Page 224 - DCOM309_INSURANCE_LAWS_AND_PRACTICES

Unit 12: Health and Catastrophe Insurance

Treatment arising from childbirth including Caesarean section (can be deleted, if maternity Notes
benefit is covered).

TPA is licensed by the IRDA who will settle the health insurance claims on behalf of the
insurance companies.
An investment in health insurance scheme would be a judicious decision. The health
insurance scheme could either be a personal scheme or a group scheme sponsored by an
employer. Some of the existing health insurance schemes currently available are individual,
family, group insurance schemes, and senior citizens insurance schemes, long-term health
care and insurance cover for specific diseases.

Critical Illness Policy is an exclusive benefit policy for individuals in the age group 20-65
years covering coronary artery surgery, cancer, renal failure, stroke, multiple sclerosis
and major organ transplants like kidney, lung, pancreas or bone marrow.

The Tata Group is one of the largest and most respected industrial houses in the country,
while AIG is a leading US based insurance and financial services company with a presence
in over 130 countries and jurisdictions around the world.
Catastrophe insurance is unlike from various other kinds of insurance in that it is hard to
estimate the entire potential cost of an insured and protected loss and a catastrophic event
results in an extremely large number of claims being filed at the same time.
Many countries have meaningful mechanisms for disaster risks, with involvement by
private insurers a common feature. For the Indian market, potentially prohibitive
insurability issues will need a public-private partnership involving Government subsidy
to provide coverage to those unable to afford it.

12.7 Keywords

Catastrophe Insurance: Catastrophe insurance refers to the insurance to protect businesses and
residences against natural disasters such as earthquakes, floods and hurricanes, and against
man-made disasters such as terrorist attacks.
Domiciliary Hospitalisation Benefit: It means medical treatment for a period exceeding three
days for such illness/injury which in the normal course would require treatment at the hospital/
nursing home but actually taken whilst confined at home in India.
Family Discount: It is a discount of 10% in the total premium is allowed to a family comprising
the insured and spouse, dependent children and dependent parents.
Health Insurance: It refers to a type of insurance coverage that pays for medical and surgical
expenses that are incurred by the insured. Health insurance can either reimburse the insured for
expenses incurred from illness or injury or pay the care provider directly.

Hospital/Nursing Home: It means any institution in India established for indoor care and
treatment of sickness and injuries.
Third Party Administrator (TPA): TPA is licensed by the IRDA who will settle the health
insurance claims on behalf of the insurance companies.

12.8 Review Questions

1. Describe the various features of health insurance policies.
2. What is the minimum criterion for health insurance policy?

LOVELY PROFESSIONAL UNIVERSITY 219