Section 9g: Health Insurance

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By Rajkamal Rao 

Go back to "The first 90 days"

If you plan to work in India for an employer, chances are that your health insurance will be covered as an employee benefit.  Group health insurance plans in India can be fairly generous and include extended family members such as parents (although age restrictions may apply).  But coverage options may be more restrictive than US plans.

If you plan to be on your own, the private health insurance market is still nascent.  The regulatory body, Insurance Regulatory and Development Authority (IRDA), was inaugurated only recently - in July 2010 - and many of its policies are still being implemented. One of its goals is to “ensure the speedy settlement of genuine claims, to prevent insurance fraud and other malpractices and put in place an effective grievance redress machinery” - suggesting that the industry has had many complaints in these areas. 

So immature is the health insurance market that in 2010, only about 15% of the population had some kind of insurance - group, private and the government’s subsidized health care program all included.  Because of this limited risk pool, insurance companies have onerous restrictions on covering for pre-existing conditions and insist on medical underwriting for anyone over the age of 45 or 50.

In November 2011, a NY Times story reported that Indians pay out of pocket for 64 percent of health care expenses - creating an opening for Western companies (such as Cigna and Aetna) to enter the Indian market.  India allows foreign insurance companies to own a maximum of a 26 percent stake in insurance joint ventures.  Pressure is on the government to relax this limit to 49% - and open up the industry to more competition.

How much does private health insurance cost?  This depends upon the policy chosen, the number and age of individuals in the plan.  One company offers a floater plan that protects the entire family on the payment of a single premium under a single sum insured. The sum insured floats among the family members insured - effectively distributing the total obligation of the policy amongst the family members. The plan is rather traditional and includes coverage for pre-medical screening, hospital benefits and even Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialist Fees.  Pre-Existing Diseases / Illnesses are covered after 48 months of continuous Insurance with any Indian Insurance company.  Such a plan, with a total policy benefit of INR 15 lakhs, costs INR 41,780 per year for a family of four with at least one member of the family over the age of 50.

A new product in the private healthcare insurance market is called a “Fixed Benefit” plan.  Closest in theme to the high deductible/catastrophic coverage plans promoted in the US, a fixed-benefit plan helps customers meet the cost of two major categories of medical expenses - hospital room charges and the costs of surgery. The costs of consultation, medication, labs, pathology and radiology are generally considered out of scope.  Because these costs are much less expensive than those in the US and are affordable out-of-pocket, the returning Indian family may do well to start off on a Fixed Benefit plan.








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