Lok Sabha Question No. 3472 (UNSTARRED), answered on 2022-08-08
Subject: Medical Insurance in Rural Areas
Ministry: FINANCE
Asked by: C.N. Annadurai, Gautham Sigamani Pon, Manjulata Mandal, Dhanush M Kumar, DNV Senthilkumar. S., Supriya Sadanand Sule, Subhash Ramrao Bhamre, Amol Ramsing Kolhe, Sunil Dattatray Tatkare, Kuldeep Rai Sharma, Gajanan Chandrakant Kirtikar, Ganesan Selvam

## GOVERNMENT OF INDIA MINISTRY OF FINANCE

## DEPARTMENT OF FINANCIAL SERVICES

## LOK SABHA UNSTARRED QUESTION NO. 3472

ANSWERED ON - 8.8.2022

## MEDICAL INSURANCE IN RURAL AREAS

3472. SHRI C.N. ANNADURAI:

DR. PON GAUTHAM SIGAMANI:

SHRIMATI MANJULATA MANDAL:

SHRI DHANUSH M. KUMAR:

DR. DNV SENTHILKUMAR. S.:

SHRIMATI SUPRIYA SULE:

DR. SUBHASH RAMRAO BHAMRE:

DR. AMOL RAMSING KOLHE:

SHRI SUNIL DATTATRAY TATKARE:

SHRI KULDEEP RAI SHARMA:

SHRI GAJANAN KIRTIKAR:

SHRI SELVAM G.:

Will the Minister of FINANCE be pleased to state:

- (a) the number of people covered under medical insurance in rural and backward areas of the country along with the details of companies providing medical insurance, State/Companywise;
- (b) whether expenditure incurred only on admission in the hospital is reimbursed under health insurance schemes and if so, the details thereof and the reasons therefor;
- (c) whether  the  Insurance  Regulatory  and  Development  Authority  of  India  (IRDAI)  has  any proposal  of  mandating  all  general  and  health  insurance  companies  to  offer  a  standard health insurance policy covering hospitalisation, pre & post-admission treatments and if so, the details thereof;
- (d) whether IRDAI has suggested to include the expenditure incurred on OPD treatment and maternity cover etc.; and
- (e) if so, the details thereof and the steps taken/ being taken by the Government to increase coverage of health insurance schemes in rural and backward areas across the country?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF FINANCE (DR. BHAGWAT KARAD)

- (a) and (b): (a): Company-wise number of health insurance policies issued in rural sector by non-life and life insurance companies during financial year 2021-22, are at Annexure-I and Annexure-II, respectively.

(b) to (d): Insurance Regulatory and Development Authority of India (IRDAI) has informed that as per the definition of "health insurance business" under Section 2 (6C) of Insurance Act, 1938, insurers can design and market products covering sickness benefit or medical, surgical or hospital benefits, (whether as in-patient or out-patient), travel cover and personal accident cover.

Further, IRDAI has put in place the regulatory framework for insurers to offer a range of health insurance products which can cover many benefits besides expenditure incurred on admission to the hospital, including expenses on day care procedures/treatments, pre-hospitalization and post-hospitalization expenses, OPD treatment expenses and maternity treatment expenses. These benefits under health insurance policies are governed by the terms and conditions of the respective insurance contract.

However,  products  offered  by  Life  insurance  companies  under  health  insurance  portfolio provide only for defined benefit which becomes payable on occurrence of the event as per the terms and conditions of the policy.

IRDAI  has  further  informed  that  it  has  mandated  all  general  and  health  insurers  to  offer indemnity based standard individual health insurance product named 'Arogya Sanjeevani' to take care of basic health insurance needs of the general public. The features of above product include  benefits  covering  hospitalisation,  pre  and  post-admission  treatments,  day  care treatments,  AYUSH  treatment,  dental  treatment  and  plastic  surgery  necessitated  due  to disease or injury, and treatment of cataract.

- (e):  With  a  view  to  increase  coverage  of  health  insurance,  the  Central  Government  has launched Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana as a centrally sponsored scheme for an annual family health cover of Rs. 5 lakh for 10.74 crore families (approximately 50 crore beneficiaries), thereby massively expanding health insurance coverage. According to information provided by the Department of Health and Family Welfare, 14.75 crore families have been covered under AB-PMJAY against the above target of 50 crore persons.

Also, Sections 32B and 32C of Insurance Act, 1938 mandate every insurer to undertake a percentage of life insurance business from the rural and social sectors.  IRDAI (Obligations of Insurers to Rural and Social Sectors) Regulations, 2015 specify the targeted percentages of business to be procured by the insurers each year for rural and social sector obligations.

In addition, IRDAI has taken the following steps to increase coverage of health insurance:

- (i)  Insurers  have  been  mandated  to  have  in  place  a  board  approved  policy  for  increasing insurance awareness among public.
- (ii)  Various  distribution  channels  have  been  introduced  through  regulations  namely,  IRDAI (Appointment of Insurance Agents) Regulations, 2016; IRDAI (Registration of Corporate Agents)  Regulations,  2015;  IRDAI  (Insurance  Brokers)  Regulations,  2018;  IRDA  (Web Aggregators)  Regulations,  2013  and  IRDAI  (Registration  of  Insurance  Marketing  Firm) Regulations, 2015, who have the ability to  provide professional advice to the prospects and distribute insurance products massively leading to increase penetration of health insurance. Insurers have also been permitted to use Common Service Centres (CSC) as a distribution channel for selling and servicing insurance products.
- (iii)  To protect the interests of all sections of the insuring public, insurers have been mandated that all health insurance products must allow entry at least upto age 65 years and all policies shall guarantee renewability in order to ensure availability of health insurance protection throughout the life time.
- (iv)  Insurers are also encouraged to introduce Wellness and Preventive Features as part of a health  insurance policy  to  enable  public  to  remain  active  and  renew  the  policies  on  an ongoing basis.
- (v) In order to provide need-based health insurance coverage, insurers are allowed to launch products under Use and File procedure which will enable insurers to launch the products seamlessly so as to reach all sections of the market segment.

## Number  of  health  insurance  policies  issued  in  rural  sector*  by  non-life  insurance companies during financial year 2021-22

| S. No.   | Name of Non-Life Insurance Company          | Number # of health insurance policies issued in rural sector*   |
|----------|---------------------------------------------|-----------------------------------------------------------------|
| 1        | Acko General Insurance Ltd.                 | 1,110                                                           |
| 2        | Bajaj Allianz General Insurance Co. Ltd.    | 77,189                                                          |
| 3        | Cholamandalam MS General Insurance Co. Ltd. | 21,463                                                          |
| 4        | Navi General Insurance Ltd.                 | 22,494                                                          |
| 5        | Edelweiss General Insurance Co. Ltd.        | 2,530                                                           |
| 6        | Future Generali India Insurance C. Ltd.     | 77                                                              |
| 7        | Go Digit General Insurance Ltd.             | 2,434                                                           |
| 8        | HDFC ERGO General Insurance Co. Ltd.        | 114,212                                                         |
| 9        | ICICI Lombard General Insurance Co. Ltd.    | 1,285,359                                                       |
| 10       | IFFCO Tokio General Insurance Co. Ltd.      | 48,264                                                          |
| 11       | Kotak Mahindra General Insurance Co. Ltd.   | 649,973                                                         |
| 12       | Liberty General Insurance Ltd.              | 378                                                             |
| 13       | Magma HDI General Insurance Co. Ltd.        | 11,391                                                          |
| 14       | Raheja QBE General Insurance Co. Ltd.       | 334                                                             |
| 15       | Reliance General Insurance Co. Ltd.         | 548                                                             |
| 16       | Royal Sundaram General Insurance Co. Ltd.   | 79,113                                                          |
| 17       | SBI General Insurance Co. Ltd.              | 341,910                                                         |
| 18       | Shriram General Insurance Co. Ltd.          | 0                                                               |
| 19       | Tata AIG General Insurance Co. Ltd.         | 9,960                                                           |
| 20       | Universal Sompo General Insurance Co. Ltd.  | 65,859                                                          |
|          | Private Total                               | 2,734,598                                                       |
| 21       | National Insurance Co. Ltd.                 | 50,711                                                          |
| 22       | The New India Assurance Co. Ltd             | 30,690                                                          |
| 23       | The Oriental Insurance Co. Ltd.             | 77,718                                                          |
| 24       | United India Insurance Co. Ltd.             | 23,797                                                          |
|          | Public Total                                | 182,916                                                         |
| 25       | Aditya Birla Health insurance Co. Ltd.      | 30,139                                                          |
| 26       | ManipalCigna Health Insurance Co. Ltd.      | 20,360                                                          |
| 27       | Niva Bupa                                   | 155,706                                                         |
| 28       | Care Health Insurance Ltd.                  | 154,333                                                         |
| 29       | Star Health and Allied Insurance Co. Ltd.   | 1,517,794                                                       |
|          | Stand-alone Health Insurers Total           | 1,878,332                                                       |
|          | Grand Total                                 | 4,795,846                                                       |

Source: IRDAI

*As per IRDAI (Rural and social sector obligations) Regulations, 2015, 'Rural Sector' means the places or areas classified as 'rural' while conducting the latest available decennial population census (Census of India).

#Provisional

## Number of individual health insurance policies issued in rural sector* by life insurance companies during financial year 2021-22

| S. No.   | Name of Life Insurance Company                                |   Number # of individual health insurance policies issued in rural sector* |
|----------|---------------------------------------------------------------|----------------------------------------------------------------------------|
| 1        | Aditya Birla Sun Life Insurance Co. Ltd.                      |                                                                        534 |
| 2        | Bajaj Allianz Life Insurance Co. Ltd.                         |                                                                         47 |
| 3        | Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. |                                                                        664 |
| 4        | Edelweiss Tokio Life Insurance Co Ltd                         |                                                                          2 |
| 5        | Future Generali India Life Insurance Co. Ltd.                 |                                                                         82 |
| 6        | HDFC Life Insurance Co. Ltd.                                  |                                                                        146 |
| 7        | ICICI Prudential Life Insurance Co. Ltd.                      |                                                                       5024 |
| 8        | Ageas Federal Life Insurance Co. Ltd.                         |                                                                         19 |
| 9        | Kotak Mahindra Life Insurance Co. Ltd.                        |                                                                       1260 |
| 10       | Max Life Insurance Co. Ltd.                                   |                                                                        681 |
| 11       | Reliance Nippon Life Insurance Co. Ltd.                       |                                                                       2236 |
| 12       | SBI Life Insurance Co. Ltd.                                   |                                                                       7045 |
| 13       | Shriram Life Insurance Co. Ltd.                               |                                                                          6 |
|          | Private (Total)                                               |                                                                      17746 |
| 14       | LIC of India                                                  |                                                                      33170 |
|          | Industry (Total)                                              |                                                                      50916 |

Source: IRDAI

*As per IRDAI (Rural and social sector obligations) Regulations, 2015, 'Rural Sector' means the places or areas classified as 'rural' while conducting the latest available decennial population census (Census of India).

#Provisional