Page 16 - Ebook health insurance IC27

The Insurance Times

 CGHS has over 44 lakh beneficiaries and is financed largely by the Government of
India budget, while the government employees also contribute a nominal amount
(ranging from Rs 15 to Rs 150 per month) from their salaries based on their scale of
pay.

 Here also, the coverage is comprehensive and includes both outpatient care and
hospitalisation. OP care is provided through CGHS dispensaries, located in major
cities.

 It also uses the facilities of the government and approved private hospitals to provide
inpatient care and reimburses the expenses to the patient or the hospital, as the case
may be.

Commercial health insurance

 Even before nationalization, non-life insurers were providing health cover, largely
on group basis, and individual health insurance schemes were few, with diverse
terms and conditions.

 After nationalization, the four subsidiaries of GIC continued to issue health insurance
policies, more as tailor-made group covers to corporates with varying terms and
conditions.

 The first serious attempt to standardize the terms and conditions of health
insurance was made by the GIC in 1986 with the launch of what is popularly
known as the "Mediclaim" policy. Mediclaim is a voluntary health insurance
scheme and covers for hospitalization and domiciliary hospitalization episodes
(and certain day care procedures) with certain exclusions like pre-existing
diseases, pregnancy and child birth, HIV-AIDS, etc (though maternity is covered
in Group Mediclaim policies).

 It is an indemnity cover, where reimbursement of expenses is provided to the insured,

2 0 Guide for Health Insurance