day spent in Hospital ( sometimes with an additional benefits due to some accident), Recuperation Benefit Cash Lump sum payable after spending 7 14 days in hospital continuously,

HEALTH CASH PLANS

A Maternity / Paternity cash grant, Home help/Home nursing / Physiotherapy, Convalescence (Gradual recovery after illness) funds maintain their own convalescence homes, Complementary Therapies homeopathy, acupuncture etc., Hearing aids / Chiropody (Treatment of hands & foots diseases),

HEALTH CASH PLANS

Funeral Grant / Prescription Costs, Health Screening, and Help lines.

Dental Insurance & Capitation Plans

Dental Insurance : Sold as a group contract to employee. Benefits, Annually renewable, payment according to the treatment, , Dentist choice. Benefits New patient examination, Preventive carePeriodic check ups, X-rays, Minor remedial carefilling, root canal treatment,

Dental Insurance
Major restorative (curative) treatment Crowns, bridges & dentures . Cover for accidents, injuries and treatment abroad, Insurance for mouth cancer Cash lump sum payment on diagnosis, Help lines.

Capitation Plans
Capitation plan is a budgeting plan. Plan usually sold to customer by dentist, Dentist undertakes an initial dental exam., Customer is placed in a particular risk group according to the examination, Higher risk group, higher monthly fee, Fees are paid to the provider (not to the dentist), who pays an agreed fixed

Capitation Plans
monthly sum to the dentist, No IPT on Fees, Without payment dentist carried out all dental work, It may include insurance against accidents, injuries, & mouth cancer, and may cover treatment abroad & help line.