UNIT: IX

Health insurance
INTRODUCTION
Over the last 50 years India has achieved a lot in terms of health improvement. How
many accident you need to realize that you need Health Cover? It takes just one visit to a hospital
to make us realize how vulnerable we are, every passing second. For the rich as well as poor,
male as well as female and young as well as old, being diagnosed with an illness and having the
need to be hospitalized can be a tough ordeal. Heart problems, diabetes, stroke, renal failure,
cancer the list of lifestyle diseases just seem to get longer and more common these days.
Thankfully there are more specialty hospitals and specialist doctors but all that comes at a cost.
The super rich can afford such costs, but what about an average middle class person. For an
illness that requires hospitalization/ surgery, costs can easily run into five digit bills. To get rid of
health worries health/ medical insurance is the answer.
In 2001 with entry of various private Insurance companies now the customers have
choice of buying this insurance from 21 Insurance companies. On August 15, 2007 Prime
Minister had announced Rs 2000 Crores for Health Insurance for poor citizens and the impact of
the same is being seen by us in the form of success of RSBY (Rashtriya Swasth Bima Yojna). In
India it is also known as Mediclaim because the first health insurance policy which was
launched in India was called Mediclaim.Health Insurance and Mediclaim are two different names
for the same product. The change has started coming and now we have started calling it Health
Insurance. Calling is as Health Insurance is a positive way of looking at this Insurance. It also
giving us a feeling that we as a society have started moving from curative medical care to
preventive medical care.
MEANING
The concept of health insurance was proposed in 1964 by Hugh
Health insurance is an insurance Policy that insures the beneficiary and the family against
any medical expenses. The medical expenses will be taken care of by the insurance
company provided you pay your premium regularly. Cover extends to pre-hospitalization
and post-hospitalization for periods of 30 days and 60 days respectively. Domiciliary
hospitalization is also covered.
The term health insurance is generally used to describe a form of insurance that plays for
medical licenses. It is sometimes used more broadly to include insurance covering
disability or long term nursing custodial care needs. Health insurance is a type of health
care system. It may comprise of a government medical care system and or a
nongovernmental insurance.
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HEALTH INSURANCE POLICY

It is a contract between an insurance company and an individual. The contract can be
renewable annually or monthly. Health insurance policy not only covers expenses incurred
during hospitalization but also during the pre as well as post hospitalization stages like money
spent for conducting medical tests and buying medicines. This covers will be to the extent of the
sum insured.
FINANCE STRUCTURE
It consists of the beneficiary and the provider and the media is the insurance premium.
The beneficiary may be an individual or his family or may be group of individuals as in the case
of employees state insurance scheme. The insurance premium may be paid by the individual (as
in case of personnel policies) or may be shared by the individual and employer When you buy a
health Insurance policy you need to pay an annual fee to the company known as premium. The
amount of coverage or cover amount or sum assured that you want will primarily decide the
premium which you need to pay. Higher the coverage amount higher the premium. In the event
of a claim, the maximum amount which the health insurance company pays you will be this
coverage amount. (as in case of ESIS). The provider may provide the benefit in the form of reemberesement of the expenses incurred to the person insurance or to be provided in the form of
various services and benefit.(as in ESIS). It may be provided through a government- sponsored
social insurance program, or from private insurance companies. It may be purchased on a group
basis or purchased by individual consumers. In each case, the covered groups or individuals pay
premiums or taxes to help protect them. From high or unexpected healthcare expenses. Similar
benefits paying for medical expenses may also be provided through social welfare programs
funded by the government. Health insurance works by estimating the overall risk of healthcare
expenses and developing a routine finance structure (such as a monthly premium or annual tax)
that will ensure that money is available to pay for the healthcare benefits specified in the
insurance agreement. The benefit is administered by a central organization, most often either a
government agency or a private. Health insurance companies are offering innovative products to
their customers these days. The latest product in this line is cashless hospitalization. Here
individuals do not have to pay for their hospital bills in case of hospitalization; the insurance
company settles the bill directly. But certain condition like the hospital needs to have a tie-up
with the insurance company.

DOES AGE EFFECTS HEALTH INSURANCE PLANS AND PREMIUMS

As age definitely affects your insurance plan in terms of coverage as well as cost. The
older
we
are,
the
costlier
the
health
insurance
premiums.
2

As we grow older, the body becomes increasingly prone to illnesses, disorders, and malaise
hence the increased insurance premium costs
TYPES OF HEALTH INSURANCE
Individual Mediclaim:
The simplest form of health insurance is the Individual Mediclaim policy. Health insurance
policy for an individual person providing that person cover for the expenses incurred due to
treatment of disease or injury is called as Individual Mediclaim policy. it covers the
hospitalization expenses for an individual for up to the sum assured limit. The insurance
premium is dependent on the sum assured value. Example: If you have 3 family members you
can get an individual cover of Rs 2 lacs each. In this case each of you are covered for 2 lacs , if 3
members face a need for hospitalization , all 3 of them can get expenses recovered upto Rs 2 lacs
All the 3 policies are independent.
Family Floater Policy:
Family Floater Policies are enhanced version of the mediclaim policy. A floater health
insurance policy covers your entire family under one policy with one sum insured and one
premium. It covers all the expenses just as covered under individual mediclaim except that the
cover is now extended to the family instead of one person. Under this, insurance will reimburse
the cost of hospitalization of any family member covered, but the total reimbursement during the
policy year is restricted to the sum insured .Example: In this case if suppose there are 3 family
members, you can take a Family floater policy for Rs 6 lacs in total. Now anyone can claim upto
6 lacs in expenses, but then the cover will go down by that much amount for that year. So if one
of the family members is hospitalized and the expenses are 4.5 lacs. It will be paid and then the
cover will be reduced to 1.5 lacs for that particular year. Next year again it will start from fresh 6
lacs. Family floater makes sense for a family because that way each one in family gets a big
cover and probability of more than 1 getting hospitalized in same year is too low until and unless
whole family is travelling together most of the times in a year. Unit Linked Health Plans:
Taking the ULHP route, health insurance companies too have introduced Unit Linked
Health Plans. Such plans combine health insurance with investment and pay back an amount at
the end of the insurance term. The returns of course are dependent on market performance. These
plans are very new and still in development phase. This is only recommended for people who can
handle market linked products like ULIP and ULPP
Group Health Insurance from an Employer

It is a much more affordable type of health insurance only when your employer will pay
for most or the entire premium (which many employers will do). Because premiums are based on
the group as a whole, the risk is spread out over many people. These policies are often the most
expensive and the most popular type of private health coverage. One of the benefits to group
health insurance coverage is that one cannot typically be denied coverage due to pre existing
conditions or other health problems. There may sometimes be a waiting period if one has not
maintained continuous coverage but everyone will be accepted.
Group Health Insurance from a Non Employer Group
It is another option to consider for obtaining health coverage. For those who have no
policy available through work or an inadequate one, group rates can be obtained from church
groups, professional and business associations such as a Chamber of Commerce. This can help
you obtain health insurance if you are unable to obtain an individual health insurance policy due
to your health.
Student Health Insurance
It is usually either a temporary health insurance plan offered through the university or
college and may sometimes be available through a private insurance company. The cost of health
care while studying abroad is covered by Students Medical Insurance. It is an essential
requirement with many foreign universities for their overseas students.
Short Term Health Insurance
It is a plan that as its name implies only offers coverage for a short amount of time,
usually anywhere from 1 month to 1 year (although some short term plans offer coverage up to 3
years). Although short term health insurance plans are typically very cheap; they are also
typically very bare bones coverage and should never be relied upon as a long term solution to
finding affordable health insurance coverage.
Critical Illness Policy
If we have a Critical Illness policy, the insurance company will pay you a lump sum
amount if you are diagnosed with a critical illness as defined by the insurance company.
(Catastrophic illness or major medical clauses Treating and managing most cancers costs a lot
of money. Some insurance plans provide for extra coverage under a "catastrophic illness" clause.
These are policies that cover major medical care needs. The policies usually have very high
deductibles and fairly low premiums. They can be good for people with chronic illnesses.
Senior Citizen Policy
It is generally for people above the age of 60 and has a shorter waiting period. The entry
age as well as renewable age (age up to which renewal is available) is higher.

Overseas Mediclaim Policy

An Overseas Mediclaim Policy provides cover for medical expenses incurred abroad for
treatment of illness and diseases contracted or injury sustained during the period of insureds of
overseas travel. Any person going abroad on holiday, business, study or employment can avail
this policy. Coverage under the medical expense section of this insurance is intended for use by
the Insured person in the event of a sudden and unexpected sickness or accident arising when the
Insured is outside the Republic of India.
HEALTH INSURANCE CLAIMS SETTLEMENT PROCESS
A bit on how health insurance claims processing works. In most cases, the Insurance
companies appoint a third part administrator (TPA) for claims processing. That means once the
health insurance policy is sold, the insurer passes on the baton to the TPA. In case of a claim, the
insured has to get in touch with the TPA for all versification and formalities. Mainly by two
ways.
Cashless settlement: If the treatment is sought in a network hospital of the insurance
provider the insurance company pays the hospital directly through their Third Party
Administrator. This type of settlement is called as Cashless settlement.
Reimbursement: If the treatment is done at some other hospital, you can file a claim for
reimbursement with the health insurance companys Third Party Administrator after you have
paid your bills. The insured can claim reimbursement for hospitalization by submitting relevant
bills/ documents for the claimed amount to the TPA.Then the TPA will pay you back the amount
after examining your claim. Here the insured avails the treatment and settles the hospital bills
directly at the hospital.
HEALTH INSURANCE SCHEMES
There are mainly two ways of health insurance schemes like governmental health
schemes and non governmental health schemes.

1. Governmental Health Insurance Schemes

Under the governmental health insurance schemes mainly two types of insurance plans
are following in India they are ESIschemes and central governmental health schemes.

a) THE EMPLOYEE STATE INSURANCE ACT (1948)

The ESI act passed in 1948 is an important measure of social security and health
insurance in this country. It provides for certain cash and medical benefits to industrial
employees in case of sickness, maternity, and employment injury.
Scope
The act extends to the whole of India.
Small power using factories employing 10 to 19 persons, and non power using factories
employing 20 or more persons.
Shops
Hotels and restaurants
Cinemas and theatures
Road motor transport establishments
Newspaper establishments
Administration
The administration of the ESI scheme under the act is entrusted to an autonomous body
called the ESI Corporation. The union minister for labor is the chairman and the secretary to
govt. of India ministry of labor is the vice chairman of this corporation. It consists of members
representing central and state governments, employers and employees organizations, medical
profession and parliament. There is a standing committee, constituted from the members of the
corporation, which acts as an executive body for the administration of the scheme. The chief
executive officers of the corporation are the director general who is assisted by four principal
officers.

Insurance commissioner
Medical commissioner
Financial commissioner
Actuary.

There is a medical benefit council which is headed by the director general of health
services, government of India who is assisted by the medical commissioner in all matters relating
to medical relief .Besides the head office in newdelhi, the corporation has 23 regional office an
d12 sub- regional offices and 844 local offices and cash offices all over the country for the
administration of the scheme.
Finance
The scheme is run by contributions by employees and employers and grants from central
and state governments. The employer contributes 4.75% of total mage bill; the employee
contributes 1.75% of wages. Employees getting daily wages of below Rs50 are exempted from
6

payment off contribution. The state governments share of expenditure on medical care is 1/8 of
total cost of medical care; the ESI Corporations share of expenditure on medical care is 7/8 of
total cost of medical care.
Benefits of Employees
The act has made provision for the following benefits to insured persons or, to other
dependants as the case may be;

Medical benefit
Sickness benefit
Maternity benefit
Disablement benefit
Dependants benefit
Funeral expenses
Rehabilitation allowance.

a) Medical benefit
Medical benefit consists of full medical care including hospitalization, free of cost, to
the insured persons in case of sickness, employment injury and maternity. The services
comprise;

Outpatient care
Supply of drugs and dressings
Specialist services in all branches of medicine
Pathological and radiological investigations
Domiciliary services
Antenatal, natal, and postnatal services
Immunization services
Family planning services
Emergency services
Ambulance services.
Health education
In patient treatment

In complicated cases where specialized treatment is necessary, patients are sent for
institutional treatment is necessary; patients are sent for institutional treatment even outside
their state at the expense of the ESI Corporation.
b) Sickness benefit
It consists of periodical cash payment to an insured person in case of sickness, if his
sickness is duly certified by an insurance medical officer
or
insurance
medical
practitioner. The benefit is payable for a maximum period of 91 days, in any continuous
period of 365 days, the daily rate being about 50% of the average daily wages. A person
7

receiving the sickness benefit is required to remain under medical treatment provided under
the act. In addition to 91 days of sickness benefit, insured persons suffering from certain
long- term diseases are entitled to extend sickness benefit.
c) Maternity benefit
The benefit is payable in cash to an insured woman for confinement/ miscarriage or
sickness arising out of pregnancy/ confinement or premature birth of child or miscarriage.
For confinement, the duration of benefit is 12 weeks, for miscarriage 6 weeks and for
sickness arising out of confinement (30 days). The benefit is allowed at about full wages.
d) Disablement benefit
The act provides for each payment, besides free medical treatment, in the event of
temporary or permanent disablement ass a result of employment injury as well as
occupational diseases. The rate of temporary disablement benefit is about 70% of the wages
as long as the temporary disablement lasts. In case of total permanent disablement, the
insured person is given life pension worked out on the basis of loss of earning capacity
determined by a medical board, while in cases of partial permanent disablement a portion of
its granted as life pension.
e) Dependants benefit
In a case of death, as a result of employment injury, the dependants of an insured person
are eligible for periodical payments. Pension at the rate of 70% of wages is payable, shared
by dependants in a fixed ratio. On monthly basis in accordance with the prescribed share. An
eligible son or daughter is entitled to dependants benefit up to the age of 18; the benefit is
withdrawn if the daughter marries earlier.
f) Funeral expenses.
Funeral benefit is a cash payment on the death of an insured person towards the expenses
on his funeral, the amount not exceeding Rs 2500.

g) Rehabilitation
On monthly payment of Rs 10, the insured person and his family members continue to
get medical treatment after permanent disablement, or retirement.
Benefits to employers
Exemption from the applicability of workmens compensation act 1923
Exemption from maternity benefit act 1961
8

 Exception from payment of medical allowance to employees and their dependants or

arranging for their medical care.
Rebate under the income tax act on contribution deposited in the ESI account.
Healthy work force.
About 3 lakh employers were covered under the scheme.
B) CENTRAL GOVERNMENT HEALTH SCHEME
The central government health scheme for the central government employees was first
introduced in New Delhi in 1954 to provide comprehensive medical care to central government
employees. The scheme is based on the principal of cooperative effort by the employee and the
employer, to the mutual advantages of both.
The facilities under the scheme include

Outpatient care through a network of dispensaries.

Supply of necessary drugs.
Laboratory and x ray investigations.
Domiciliary visits.
Hospitalization facilities at government as well as private hospitals recognized for the
purpose.
Specialist consultation
Pediatric services including immunization
Antenatal, natal and postnatal services
Emergency treatment
Supply of optical and dental aids at reasonable rate
Family welfare services.

The scope of the scheme has been gradually extended over the year to cover cities outside
Delhi as well as other sectors of population such as the employees of the autonomous
organizations, retired central govt servants, widows receiving family pension, members of
parliament, ex-governors and retired judges. The employees state insurance scheme and the
central government health scheme cover two large groups of wages earners in the country. They
are well organized health insurance and are providing reasonable medical acre plus some
essential preventive and promotive health services.
2. Non Governmental Health Insurance Schemes.
In nongovernmental or private voluntary agencies will come under 2nd category. Now so
many groups of companies are issued the health insurance policies.
List of Some Health Insurance Companies.
9

Apollo DKV Insurance Company Ltd.

Aviva Life Insurance
Bajaj Allianz General Insurance Co. Ltd.
Birla Sun Life Insurance
E-Meditek Solutions Limited
Family Health Plan Limited
Health India-Bhaichand Amoluk Insurance Services Pvt. Ltd.
HSBC Health Insurance
ICICI Lombard General Insurance Co. Ltd.
Life Insurance Corporation Of India
Max New York Life Insurance
Med Assist India Ltd.
MetLife India Assurance Company
National Insurance Company
Paramount Health Group
Reliance Health
Royal Sundaram Alliance Insurance Company Limited
Star Health and Allied Insurance Company Limited
Tata AIG
The New India Assurance Co. Ltd.
United Healthcare
United India Insurance
There Are Two Major Insurance Companies In India Namely:

- The Life Insurance Company of India (LIC)

- The General Insurance Company of India (GIC)
a).The Life Insurance Corporation (LIC) offers:

The Asha Deep Plan:

It provides cover for cancer, paralytic stroke resulting in permanent disability, renal failure
and coronary artery disease where by-pass surgery has been done. It caters to people between 18 65 years.
Jeevan Asha:
The Jeevan Asha policy is the other healthcare product offered by LIC. It is an openended scheme covering many surgical procedures.
.
b) The insurance policies offered by GIC are:
While LIC deals with insurance for life coverage only, the GIC deals with the other
10

aspects of insurance, including health. Following are the main health policies offered by the
Indian Insurance Companies. These policies are regulated by the General Insurance Corporation
and are marketed by the four big insurance companies: United India Insurance Co Ltd., New
India Assurance Co Ltd., Oriental Insurance Co Ltd. and National Insurance Co Ltd
1. Mediclaim

Insures against any hospitalization expenses that may arise in future. This policy is
designed to prevent the insured from paying for any hospitalisation expenses owing to illness or
injury suffered by the insured, whether the hospitalisation is domiciliary or otherwise.
It covers the expenses incurred on the following:

Room boarding expenses by the hospital nursing home

Nursing expenses

Operation theatre expenses

Surgeon, anaesthetist, medical practitioner, consultants, specialists fees

Also for any cost of equipment like pacemaker, artificial limbs and charges paid for
anaesthesia, blood, oxygen, operation charge, surgical appliances, medicines and drugs,
diagnostic material and x-rays, dialysis and chemotherapy, radiotherapy, and cost of
organs etc.

2. Jan Arogya Bima Policy

It insures hospitalization or domiciliary hospitalization expenses incurred on medical or
surgical treatment for any illness or disease (contracted after 30 days from the commencement of
the policy) or injury. Any person in the age group of three months to 70 years can be insured
under this. The risk insured include sudden illnesses like heart attack, jaundice, pneumonia,
appendicitis, paralytic attack, food poisoning or accidents that require hospitalization. This
insurance policy was designed for the lower income group of society and the common masses.
The entire idea was to protect them from high costs of hospitalization.
3. Overseas Mediclaim Policy
Any person going abroad on holiday, business, study or employment can avail this
policy. Coverage under the medical expense section of this insurance is intended for use by the
Insured person in the event of a sudden and unexpected sickness or accident arising when the
11

Insured is outside the Republic of India.

4. Personal Accident Policy
The policy compensates an individual against death, loss of limbs, loss of eyesight,
permanent total disablement, permanent partial disablement and temporary total disablement,
solely and directly resulting from accidental injuries.
5. Critical Illness Policy
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.
6. New India Assurance Bhavishya Arogya
This caters to persons between 3 to 50 years. This policy is essentially to take care of
medical expenses needs of persons in their old age. The policy provides for expenses in respect of
hospitalisation and domiciliary hospitalisation during the period commencing from the Policy
Retirement Age selected till survival. This is selected by the insured for the purpose of
commencement of benefits in the policy.
Health insurance products from some private insurance companies:

1. Bajaj Allianz Health Guard

Covers individuals between 5 to 55 years. Children below 5 years can be insured
if the parents are conurrently insured with the company. It provides cashless facility across
various hospitals across India. Herein pre-existing illness and injuries are covered in the
year of cover, if the insured renews his policy consecutively for 5 years.
2. Royal Sundaram Health Shield Gold
Covers individuals between 5 to 55 years. From 91 Days to 75 years and also
persons above the age of 55 years are covered as a part of family and not on individual
basis. All in hospitalization expenses are covered (period of stay in hospital should be
more than 24hours). Pre hospitalization expenses are covered for a period of 30 days &
post hospitalization for 60 days. Under this policy pre-existing illness and injuries are
covered in the 6th year of cover, if the insured renews his policy consecutively for 5 years.
Maternity treatment charges are covered upto the extent of Rs. 20,000. These include
12

expenses incurred in hospital/ nursing homes as in patient in India.

3. Birla Sun Life
Birla Sun Life Insurance is the coming together of the Aditya Birla group and Sun
Life Financial of Canada to enter the Indian insurance sector. The Aditya Birla Group, a
multinational conglomerate has over 75 business units in India and overseas with
operations in Canada, USA, UK, Thailand, Indonesia, Philippines, Malaysia and Egypt to
name a few.
4. HDFC Standard Life
HDFC Standard Life Insurance Co. Ltd. Is a joint venture between HDFC Ltd.,
Indias largest housing finance institution and Standard Life Assurance Company,
Europes largest mutual life company.
5. ICICI Pru
ICICI Prudential Life Insurance is a joint venture between the ICICI Group and
Prudential plc., of the UK. ICICI started off its operations in 1955 with providing finance
for industrial development, and since then it has diversified into housing finance consumer
finance, mutual funds to being a Virtual Universal Bank and its latest venture Life
Insurance.
6. Om Kotak Mahindra
Established in 1985 as Kotak Capital Management Finance promoted by Uday
Kotak the company has come a long way since its entry into corporate finance. It has
dabbled in leasing, auto finance, hire purchase, investment banking, consumer finance,
broking etc.
7. Tata AIG General Insurance Company
The Tata AIG joint venture is a tie up between the established Tata Group and
American International Group Inc. 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.
8. Max India
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Max India Limited is a multi-business corporation that has business interests in

telecom services, bulk pharmaceuticals, electronic components and specialty products. It
is also the service-oriented businesses of healthcare, life insurance and information
technology.

BENEFITS OF HEALTH INSURANCE COMPANIES IN GENERAL

-

The cost of doctors fees,

It reimburses the medical expenses.

Medicine and hospitalization expenses are getting dearer by each day.

Rising medical expenses can burn a hole in your pocket in case of a medical emergency
or during an illness. By taking a health insurance policy a person can safeguard himself
and his family from the burden of high cost of treatment.
- Discount on insurance premium is available on family package.
- The Premiums are lower for younger people.
- Disability benefits
If we get to the point that you cannot work, find out if the employer has a
long-term disability insurance policy before we leave the job. This type of policy often replaces
60% to 70% of the income.

HEALTH INSURANCE FOR NURSES

It has often been said that, Nurses make the worst patients. Although this may be hard
to believe, it is very true, as many nurses refuse to take the time to get the treatment necessary
for a specific ailment or follow the doctors orders when it comes to their own health needs.
Nurses need to be conscious of their own personal obligation to take care of themselves, even
when it comes down to health insurance. In the United States today, nursing is a highly lucrative
business and any nurse can have his or her choice of which hospital to work at, which benefits
package to go for, and which job specialization to follow. There is a misconception when it
comes to nurses, or anyone working in the medical field, and health insurance. Many assume that
nurses are eligible for, and receive, the best health insurance possible at a very affordable cost, or
even free insurance. That is not always the case for nurses. There are several factors that need to
be looked at that really influence who gets insurance, from where, and at what cost. Health
insurance quotes for nurses can actually be quite high, despite preconceptions about policies for
this occupation. Aside from the usual factors that determine costs and eligibility, such as age,
14

gender, pre-existing conditions, etc, nurse health quotes are not easy to come by and much
research needs to be done in order to ensure nurses get the best coverage.
The first consideration is that type of nurse you are. Several types of nurses, as is well
known, work in different sectors of the medical field. The type of nurse you are determines just
how high your rates will be. For trauma nurses, for example, health insurance quotes may be
high because of the stress and quick reactions associated with the job. Trauma nurses must
respond quite quickly to several different accidents and patients, so there is a high risk of injury
due to mistakes or errors. On the other side of the spectrum are traditional nurses, who work in a
more relaxed setting, typically in areas where there are run-of-the-mill patients and where they
simply take a person's blood pressure, or draw blood. Traditional nurses may still be placed in
the high risk pool, however, despite the decreases amount of danger that an injury or the like
could occur. For those nurses whose employer does not provide insurance, they do but the rates
are very high, there are other options. Nurses, who help people when they get sick, should be
able to get help when they themselves get sick. There are options and ways of finding affordable
nurse health quotes that will contain all the coverage needed to keep nurses in good health. The
same types of policies are available to nurses, such as Preferred Provider Organization (PPO),
Health Maintenance Organization (HMO), and Point of Service (POS) plans. But because nurses
are put in the high risk category by insurance companies,
Why Is It Different?
What makes health insurance for nurses different than other health insurance? There are
a couple key points to remember. First of all, nursing is a profession that often puts an individual
in a potentially harmful situation. This may include exposure to radiation, drugs, abuse from
patients, or other such things. As a result, a nurse is often considered higher-risk. Some hospitals
cover their nurses in this and many of these items are covered in workmans compensation or in
the nurses personal insurance. But, when it comes to off the job activities, hospitals may be
more willing to slack off, letting the nurse cover expenses even when it seems like the medical
needs should be covered under insurance
Responsibility of the Nurse
First of all, you need to talk to the hospital that you work for. See if there is any way that
they can up your insurance or else explain where they are coming from with the coverage that
they offer. Next, check into secondary insurance options for you and for your family. You may be
able to find an accident health insurance or another primary health insurance that gives you
better options than what you already have. Although this option may be a little more expensive,
you will feel much more comfortable in the long run with a health insurance that you can trust
with your life. Finally, make sure that you are reducing the factors in your life that could tend to
create health problems. Follow a healthy diet, exercise on a regular basis, cut smoking and
drinking, and make sure that you follow all medical procedures with caution.
15

Challenges to Finding Affordable Health Insurance for Nurses

Nurses are exposed to HIV, Hepatitis, measles, tuberculosis and other communicable and
blood borne diseases as well as x-ray exposure, chemical exposure, back injury, stress, and
exhaustion. What is even more ironic is that many nurses tend to fight for health care for their
patients and the uninsured, before ensuring they have their own coverage. While this all seems
like bad news, the good news is there are insurance companies that have set up health insurance
programs for nurses
Conclusion:The escalating cost of medical treatment today is beyond the reach of a common man. In
case of a medical emergency, cost of hospital room rent, the doctor's fees, medicines and related
health services can work out to be a huge sum. In such times, health insurance provides the much
needed financial relief. 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. So health insurance is very importand to preservethe precious health by investing
the money.

BIBLIOGRAPHY.
Book reference:1. Dr Park JE. Parks textbook of preventive and social medicine. 20 th ed. Banarsidas
Bhanot Publications: India; 2008.p. 743- 746, 832
2. Ellis RJ, Hartley CL. Nursing in todays world. 5 th ed. J.B Lippincott publications:
Philadelphia; 1998. P. 296
3. Cassel.J, The contribution of the social environment to host resistance: the Fourth Wade
Hampton Frost Lecture. Am J Epidemiology 1976, 234-38

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4. Wilkinson RG. Income distribution and life expectancy. BMJ, 1992, 387
5. Ben SholmoY, White IR, Marmot M. Does the variation of socio-economic
characteristics of an area affect mortality? BMJ, 1996. 456.
6. Kaplan G Pamuk E Lynch JW Cohen RD Inequality in income and mortality in the
United States: Analysis of mortality and potential pathways. BMJ, 1996, 356
7.

Kennedy BP, Kawachi I, Prothrow-Stith D. Income distribution and mortality: Cross

sectional ecological study of Robin Hood Index in the United States. BMJ 1996, 312,

8. Ahluwalia MS. Economic performance of states in post-reforms period. Economic and

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4)
5)

www.healthinsuranceindia.org/
www.searo.who.int/linkfiles/social_health_insurance_an2
en.wikipedia.org/wiki/Healthcare_in_India.
www.srtt.org/downloads/communityhealth.pdf
www.healthinsurancebox.com/

6) http://doctor.ndtv.com/storypage/ndtv/id/3723/type/feature/Health_Insurance_in_India.html?cp

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