Heath Insurance

1
(No Transcript)
2
Know Insurance

• The person or business that gets compensated if
  the loss occurs is known as the Insured.
• The company that agrees to pay the compensation
  is known as the Insurer.
• The money that is paid by the Insured(person) to
  the Insurer(company) is called the Premium.

3
Health Insurance

• System of assurance to make contingencies of
  health care expenses.
• To provide protection against financial loss by
  unforeseen sickness.
• To meet cost of good medical care.
• Relieves anxiety and tension.

4
Definition

• 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.

5
Principles of Insurance

• Utmost good faith
• Insurer and the insured should have good faith to
  each other
• Insurer must provide complete accurate
  information
• the insurance contract must be signed by both
  parties (i.e insurer and insured) in an absolute
  good faith or belief or trust.

6

• Insurable interest
• Insured must have insurable interest in the
  subject matter of the insurance
• For example - The owner of a taxicab has
  insurable interest in the taxicab because he is
  getting income from it. But, if he sells it, he
  will not have an insurable interest left in that
  taxicab.

7
Continues..

• Principles of indemnity
• Indemnity means security, protection and
  compensation given against damage, loss or
  injury.
• According to the principle of indemnity, an
  insurance contract is signed only for getting
  protection against unpredicted financial losses
  arising due to future uncertainties.

8

• Principle of Subrogation
• Subrogation means substituting one creditor for
  another.  
• Principle of loss minimization
• It is the duty of the insured to take all
  possible step to minimize the loss to the insured
  items on the happening of the uncertain event

9
Continues..

• Principle of Causa Proxima
• The loss of the insured property can be caused by
  more than one cause in succession to another
• The property may be insured against some causes
  and tot against all causes
• In such causes the proximate/nearest cause of
  loss to be considered

10
Health Insurance

• It is contract between an health insurance
  company and an individual or his sponsor (e.g. an
  employer).
• The contract can be renewable annually or
  monthly.
• The type and amount of health care costs that
  will be covered by the health insurance company
  are specified in advance, in the member contract
  or "Evidence of Coverage" booklet.

11
Terminologies Health Insurance

• Premium The amount the policy-holder or his
  sponsor (e.g. an employer) pays to the health
  plan each month to purchase health coverage.
• Deductible The amount that the insured must pay
  out-of-pocket before the health insurer pays its
  share.
• Coinsurance Instead of, or in addition to,
  paying a fixed amount up front (a co-payment),
  the co-insurance is a percentage of the total
  cost that insured person may also pay.
• Exclusions The insured person is generally
  expected to pay the full cost of non-covered
  services out of their own pocket.

12
Continues..

• Coverage limits Some health insurance policies
  only pay for health care up to a certain amount.
• Capitation An amount paid by an insurer to a
  health care provider, for which the provider
  agrees to treat all members of the insurer.
• In-Network Provider (U.S. term) A health care
  provider on a list of providers preselected by
  the insurer.
• Explanation of Benefits A document sent by an
  insurer to a patient explaining what was covered
  for a medical service, and how they arrived at
  the payment amount and patient responsibility
  amount.

13
Thank You.