Health insurance is popularly known as mediclaim. It is one of the most rapidly growing sectors in India. In many developed countries, health insurance works as an independent kind of insurance. Health insurance is made compulsory and legally mandatory in these developed countries. Due to this the patient need not have to spend a single penny. All the bills of the doctors are paid by the insurance companies. Whenever a patient falls ill, he just has to go to the hospital, show his mediclaim card and get admitted and on recovery straight way go back to home. The bills of the patient are paid by the insurance company on his recovery. This process is called as cashless hospitalization. In India, the health insurance or mediclaim is still in a very primary stage.
Mediclaim was started by Mussolini in Italy during the period of Second World War. Initially mediclaim was available to only government employees and limited persons. But slowly this sector has reached to all type of people and has become compulsory and mandatory. In India, health insurance is considered as a subtype of general insurance and is sold as personal cover. It is developing slowly nowadays. The life insurance companies are also providing health insurance in the form of critical illness rider.
Grossly there are three sections of health insurance:
Health Insurance Company:
These insurance companies prepare different types of insurance policies and sell them to common people. These insurance products are personal insurance, group insurance, and family insurance type. The policy holder pays premium to the insurance companies for buying these insurance products and the insurance companies provide them the mediclaim policies.
These hospitals treat the mediclaim policy holders in their illness. The mediclaim policies are applicable only after 24 hours of hospitalization. These hospitals should have their empanelment at the insurance office and at Third Party Administrators (T.P.A) Company, then only the policy holders can be treated at these hospitals.
Third Party Administrators:
Third Party Administrators
The third party administrators are the companies which inspect the hospitals and then do their empanelment. These companies have prepared a chain of such hospitals. The third party administrators have experts from insurance sector and medical field to assist them. These experts play a very important role in admitting the policy holders to hospitals and settling their claim. The third party administrators also perform the functions of sending the identity card to the policy holders, providing toll free services; settle the claims with the hospitals and many other such jobs. In India there is an independent health insurance department in every insurance company, then be it a life insurance company or general insurance company. This department carries out all the functions of health insurance.
Following three companies in India carries out solely the business of health insurance:
1) Star Health and Allied Insurance Company
2) Apollo Munich Health Insurance Company
3) Max Bupa Health Insurance Company
Along with these companies now many other companies like Religare, HDFC standard, S.B.I etc also have started taking steps to establish independent health insurance company. It is expected that in the coming 5 years minimum 25-30 company will be working independently in the health insurance sector. Along with this, 28 third party administrators company are working in the insurance sector in the Indian market. There is wide scope for careers in Health Insurance Companies. For example: Health care management companies, health care service providers, corporate hospitals, companies organizing medical tourism, companies involved in medical trials, biomedical companies, patient counseling companies requires manpower at different levels. For this the minimum skills required are graduatation in any discipline, diploma in health insurance and basic knowledge of computer.
The medical professionals have a great scope in this sector. The doctors have very less knowledge of health insurance. The diploma of health insurance has become very essential for the doctors who want to do their career in abroad. The field of health insurance also has opportunities for those who have done diploma or degree in pharmacy or have completed their B.Sc and working as medical representative. Their knowledge of medical sector can prove beneficial for them in this field. The health insurance has more scope for ladies since most of the jobs are of back office type. The natural qualities of woman are very useful for back office management and providing customer care in health insurance companies and T.P.A hospitals. But for this the knowledge of health insurance is essential.
The concept of family doctor has disappeared now. For protection from the increasing medical bills and the enormous cost of medicines, mediclaim is the only option. Only 4% people of Indian population are insured under mediclaim. It is predicted that till 2012, the health care sector of India will have a turnover of 20,000 crores. The big hospitals of 300 – 500 beds are being developed on large scale in rural areas. This sector will require huge man power in the coming future. Some experts of this sector have demanded to set up a separate Health Insurance Regulatory Authority to regulate the remarkable growth and capability of this sector.
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