PGDHIM SEM 1 ASSIGNMENT 1

 

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Post Graduate Diploma in Health Insurance Management (PGDHIM)

 

1^st SET OF ASSIGNMENT

PRN No.:_________________                                                                 

Student Name:____________

Answer the following questions:

Course 1: Health Insurance, Its Models & Financials

 

Question. Describe the current scenario of Health Insurance Industry in India ?     (5 Marks)

Answer: According to Money Digest February 2003. 1 in 3 person develop some life threatening cancer.

•        1 in 4 person contact heart disease before they retire.

•        1 in 20 person Risk the chance of having stroke before the age of seventy.

According to World Bank Report;

 

 

Question. • What are the Rating Methods in health insurance?                                 (5 Marks)

Answer: Rating rules for health insurance vary based on the type of insurance. There are a variety of factors that go into how health insurance premiums are determined. The rules vary significantly depending on the type of coverage, and in some cases, on the state where the policy is issued.

Two types of rating—community rating and

 

 

Course 2: Public Health Insurance

i. Short note on:

Question. •Universal Health Coverage in India                                       (3 Marks)

Answer: Ensuring equitable access for all Indian citizens, resident in any part of the country,regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to

 

 

Question. •Ayushman Bharat                                                                    (2 Marks)

Answer: Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a scheme that aims to help economically vulnerable Indians who are in need of healthcare facilities.

Prime Minister Narendra Modi rolled out this health insurance scheme on 23 September 2018 to cover about 50 crore citizens in india and already has several success stories to its credit. As of September 2019, it was reported that 18,059 hospitals have been empanelled, over 4,406,461 lakh beneficiaries have been admitted and over 10 crore e-cards have been issued.

 

 

Question. ii. What is RSBY scheme? What are the key features of the RSBY Scheme?       (5 Marks)

Answer: RSBY- THE SCHEME

RSBY has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.

 

 

Course 3:  Health Insurance Products & Underwriting

 

Question. • What are the different types of benefits that are associated with the long term care health insurance plans?                                                                (3 Marks)

Answer:  Long term care insurance is designed to avoid the financial hit medical costs can incur on your retirement, particularly when involving hospitals stays or assistance needs at home. Long term care insurance is designed to pick up those expenses not normally covered by traditional plans such as HMO policies or Medicare. These include normal living functions such as personal hygiene, movement assistance, special medical diet, and monitoring at home. Even when using basic living assistant labor, the aggregate

 

 

Question. • Coinsurance                                                                             (2 Marks)

Answer: In health insurance, copayment is fixed while co-insurance is the percentage that the insured pays after the insurance policy's deductible is exceeded, up to the policy's stop loss. It can be expressed as a pair of percentages with the insurer's portion

 

Question. • Discuss about the similarities and differences between individual insurance and group medical insurance benefits.  (5Marks)

Answer: Insurance is compulsory, whether you opt for a group plan or an individual plan. A lot of people rely only on their group insurance plan, while others view this kind of insurance cover only as a back-up plan for their individual cover. Though both the kinds provide the basic coverage, there are some very prominent differences between individual and group insurance

 

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