MASSIVE HEALTH INSURANCES FOR COMMONMEN AND NEW ROLE OF HEALTH INSURANCE BROKERS

1. MASSIVE HEALTH INSURANCES FOR COMMONMEN AND NEW ROLE OF HEALTH INSURANCE BROKERS BY MR. K.L. NAIK (M.A.)

2. SPECIFIC FEATURES OF HEALTH INSURANCESSAD STORY OF COMMON MAN • IT IS A TALE OF COMMON MAN THAT IN HIS LIFE, ‘HEALTH’ AND ‘WEALTH’ CONSUME EASCH OTHER! FROM THE AGE OF 25 TO 60, ONE CARELESSLY HUNTS TO GET MORE AND MORE WEALTH AND IN THE PROCESS, HEALTH IS IGNORED. IN MAD RUSH TO GAIN WEALTH- ONE LOSES HEALTH. THEN FROM THE AGE OF 50 TO 60, ‘HEALTH’ DETERIORATES AND ‘WEALTH’ IS CONSUMED RAPIDLY. FROM THE AGE OF 61 ONWARDS UPTO 65 OR 70, ONE LOSES BOTH HEALTH AND WEALTH. HEALTH INSURANCE POLICIES ARE ALSO DIFFICULT WITH EXCLUSIONS AND WHATEVER ELEMENTS ARE COVERED TO MAINTAIN HEALTH, ALSO FACE ODDS IN CLAIMS SETTLEMENTS! OLD AGE, FINANCIAL AND PHYSICAL STRAINS AND PRACTICAL PROBLEMS AFTER HEALTH INSURANCE GIVES A STORY OF SADNESS! COMMON MEN OF MIDDLE AND LOWER CLASS FIND HEALTH INSURANCES UNAFFORDABLE! • HEALTH INSURANCE AIMS TO PROTECT ALL CITIZENS, POOR-N-LOWER MIDDLE CLASS WHO CANNOT AFFORD TO BUY INSURANCE. STATE SPONSORED HEALTH INSURANCE SCHEMES LIKE AYUSHMAN BHARAT SCHEME ARE DESIGNED TO COVER MASSES.

3. UNDER SUCH A SCENARIO, ‘MODICARE’ OF OUR PRIME MINISTER IS A RAY OF HOPE WITH MASSIVE HEALTH INSURANCE SCHEMES COVERING MORE THAN 100 MILLION FAMILIES I.E. MORE THAN 500 MILLION PLUS POPULATION OF LOWER MIDDLE AND POOR CLASSES OF OUR SOCIETY! IT HAS BECOME A REALITY OF LIFE THAT HEALTH INSURANCE SCHEMES LIKE AYUSHMAN BHARAT ARE FOR THE PEOPLE, OF THE PEOPLE, BY THE WELFARE STATES GOVERNMENTS. ‘MODICARE’ IS A NEW WORD FOR ALL KINDS OF HEALTHCARE- MEDICARE SERVICES AVAILABLE AT HOSPITAL CHAINS ON CASHLESS BASIS i.e EXPENSES ARE REIMBURSED DIRECTLY BY GOVERNMENT FUNDING TO SERVICE PROVIDERS OF HEALTHCARE. • HEALTH INSURANCES ARE HANDLED BY BOTH LIFE INSURERS AND GENERAL INSURERS AS WELL AS SPECIALIZED HEALTH INSURANCE COMPANIES WITH THIRD PARTY ADMINISTRATIVE SERVICE COMPANIES. • HEALTH INSURANCE IN ALL ADVANCED AND EMERGING MARKETS OF THE WORLD IS RAPIDLY INCREASING AS SEGMENT OF GENERAL INSURANCE WITH EVER INCREASING RATIO OF TOTAL GLOBAL PREMIUMS. • ACCORDING TO WORLD INSURANCE PREMIUMS ESTIMATED FOR 2018 IN SIGMA REPORT 3/2019, MOTOR IS 33% AND HEALTH IS ONLY 32% INCLUDING ACCIDENT OUT OF GLOBAL NON-LIFE PREMIUMS OF US$ 2373 BILLION FOR 2018. THUS, HEALTH INSURANCE IS APPROXIMATELY US$ 680 BILLION i.e. 27% FOR THE YEAR 2018.

4. HEALTH PREMIUMS HAVE BECOME NUMBER TWO SEGMENT AFTER MOTOR IN ALMOST ALL ADVANCING-EMERGING MARKETS. • THE AYUSHMAN BHARAT SCHEME IS THE WORLD’S BIGGEST HEALTHCARE SCHEME ENCOMPASSING MORE THAN 500 MILLION POPULATION AMONG LOWER MIDDLE AND POOR CLASS OF OUR SOCIETY. • HEALTH INSURANCE IS FUNDED BY CENTRAL STATE GOVERNMENTS IN VARIOUS KINDS OF HEALTH INSURANCE SCHEMES. • IN CONTEXT WITH INDIAN MARKETS, HEALTH INSURANCE PREMIUMS ARE AROUND 30% OF TOTAL NON-LIFE PREMIUMS AS INDICATED HEREUDER:

5. SPECIFIC CHARACTERISTICS OF HEALTH INSURANCE: • THE WORLD HEALTH ORGANIZATION- WHO- DEFINES HEALTH AS WELLBEING CONDITIONS OF ALL HUMAN BEINGS- PHYSICALLY, MENTALLY AND SOCIALLY. • MERE ABSENCE OF DISEASE DOES NOT MEAN GOOD HEALTH AS SOME DISEASES REVEAL ONLY AT CRITICAL LEVEL OF SPREADING IN THE HUMAN BODY. • LIFESTYLES, ENVIRONMENT AND GENETIC FACTORS CAUSE HEALTH PROBLEMS. • HEALTHCARE- MEDICARE- HOSPITALIZATION-SURGERIES AND TREATMENTS FOR DIAGNOSIS AND CURE ARE BECOMING VERY COSTLY WITH PHARMA COMPANIES MANUFACTURING DRUGS, MEDICINES AND ALL HEALTH RELATED MEDICINES HAVE BEEN BECOMING COSTLIER DAY BY DAY. HEALTHCARE COSTS SHOULD NOT MAKE TREATMENTS OF FATAL SICKNESS UNAFFORDABLE! VARIOUS HEALTHCARE SERVICES ARE COVERED SO THAT LOWER MIDDLE CLASS AND POOR CLASS FAMILIES GET ALL THE HEALTHCARE SERVICES- ‘MODICARE’- FREE OF COST.

6. HEALTH INSURANCE SCHEMES ARE FOR THE PEOPLE AND OF THE PEOPLE BY SUPPORT OF THE GOVERNMENTS FUNDING OF COSTS DIRECTLY TO HEALTHCARE SERVICE PROVIDER HOSPITALS, CHEMISTS, DRUGGISTS AND CLINICS. • A VAST TASKFORCE OF ALL SERVICE PROVIDER HOSPITAL CHAINS, DRUGGISTS, CHEMISTS, AGENCIES, INSURANCE COMPANIES, INTERMEDIARIES AND SO ON ARE WORKING TO REACH ‘COMMON MEN’ BY SERVING POORS IN EFFECTIVE AND EFFICIENT WAYS. • HEALTHCARE OF MASSESIS A MISSION OF EVERY INDIAN AND ALL HAVE BEEN BECOMING INVOLVED IN REACHING THE GOAL- THE RIGHT TO LIVE HEALTHY. RIGHT WAYS OF LIVING MUST MAKE US HEALTHY, WEALTHY AND WISE BECAUSE WEALTH IS NOT CONSUMED BY COSTS TO CURE ILL HEALTH AND MAINTAIN GOOD HEALTH. • THE NATIONAL PHARMACEUTICAL PRICING AUTHORITY- NPPA- HAVE REVEALED THAT THEY ARE MAKING PROFITS OF 1737% ON DRUGS. CONSUMABLES AND DIAGNOSTICS ACCOUNT FOR 46% OF PATIENTS BILLS. MAJOR BENEFICIARIES ARE HOSPITALS RATHER THAN DRUG MANUFACTURERS BECAUSE OF INFLATED BILLS.

7. ALL SUCH ASPECTS ARE CONSIDERED WHILE LAUNCHING THE LARGEST HEALTH INSURANCE SCHEMES VIZ. THE AYUSHMAN BHARAT ON SEPTEMBER, 2018. 50 CRORE PEOPLE OF 10 CRORE FAMILIES ARE COVERED ALL OVER THE SUB-CONTINENT OF INDIA AND THE SCHEME IS POOR PEOPLE-FRIENDLY WITH RS. 500,000 EXPENSES FOR HOSPITALIZATION BY EACH FAMILY- THESE AMOUNTS ARE FUNDED BY THE CENTRAL AND STATE GOVERNMENTS. ONE YEAR OF THIS LARGEST WORLD HEALTH INSURANCE SCHEME WILL BE COMPLETED ON 31ST AUGUST, 2019. MORE THAN 500 MILLION POOR PEOPLE HAVE BENEFITED SO FAR AND THE NUMBER IS INCREASING. ALMOST 60% OF OUR POPULATION OF POOR PEOPLE ARE BENEFICIARIES FOR THE FIRST TIME AFTER INDEPENDENCE. • INSURANCE COMPANIES HAVE BEEN ACTIVELY INVOLVED IN THE PRACTICAL IMPLEMENTATION OF THIS MASSIVE SCHEME AND INSURE THE GOVERNMENT. INITIAL SUCCESS OF ALL IN HANDLING HEALTH INSURANCE SCHEMES CAN BE POINTED OUT AS UNDER: • 1354 HEALTH PACKAGES ARE OFFERED FOR CORONARY BYPASS SURGERY, KNEE REPLACEMENT AND STINTING ARE MADE 15% TO 20% CHEAPER. • EACH HOSPITAL MUST HAVE ‘AYUSHMAN MITRA’ TO IMMEDIATELY ATTEND TO PATIENTS. • ALL THE BENEFICIARIES ARE GIVEN THE CODES FOR IDENTIFICATION AND ELIGIBILITY. • CASHLESS TREATMENT FACILITY AT BOTH PUBLIC AND PRIVATE HOSPITALS. • RS. 500,000 PER FAMILY FOR ANY GENDER FOR HOSPITALIZATION.

8. ALLOPATHY AND ITS ALTERNATIVES ARE COVERED FOR TREATMENTS AS PER ANSH. • ANY FAMILY COVERED ANYWHERE IN INDIA CAN BE TREATED BY HOSPITALS ANYWHERE IN INDIA. • PRE-EXISTING DISEASES ARE COVERED. • FIXED TRANSPORTATION ALLOWANCES FROM RESIDENCE TO HOSPITALS ARE GIVEN TO ALL ELIGIBLE FAMILIES. • ‘MODICARE’ IS THE COMMON NAME OF THE VARIOUS KINDS OF GOVERNMENT SPONSORED HEALTH INSURANCE SCHEMES. • NEW INDIA IS AWAKENED AND THE MARCH IS ON AND ON FOR MAKING ‘INDIA’ WITH LIFESTYLES HEALTHY AND WISE! • INDIAN INSURANCE INDUSTRIES’ ALL PLAYERS ARE ACTIVELY INVOLVED WITH THE VARIETY OF INNOVATIVE PRODUCTS SATISFYING ALL KINDS OF REQUIREMENTS FOR HEALTH TREATMENTS ANYWHERE IN INDIA. • COMMON MAN NOW DOES NOT FIND HIMSELF LEFT ALONE AS HEALTH INSURANCE IS NOW REALISTICALLY AN AFFORDABLE, EFFICIENT AND BENEVOLENT PROTECTION AGAINST ANY CAUSE OF LOSING GOOD HEALTH.

9. AWARENESS, EDUCATION AND MISSIONARY ZEAL TO MAKE NEW INDIA STRONGER IS A DREAM BECOMING REALITY. • ‘GOOD HEALTH’ OF CITIZENS IS THE ROOT OF ‘GOOD WEALTH’. • ‘HEALTH’ AND ‘WEALTH’ ARE TO BECOME ‘COMPLEMENTARY’.

10. NEW ROLE OF HEALTH INSURANCE BROKERS: • INSURANCE BROKER IS TO REACH GRASS ROOTS LEVELS OF OUR SOCIETY TO BRING COMMON MAN ON MASSIVE SCALE OF LOWER MIDDLE AND POOR PEOPLE WHO CANNOT AFFORD INSURANCES. ALL THESE SEGMENTS OF SOCIETY ARE TO BE BROUGHT IN THE MAIN STREAM OF INSURANCE PROTECTIONS FOR THEM TO INSURE AND BE SECURE. • NEW ROLE OF HEALTH INSURANCE BROKERS IS TO BE PLAYED WITH A MISSIONARY ZEAL TO ARISE, AWAKEN AND STRENGTHEN COMMON MEN IN THEIR STRUGGLE TO LIVE A BETTER LIFE WITH GOOD HEALTH- MENTAL, PHYSICAL AND SOCIAL. • INSURANCE BROKERS REPRESENT INSUREDS TO INSURERS AND GIVE THEIR CONTRIBUTION BY TECHNOLOGICAL AND MARKETING SKILLS. • INSUREDS ARE LAYMEN, INSURANCE BROKERS PROVIDE INSURANCE TECHNOLOGICAL KNOWLEDGE TO HANDLE RISK MANAGEMENT AND CLAIMS MANAGEMENT OF ALL INSUREDS.

11. INSURANCE BROKERS HAVE EXPERTISE TO MANAGE EXPERTS WITH ‘KNOW WHO’ AND ‘ KNOW HOW’ TO NEGOTIATE BETTER DEAL WITH INSURERS WITH INSURANCE POLICY TERMS TO COVER RISKS OF ALL INSUREDS. • INSURANCE BROKERS HAVE PERSONALISED RELATIONS WITH HEALTH INSURERS IN A MARKET. • THEY ALSO MAKE ANALYTICAL STUDY OF VARIOUS INNOVATIVE PRODUCTS OF MANY INSURERS. • HEALTH INSURANCE BROKERS AND HEALTH INSURERS CREATE TEAMS OF DEDICATED SPECTIALISTS. ‘TEAM’ IS A TERM WITHOUT ‘I’ – EGO OF ANY ONE. • ‘HEALTH IS A SEGMENT OF GENERAL INSURANCE AS WELL AS LIFE INSURANCES. COMPREHENSIVE PACKAGE POLICIES ARE ISSUED TO COVER INNOVATIVE PRODUCTS, SPECIFIC GROUP INSURANCE SCHEMES AND

12. IMPLEMENTATION OF MASSIVE HEALTH INSURANCE SCHEMES AIMED AT REACHING MILLIONS OF FAMILIES. HUGE TASK FORCE REQUIRED TO FULFIL THE NOBLE CAUSE OF MAKING AVAILABLE HEALTHCARE SERVICES FOR CRITICAL ILLNESS, CARDIC SURGERIES , CANCER ETC. HEALTH PORTFOLIO OF INSURED RISKS IS GROWING RAPIDDLY IN THE MOST ADVANCED, ADVANCING AND EMERGING ECONOMIES OF THE WORLD. • TODAY ACCORDING TO SIGMA REPORTS 3/19, GLOBAL GENERAL INSURANCE PREMIUMS FOR 2018 ARE US$ 2373 BILLION! OUT OF THESE, HEALTH PREMIUMS ARE ESTIMATED AT US$ 640 BILLION WHICH IS ALMOST 27% OF TOTAL GLOBAL NON-LIFE PREMIUM OF US$ 2373 BILLIONS

13. HEALTH INSURANCE SCHEMES ARE UNIQUE AS COMPARED TO OTHER CLASSES OF GENERAL INSURANCES WITH SPECIFIC CHARACTERISTICS: • HEALTHCARE SERVICES MUST REACH THE GRASSROOTS LEVEL COVERING LOWER MIDDLE AND POOR CLASS PEOPLE WHO CANNOT AFFORD HEALTHCARE SERVICES WITHOUT THE SUPPORT OF STATE GOVERNMENTS FOR FUNDING THE SCHEMES IMPLEMENTED THROUGH INSURANCE COMPANIES, THEIR AGENTS, TPA’S PROVIDE SERVICES TO INSURED MASSES. • AGENTS ARE EMPLOYEES OF A PARTICULAR INSURANCE COMPANY AND REPRESENT INSURERS TO INSUREDS. • INSURANCE BROKERS REPRESENT INSUREDS TO INSURERS. • HEALTH INSURANCE HAVE MAJOR ELEMENTS OF CORPORATE SECTOR SCHEMES WHERE INSURANCE BROKERS MAKE VALUE ADDED CONTRIBUTIONS • GOVERNMENT WELFARE HEALTH INSURANCE SCHEMES ARE GIANT STEPS WHERE INSURANCE BROKERS PROVIDE ADVISORY FUNCTIONS AS AND WHEN REQUIRED • DIRECT INSURANCE BROKERS HANDLE AROUND 5% OF HEALTH INSURANCE PORTFOLIO • REINSURANCE BROKERS ROLE IS VITAL IN DESIGNING REINSURANCE PROGRAM TO PROTECT ENTIRE HEALTH INSURANCE PORTFOLIO OF REINSURED INSURANCE COMPANIES

14. ROLE OF REINSURANCE BROKERS : • Reinsurance :- • Reinsurance • Insurance • Insured Insurer • Reinsurers C A B D E

15. NEW ROLE OF HEALTH INSURANCE BROKERS : • MASSIVE SCALE OF INSUREDS ARE TO BE APPROACHED TO BRING THEM IN THE MAIN STREAM OF INSURANCE PRODUCT. • TO HELP IN DEVISING INNOVATIVE NEW PRODUCTS. • TO HANDLE MARKETING OF NEW PRODUCTS. • TO COLLECT PREMIUMS WELL IN TIME. • TO HANDLE CLAIM WITH TECHNOLOGICAL SOUND SYSTEM SO THAT PROMPT AND POSITIVE SETTLEMENTS OF CLAIMS TAKES PLACE. • TO EMPLOY TECHNOLOGICALLY SOUND TASK FORCE OF THEIR OWN EMPLOYEES TO HANDLE MILLIONS AND MILLIONS OF INSUREDS ALL OVER THE COUNTRY. • TO MAKE VALUE ADDED CONTRIBUTIONS BY ARRANGING SYMPOSIUMS, WORKSHOPS, SEMINARS AND CONFERENCES INVITING NATIONAL AND INTERNATIONAL EXPERTS ETC.

16. SPECIFIC CHARACTERISTICS OF (RE)INSURANCE BROKERS TO PLAY NEW ROLE : • REPUTABLE WITH BEST STANDARDS OF TECHNOLOGICAL EXPERTISE AND MARKETING SKILLS. • RESOURCEFUL WITH PERSONALISED CONTACTS AMONG CORPORATE AND NON CORPORATE INSUREDS.ABILITY TO CONVINCE INSUREDS ABOUT ACCEPTING NEW PRODUCTS OF INSURERS. • RESPONSIBLE i.e. CONDUCTING ALL BUSINESS DEALS WITH EXCELLENCE. INSURANCE BROKERS ARE RESPONSIBLE TO EITHER-SIDE OF THE INSURANCE CONTRACT- INSUREDS AS WELL AS INSURERS. PROMPT RESPONSE ABILITY IS THE KEY FACTOR IN BROKING SERVICE. • REASONABLE PUTTING PROPOSALS WITH A REASONABLE APPROACH WHICH IS LOGICAL AND PRACTICAL. • REACHABLE INSURANCE BROKERS’ TEAM SHOULD BE AVAILABLE TO EITHER-SIDE 24 HOURS FOR ALL THE 7 DAYS. • RELIABLE IN DATA- MINING OF HEALTHCARE SERVICES PROVIDERS – DRUGGISTS, CHEMISTS, PUBLIC AND PRIVATE HOSPITALS AND REQUIREMENTS OF REGULATORS.

17. CLAIMS HANDLING SERVICES INSURANCE BROKERS MAKE PRESENTATION OF CLAIMS IN TECHNICALLY SOUND WAYS SO THAT CLAIMS MANAGERS OF INSURERS CAN BE SATISFIED AND CLAIMS SETTLEMENTS CAN BE PROMPT, POSITIVE AND SMOOTH PROCESS. • VALUE ADDED CONTRIBUTION TO ORGANIZE SEMINARS TO SERVE THE MAIN PURPOSE OF EDUCATING INSUREDS FOR THEIR RISK MANAGEMENT RELATED TO HEALTH. • HEALTH INSURANCE BROKERS CAN ORGANIZE SPECIFIC TRAINING REQUIRED FOR THE VARIOUS TEAMS OF THEIR TASK-FORCE.

18. CLAIMS HANDLING : • PRESENTATION OF CLAIMS AND COMPLETING ALL DOCUMENTATION TO SATISFY CLAIMS MANAGER OF INSURERS. INSURANCE BROKERS REMAIN IN PERSOANL TOUCH WITH THE CLAIMS MANAGER OF INSURERS AND PROMPTLY RESPOND TO GIVE TECHNICAL CLARIFICATIONS. GENUINE- VALID CLAIMS ARE SETTLED. FRAUD AND BOGUS CLAIMS ARE NOT ENTERTAINED. • CLAIMS SETTLEMENTS DIRECTLY TO SERVICE PROVIDERS- HOSPITAL CHAINS, DRUGGISTS, CHEMISTS, PRIVATE AND PUBLIC HEALTHCARE CENTRES. • CLAIMS MANAGEMENT IS BEST BY ‘CASHLESS’ TREATMENTS TO INHOSPITAL PATIENTS. • CLAIMS MANAGEMENT IS THE SOUL OF SUCCESSFUL IMPLEMENTATION WITH MAXIMUM SPREAD AMONG ALL BENEFICIARIES AT SEMI-URBAN AND RURAL LEVELS.

19. CONCLUSION: HEALTH INSURANCE BROKERS PROVIDES PROFESSIONAL EXPERTISE AND SKILLS WITH: • BUSINESSLIKE APPROACH • TECHNICAL SKILLS WITH ‘KNOW HOW’ • PERSONALIZED BROKING WITH ‘KNOW WHO’ • A MISSIONARY ZEAL TO SERVE LOWER MIDDLE CLASS AND POOR CLASS PEOPLE TO BRING THEM IN THE MAIN STREAM OF NATIONS GROWTH • TO MAKE HEALTH INSURANCE A MOVEMENT ‘OF’ THE PEOPLE ‘FOR’ THE PEOPLE BUT ‘BY’ DEDICATED HEALTH INSURANCE BROKING SERVICES. INSURANCE BROKERS VALUE ADDED SERVICES FOR THE AWAKENING OF MASSES WITH A VISION OF REALIZING THE DREAM: SOUND HEALTH OF ALL IS REAL WEALTH FOR ALL.