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Health Insurance Mayhem

The Ministry of Health (MoH) has presented the bill of Health Insurance Act to the Council of Ministers and they have decided to pass it in the Parliament. The former health minister Gagan Thapa was also actively participating in campaigns like “Mero Barsha 2074” on the theme “Ma Swastha, Mero Desh Swastha” to increase awareness about the importance of health. The major objective of the campaign is to encourage people towards a life-long commitment to become healthy. In order to make this campaign effective, the government has launched an android app which collects information of individuals and uses the details from social media platforms to further notify others about this campaign.

The app surveys people to know whether they are following a healthy lifestyle. The campaign asks for commitments like:

  1. Quitting all forms of tobacco use and intake of alcohol.
  2. Consumption of healthy food
  3. Regular exercise
  4. Timely screening
  5. Being mindful towards the health of family and society

Here, health insurance is related to the fifth commitment of the campaign. Health insurance of the family members can help in treatment of diseases in the future. Former health minister Thapa has also stated that health insurance bill is in the process of being tabled at the Parliament. After the bill passes through the Parliament, the government will make an attempt to include every citizen under the health care policy.

Schemes of some Insurance Companies

Shikhar Insurance and Metlife are two among several companies in operation offering health insurance. They have come up with various schemes ranging from 2 lakhs to 20 lakhs. One can purchase these policies for themself, family, employee, or as a couple. The health insurance policy from Shikhar covers expenses incurred during 30-day pre-hospitalisation and 60-day post-hospitalisation. The policy also covers 150 advanced technological surgeries and procedures which require less than 24-hour hospitalisation. The eligible age for this policy is 5-65 years. It is mandatory for people over the age of 45 and people wanting a policy over Rs. 5 lakh to have a health checkup prior.
The critical care policy of Metlife provides financial protection if one is diagnosed with any of the 31 illnesses: Stroke, Major Cancer, First Heart Attack, Coronary Artery Diseases, Kidney Failure, End Stage Liver Failure, Primary Pulmonary Hypertension, End Stage Lung Disease, Bone Marrow Transplantation, and so on. In addition, it provides lump sum cash in case of death before any illness is diagnosed. The eligible age for this policy is 18-59 years and its term is for a year. It can be renewed for up to five years.

The trappings

While looking at the bright side of having a policy from an insurance company, one must not overlook the trappings they may get into. After all, insurance companies are a business and the sole reason for the existence of any business is to make profit. The insurance companies provide various policies which allure customers by showing lump sum they can receive if a mishap occurs. But the ultimate aim of the insurance company is not to provide the lump sum but to keep in as much money as possible. They take help of various terms and conditions to avoid timely payment to the customer. In order to be safe from such company malpractices one must be very careful while making the selection.

Another major trapping many people fall into is that they think the health insurance companies are liable to pay even for pre-existing illness. But most health insurance do not take liability for pre-existing illnesses. If an individual makes claim for insurance money during the first year of enrollment into the policy, the insurance company has got the right to look back to verify if it was caused due to a pre-existing condition. If it is due to a pre-existing illness, the insurance company can refrain from paying the claim bills. In some cases, they charge an extra amount to provide the amount for the treatment. Also, most health insurance plans only cover the expenses for surgery that can be completed within 24 hours. But in critical conditions, the surgery may take longer than the defined time period.

Benefits of insurance (Life with and without health insurance)

Health insurance for oneself, family and employees has got various benefits. Although, it may seem an expense today, it is actually a saving for the future. Health insurance policies provide benefits of outpatient care, emergency room, inpatient care, drugs, counseling, psychotherapy, lab test, screenings, vaccines, and pediatric services. These benefits vary according to the policy purchased. The more expensive policy one takes, the more health benefits they receive.

Issues about Obamacare

Former President Barack Obama had also understood the importance of health care for US citizens. He attempted to make the facility of hospitals and physicians easily accessible to people at lowered costs. He made an attempt to implement Protection and Affordable Care Act which is nicknamed as Obamacare to increase the quality of health insurance and its affordability. It was passed as a law in 2010. The act bans insurance companies from denying health coverage to people with pre-existing illness. Besides, it also allows people above 26 to remain under the policy of the parents. But it is facing allegations of being a “Job Killer” by Republicans as the policy of the law adds to the cost of business. After Republican candidate Donald Trump became the President of the United States, he is making an attempt to repeal and replace Obamacare with the previous bill.

Notion of Health insurance in a country like Nepal

The Gross Domestic Product (GDP) of Nepal in 2016 is worth $21.2 billion and per capita income of a Nepali is $766. Due to this low per capita income of the average Nepali, most are unable to have treatments even for common diseases like malaria, kalazar, tuberculosis, and dysentery. Also due to poor nutrition, most of the Nepali population are at risk of major diseases. Moreover, the increasing air pollution, lack of clean water and poor medical access have put a major portion of Nepalis at risk. The govenment must integrate health insurance into its public care policies.

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