Lok Sabha Question No. 2502 (UNSTARRED), answered on 2018-03-09
Subject: Coverage of Health Insurance Schemes
Ministry: FINANCE
Asked by: KAPIL MORESHWAR PATIL

## GOVERNMENT OF INDIA MINISTRY OF FINANCE DEPARTMENT OF FINANCIAL SERVICES

## LOK SABHA UNSTARRED QUESTION NO. 2502

TO BE ANSWERED ON 9 th  March 2018/ Phalguna 18, 1939 (Saka)

Coverage of Health Insurance Schemes

2502: SHRI KAPIL MORESHWAR PATIL:

Will the Minister of FINANCE be pleased to state:

- (a) whether  only  15  per  cent  population  of  the  country  has  been  covered  under Health  Insurance  Schemes  and  if  so,  the  details  thereof  and  the  reaction  of  the Government thereon;
- (b)  whether the expenditure incurred only on admission in the hospital is reimbursed under health insurance schemes, if so, the details thereof and the reasons therefor;
- (c)  whether the Insurance Regulatory and Development Authority of India (IRDAI) has suggested to include the expenditure incurred on OPD treatment and maternity cover etc.; and
- (d)  if so, the details thereof and the steps taken/being taken by the Government to increase coverage of health insurance schemes?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF FINANCE (SHRI SHIV PRATAP SHUKLA)

- (a) As  per  Insurance  Regulatory  and  Development  Authority  of  India  (IRDAI),  the total  number  of  lives  covered  under  any  type  of  health  insurance  policy  as  on  31 st March, 2017 were 43.75 crore which is approximately 36 per cent of India's population as per Census 2011.
- (b) to (d)    Health Insurance Policies generally provide coverage for inpatient treatment including  Domiciliary  Hospitalization  benefits  subject  to  policy  terms  and  conditions. However, more number of health insurance products now provide coverage for Out Patient  Department  (OPD)  treatment  in  order  to  encourage  policyholders  to  go  for treatment  at  early  stages.  IRDAI  (Health  Insurance)  Regulations,  2016  inter-alia enable  the  insurers  to  introduce  wellness  and  preventive  features  as  part  of  health insurance  policies.  During  the  year  2016-17,  the  Rashtriya  Swasthya  Bima  Yojana (RSBY) was in implementation in 15 States/UTs involving 265 districts, covering 3.63 crore families. Some of the insurance products where OPD treatment and maternity cover are being covered is at Annexure.

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## Annexure referred to in reply to part (b) to (d) of Lok Sabha Unstarred Question no. 2502 to be answered on 9 th  March 2018.

| Name of the Insurance Company           | Name of the Insurance Product            |
|-----------------------------------------|------------------------------------------|
| Star Health Insurance Company           | Star Health Gain Insurance Policy        |
| Cigna TTK Health Insurance Company      | Pro Health Group Insurance Policy        |
| DHFL General Insurance Limited          | Group Health Insurance Policy            |
| DHFL General Insurance Limited          | Group Personal Accident Insurance Policy |
| Liberty Videocon General                | Liberty Group Health Policy              |
| Magma HDI General Insurance Co. Ltd     | One Health                               |
| New India Assurance Co. Ltd.            | New India Premier Mediclaim Policy       |
| Apollo Munich Health Insurance Co. Ltd. | Day 2 Day Care                           |