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Health Insurance - A Comprehensive Study 641

surance business is continuously rising up in India Being Inclusive
[5] .It has been noted that a large majority of Indian There are some common and permanent exclusions
population depends on the private sector, mostly in about which a policyholder must be aware of. It must
the form of out of pocket spending that accounts for also be understood that the exclusions are not stan-
more than 70% of all health spending in India.
dard for all policies but there are some which the in-
Growth of Public Sector Vs Private Sector sured needs to know about before purchasing health
insurance.
In 2003-04, there was 36.78 percent growth in total
premium out of which private sector growth rate was Specific Ailments [10]
157.02 percent and that of public sector was 28.89 The expenses on the treatment of diseases such as
percent.Initially the idea of running health insurance Cataract, Benign Prostatic Hypertrophy, Hysterecto-
as a stand-alone product - as a one-line business was my for Menorrhagia or Fibromyoma, Hernia, Hydro-
disliked by people. The fact remains that any scheme cele, Congenital Internal Disease, Fistula in anus,
of health insurance to be introduced on large-scale in Piles, Sinusitis and related disorders, Gall Bladder
India requires a tremendous attention to be given to Stone removal, Gout and Rheumatism, Calculus dis-
the organisational capacity on the part of the insur- eases, Joint replacement due to Degenerative Condi-
ers and the regulators to bring together the different tion and age related Osteoarthritis and Osteoporosis
elements that constitute Health Marketing. are generally not payable until a specific period of
The various providers of services fall under this clas- time, which differs from company to company. The
sification; behind all this the lusting fear that the per- specific diseases may also differ with the company
sons who are likely to be covered by this scheme Pre-existing diseases [11]
would be a moral hazard - the choice of selection, the
choice of ‘adverse selection’ to put it, which is going If the policy holder is already suffering from a disease
to impinge on the ‘rating structure’ which insurance then it is considered as a pre-existing disease which
companies would like to adopt. The basic thing that are not covered as Insurance is done for uncertain
keeps people away from getting into this business things. Usually there is a waiting period of 2-4 years
is the fact that today in this country as distinct from or more depending upon the type of disease & its risk
any other advanced country in the world, we do not if the insurer agrees to cover it. Pre-existing diseas-
have a basic social structure affording State aid to es like cataract, kidney stones, arthritis, few chronic
people, on a regular basis. Other developed coun- diseases, joints treatment and more are some which
tries have a National Policy on Health. Where they could be excluded.
have a system by which people are taken care of, for [11]
their basic requirements on health, where provision Waiting Period clause
of health facilities is considered to be a fundamental Except for accidents and deaths, most policies do not
duty on the part of the State, and expecting that to provide cover immediately, even for those diseases
be provided is considered to be a fundamental right. which are not excluded. There usually is a waiting

Star Health and Allied Insurance Co Ltd commenced period of 1-2 months post which the insured can reap
its operations in 2006 with the business interests in the benefits of the policy.
Health Insurance, Overseas Mediclaim Policy and Pregnancy [11]
Personal Accident. With no other insurance category
to focus and divide our attention, we use our resourc- Costs like pregnancy, child birth, vaccination and
es to focus on service excellence, design products likewise would generally not be covered under a
and use core competency of innovation to deliver the health insurance policy. Pregnancy could have a
best to our customers. Today we have emerged as waiting period of 1-2 years. Therefore the insured can
India’s First Stand-Alone Health Insurance Company. receive decent benefits for pregnancy if they plan for
At Star Health Insurance, the Company offers a wide the child accordingly.
range of Health Insurance products at affordable [11]
prices to make health insurance every human being’s Surgeries
right. As a Company, single-mindedly dedicated to Surgeries such as joint replacement, cosmetic sur-
Health insurance, Star Health have built a promising gery, dental surgery, are usually not covered in a
path for the future of Indian population. health insurance policy.

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