HEALTH INSURANCE TO OESAI WORKSHOP APRIL 2016 PRESENTER ANDREW CARTWRIGHT.

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Presentation transcript:

HEALTH INSURANCE TO OESAI WORKSHOP APRIL 2016 PRESENTER ANDREW CARTWRIGHT

UNDERSTANDING HEALTH INSURANCE WHAT IS THE PHILOSOPHY OF INTENDED PROGRAMME? WHAT IS INTENDED COVERAGE? WHAT IS EXCLUDED? WHAT IS TARGET MARKET? WHO ARE HEALTHCARE PARTNERS? UNDERWRITING PREMIUMS and CLAIMS

PHILOSOPHY - SOME QUESTIONS Universal Community Healthcare ? Private Health Insurance? City based provision? Rural and remote cover? Basic coverage? International standard provision? Government subsidy? Private funding? Non profit provision? Profit driven schemes?

INCLUSIONS Emergency medical transfer Hospital and medical costs Nursing at home following discharge Hire of crutches/ wheelchairs or other mobility aids Emergency dental treatment Travel insurance Contribution to funeral expenses

EXCLUSIONS Pre-existing conditions Alcoholism/ narcotics dependency Self inflicted injury Contraception/ Sterilisation Fraudulent acts Travel exceeding 30 days outside country limits Any claim as result of travel against advice medical or Governmental Birth defects Air travel while 28+ weeks pregnant Artificial heart implantation Organ transfer HIV or AIDS related complications

EXCLUSIONS (contin) Medical treatment for learning difficulties A D D, hyperactivity, speech therapy Evacuation where insured not getting medical treatment at venue. Mental or nervous disorders Transfer of pregnant women for routine childbirth Any costs regarded by insurers' physicians as unnecessary or excessive. Any claim made more than 3 months after treatment Any claim not supported by original documentation.

CLAIMS Point of delivery analysis Documents required Fraud avoidance Limits of coverage Payment to providers of care or individuals

HEALTHCARE PARTNERS Partnership with existing Government hospitals Exclusive hospitals for scheme members Partnership with private hospitals

UNDERWRITING Detailed individual medical history questionnaire Detailed actuarial analysis of country conditions Analysis of specific diseases and magnitude of problems Life expectancy Lifestyle stereotypes Prevention

TARGET MARKET International Community Top 15-20% income earners of indigenous population The wider population

PREMIUMS Premium payment schedules Grades of membership Government subsidy Collection methods

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