INSURANCE Human life is exposed to many risks, which may result in heavy financial losses.

Insurance is one of the devices by which risks may be reduced or eliminated in exchange for premium. In words of Chief Justice Tindal, Insurance is a contract in which a sum of money is paid by the assured in consideration of the insurer's incurring the risk of paying larger sum upon a given contingency. In its legal aspects it is a contract whereby one person agrees to indemnify another against a loss which may happen or to pay a sum of money to him on the occurring of a particular event. All contracts of insurance (except marine insurance) may be verbal or in writing, but practically contracts of assurance are included in a document. DEFINITION Risk-transfer mechanism that ensures full or partial financial compensation for the loss or damage caused by event(s) beyond the control of the insured party. Under an insurance contract, a party (the insurer) indemnifies the other party (the insured) against a specified amount of loss, occurring from specified eventualities within a specified period, provided a fee called premium is paid. In general insurance, compensation is normally proportionate to the loss incurred, whereas in life insurance usually a fixed sum is paid. Some types of insurance (such as product liability insurance) are an essential component of risk management, and are mandatory in several countries. Insurance, however, provides protection only against tangible losses. It cannot ensure continuity of business, market share, or customer confidence, and cannot provide knowledge, skills, or resources to resume the operations after a disaster.

BASIC PRINCIPLES OF INSURANCE The following are the basic essentials 'or requirements of insurance irrespective of the type of insurance concerned. 1. UTMOST GOOD FAITH All types of contracts of insurance depend upon the contracts of utmost good faith. Both parties (insurer and the insured) in the contract must disclose all material facts for the benefit of each other. False information or non-disclosure of any important fact makes the contract avoidable. So the conditions to show utmost good faith is very strict on the part of the insured. 2. INSURABLE INTEREST The insured must possess an insurable interest in the object insured. It may be defined as a financial interest in the subject matter of contract. The presence of insurable interest is a legal requirement. So an insurance contract without the existence of insurable interest is not legally valid and cannot be claimed in a Court. The object of this principle is to prevent insurance from becoming a gambling contract. 3. PRINCIPLE OF INDEMNITY All types of contracts except life and personal accident insurance are contract of indemnity. According to them, the insurer undertakes to indemnify the insured against a loss of the subject matter of insurance due to insured cause. In life assurance the question of loss and, therefore, of its indemnification does not rise. Because the loss of life cannot be estimated in term of money. The principles of indemnity is based on the idea that the assured in the case of loss only shall be compensated against the actual total loss. But if no event happens, the insured has not to receive any amount, so in this case the premiums paid by him becomes the profit of the Insurance.

4. DOCTRINE OF SUBROGATION This principle applies to the contract of indemnity only i.e. marine and fire. It lays down a principle which is quite equitable. According to this doctrine, where a loss occurs and the insurer pays as for a total loss, he is entitled to all the rights and remedies which the insured has against a third party in respect of loss so paid for. It prevents the insured being indemnified from two sources in respect of the same loss. Suppose A has damaged B is motor car negligently. If he pays B is loss in full. B cannot collect the same from the insurance company. On the other hand if B applied to his insurance company for indemnity under his policy, he will not be permitted to collect the damages from A. In the latter case the insurance company will be entitled to collect that amount. 5. DOCTRINE OF PROXIMATE CAUSE This principle is found very useful when the loss occurred due to series of events. It means that in deciding whether the loss has arisen through any of the risks insured against, the proximate or the nearest cause should be considered. To take an illustration in one case where a policy holder sustains an accident while hunting. He was unable to walk after the accident and as a result of lying on wet ground before being picked up, he suffered pneumonia. There was an unbroken change of cause between the accident and the death, and the proximate cause of the death, therefore, was the accident and not the pneumonia. 6. CANCELLATION Both parties have right to cancel the policy before its expiry date. The period of .the policy comes to an end on the cancellation of policy. So the protection provided by the insurer to the insured stops from the date of such cancellation. The premium received by the insurance company is also returnable to the insured. 7. ATTACHMENT OF RISK Without the attachment of definite risk to the policy, the contract of insurance cannot be in force. So in this case the consideration fails and the premium received by the insurance company must be returned.

8. MITIGATION OF LOSS When the event insured against takes place, the policy holder must do every thing to minimize the loss and to save what is left. This principle makes the insured more careful in respect of this insured property.

9. ARBITRATION Most fire and accident insurance policies contain an arbitration clause which provides for referring' to differences to an arbitration. The arbitrator is to be appointed in writing by the parties in difference. The object of this clause is to reduce litigation.

LIC JEEVAN BAHRTI FEATURES Introduction LICs Jeevan Bharati-I is a plan exclusively for women. It is a with profit plan having special features considering the needs of women. The plan also provides for Accident Benefit, Critical Illness Benefit and Congenital Disability Benefit as optional Riders 1. SPECIAL FEATURES 1. Encashment of Survival Benefit as and when needed: The policyholder at her option may avail the survival benefit any time on or after its due date. If opted to avail later, increased survival benefit at the rate decided by the corporation from time to time will be payable. 2. Flexibility to pay premiums in advance: The mode of premium payment is only yearly under this plan. However, policyholder may pay the next yearly premium in advance in instalments (maximum upto 3 instalments) during the year. If premiums are paid in advance a premium rebate may be allowed as may be decided by the Corporation from time to time 3. Option to receive maturity proceeds in the form of an annuity: : The policyholder shall have the option to receive the maturity proceeds in the form of annuity. The rate of annuity will be based on the annuity rates prevalent at the time of stipulated Date of Maturity. 4. Auto Cover:: After two years premiums have been paid, whenever premium payment is discontinued, the life cover for full sum assured will continue for 3 years from the due date of first unpaid premium. If death occurs during the Auto Cover period, then death benefit after deducting unpaid premiums, with interest is payable along with the vested bonus, if any. The auto cover shall not be available for rider benefits. 2. OPTIONAL RIDERS:

The following riders are available under this plan: A. CRITICAL ILLNESS (CI) RIDER : An amount equal to the Critical Illness Rider Sum Assured will be payable in case of diagnosis of defined categories of critical illnesses. A person is eligible for this benefit upto a maximum age of 60 years but subject to a maximum of the policy term. This benefit can be availed for a minimum Sum of Rs 50000 and for a maximum Sum equal to the Sum assured under the basic plan subject to the maximum of Rs 5 lakh overall limit taking all critical illness riders under all existing policies of the Life Assured. (For details refer the sales brochure of Critical Illness rider) B. ACCIDENT BENEFIT RIDER: An additional amount equal to the Accident Benefit Rider Sum Assured is payable upon death or total and permanent disability due to accident during the policy term. This benefit can be availed for a minimum sum of Rs 50000 and for a maximum sum equal to the Sum Assured under the Basic Plan subject to the maximum of Rs.50 lakhs. C. CONGENITAL DISABILITIES BENEFIT (CDB) RIDER: This rider can be opted for by a female between the ages of 18yrs and 35 years. An amount equal to 50% of the CDB Sum Assured is payable if the Life Assured gives birth to a child with specified congenital disabilities. This benefit is available for a maximum of two such children and this benefit ceases at the age of 40 years. This benefit can be availed for a minimum Sum of Rs 50000 and a maximum sum of Rs 500000. (For details refer the sales brochure of Congenital Disability Benefit Rider)

3. ELIGIBILITY CONDITIONS (For Basic Plan): Minimum age at entry : 18 years (completed) Maximum age at entry : 55 years (nearest birthday) Maximum age at maturity : 70 years (nearest birthday) Policy term : 15 and 20 years Minimum Sum Assured : Rs. 50,000/Maximum Sum Assured : Rs. 25,00,000/(Sum Assured shall be in multiples of Rs.5,000/-) 4. SAMPLE PREMIUM RATES FOR BASIC PLAN : Tabular Annual Premium per 1000 SA AGE/TERM 15 20 20 79.35 63.90 25 79.45 64.10 30 79.70 64.55 35 80.25 65.45 36 80.45 65.70 37 80.60 66.00 40 81.35 67.00 45 83.15 69.50 50 86.05 73.50 5. HIGH SUM ASSURED REBATES: Sum Assured (in Rs) 1,00,000 to 4, 99,999 5, 00,000 and above Rebate per thousand Sum Assured Rs 2.00 Rs 4.00

6. LOAN: Loan is available under the plan after the policy acquires paid-up value. 7. GRACE PERIOD: A grace period of one-month but not less than 30 days will be allowed for payment of premium .

8. REVIVAL: A. REVIVAL DURING THE AUTO COVER PERIOD: (i) If Critical Illness Rider is not opted for: During the Auto Cover Period, the Life Assured can pay one or more instalments of premiums with interest without submission of any evidence of health. On payment of part or full arrears of premiums with interest, the Auto Cover Period of 3 years from the due date of new FUP shall again be available during the term of the Policy. If any survival benefit falls due during the above 3-year auto cover period the same will be paid after deduction of unpaid premiums with interest until the due date of the survival benefit, provided it is more than the unpaid premiums with interest. If the survival benefit is insufficient to cover the arrears of premiums with interest up to the due date of such survival benefit, then the survival benefit will be payable only on payment of such arrears of premiums with interest , during the period of the aforesaid 3 years or on revival of the policy thereafter. (ii) If Critical Illness Rider is opted for: During the auto cover period, the policy can be revived by payment of full arrears of premium together with interest and subject to submission of proof of continued insurability of the Life Assured to the satisfaction of the Corporation. The Corporation reserves the right to accept at original terms, accept at revised terms or decline the revival of the policy. The revival of the policy shall take effect only after the same is approved by the Corporation and is specifically communicated to the Life Assured. If any survival benefit falls due during the above 3-year auto cover period the same will be paid only after revival of the policy as stated above. B. REVIVAL OTHER THAN DURING AUTO COVER PERIOD : If the Policy has lapsed, and the policy is not under the period of auto cover, the policy can be revived within a period of 5 years from the date of first unpaid premium and before the date of maturity by payment of full arrears of premium together with interest and subject to submission of proof of continued insurability of the Life Assured to the satisfaction of the Corporation. The Corporation reserves the right to accept at original terms, accept at revised terms or decline the revival of a discontinued policy. The revival of discontinued policy shall take effect only after the same is approved by the Corporation and is specifically communicated to the Life Assured. The Rider/s shall be revived along with the Basic plan and not in isolation.

9. PAID UP VALUE: If after at least three full years premiums have been paid and any subsequent premium not paid, this policy shall not be wholly void after the expiry of three years Auto Cover Period ,but shall continue as a paid up policy. The Sum Assured of the policy shall be reduced in the same proportion as the number of premiums actually paid bears to the total number of premiums stipulated for in the policy , less any survival benefit paid. This reduced Sum is called the paid up value. The policy thereafter shall be free from all liabilities for payment of the premiums, but shall not be entitled to the future bonuses. The existing vested reversionary bonuses, if any, will remain attached to the reduced paid-up Policy. This paid up value shall be payable on the date of maturity or at Life Assureds prior death. No survival benefit shall be payable under paid up policies. The rider benefits will cease to apply if the policy is in lapsed condition and will not acquire any paid up value. 10. SURRENDER VALUE: The Guaranteed Surrender value will be available after the expiry of 3 policy years provided the premiums have been paid for at least three years. The Guaranteed Surrender Value is equal to 30% of the total amount of premiums paid excluding the premiums paid for the first year, any premiums paid towards riders, all extra premiums that may have been paid less the amount of survival benefits paid earlier. The cash value of any existing bonuses, if ,any will also be paid . Corporation may, however, pay special surrender value as the discounted value of Paid up sum assured and vested bonus, if any, as applicable on date of surrender, provided the same is higher than guaranteed surrender value. 11. EXCLUSIONS: Suicide: This policy shall be void if the Life Assured commits suicide (whether sane or insane at that time) at any time on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of commencement of risk under the policy and the Corporation will not entertain any claim by virtue of this policy except to the extent of a third partys bonafide beneficial interest acquired in the policy for valuable consideration of which notice has been given in writing to the branch where the Policy is being presently serviced (where the policy records are kept), at least one calendar month prior to death.

12. COOLING OFF PERIOD: If women are not satisfied with the Terms and Conditions of the policy, women may return the policy to us within 15 days. Benefits A. Survival Benefits: On Survival the following benefits are payable: For 15 Years Term 20% of the Sum Assured payable at the end of 5 years. 20% of the Sum Assured payable at the end of 10 years. 60% of the Sum Assured payable together with vested bonus, and Final Additional Bonus, if any, at the end of 15 years. For 20 Years Term 20% of the Sum Assured payable at the end of 5 years. 20% of the Sum Assured payable at the end of 10 years. 20% of the Sum Assured payable at the end of 15 years. 40% of the Sum Assured payable together with vested bonus and Final Additional Bonus, if any at the end of 20 years. B. Death Benefit: In case of death of the life assured during the policy term, the full sum assured is payable irrespective of the survival benefits paid earlier. The vested bonuses and Final Additional Bonus, if any are also payable.

Statutory warning: Some benefits are guaranteed and some benefits are variable with returns based on the future performance of womenr Insurer carrying on life insurance business. If womenr policy offers guaranteed returns then these will be clearly marked guaranteed in the illustration table on this page. If womenr policy offers variable returns then the illustrations on this page will show two different rates of assumed future investment returns. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what women might get back, as the value of womenr policy is dependent on a number of factors including future investment performance.

Age of LA (Yrs.) Term (Yrs.) Sum Assured(Rs.) Annual Premium

Benefit Illustration 35 20 100000 6345

Total Death Benefit during the year End premiums Variable Total of paid till Year end of Guaranteed Scenario Scenario Scenario Scenario 1 2 1 2 year 1 6345 100000 2200 4500 102200 104500 2 3 4 5 6 7 8 9 10 15 20 12690 19035 25380 31725 38070 44415 50760 57105 63450 95175 126900 100000 100000 100000 100000 100000 100000 100000 100000 100000 100000 100000 4400 6600 8800 11000 13200 15400 17600 19800 22000 36667 48900 9000 13500 18000 22500 27000 31500 36000 40500 45000 75000 100000 104400 106600 108800 111000 113200 115400 117600 119800 122000 136667 148900 109000 113500 118000 122500 127000 131500 136000 140500 145000 175000 200000

BENEFIT ON SURVIVAL / MATURITY AT Total THE END OF YEAR End premiums of paid till Variable Total Year end of Guaranteed Scenario Scenario Scenario Scenario year 1 2 1 2 1 2 3 4 5 6 7 8 9 10 15 20 6345 12690 19035 25380 31725 38070 44415 50760 57105 63450 95175 126900 0 0 0 0 20000 0 0 0 0 20000 20000 40000 0 0 0 0 0 0 0 0 0 0 0 48900 0 0 0 0 0 0 0 0 0 0 0 100000 0 0 0 0 20000 0 0 0 0 20000 20000 88900 0 0 0 0 20000 0 0 0 0 20000 20000 140000

Note: i)his illustration is applicable to a standard (from medical, life style and occupation point of view) life. i) The non-guaranteed benefits (1) and (2) in above illustration are calculated so that they are consistent with the Projected Investment Rate of Return assumption of 6% p.a.(Scenario 1) and 10% p.a. (Scenario 2) respectively. In other words, in preparing this benefit illustration, it is assumed that the Projected Investment Rate of Return that LICI will be able to earn throughout the term of the policy will be 6% p.a. or 10% p.a., as the case may be. The Projected Investment Rate of Return is not guaranteed. Section 45 of Insurance Act, 1938: No policy of life insurance shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and

that it was fraudulently made by the policyholder and that the policyholder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose. Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life assured was incorrectly stated in the proposal. Prohibition of Rebates (Section 41 of INSURANCE ACT ,1938) : (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebates as may be allowed in accordance with the published prospectuses or tables of the insurer provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taking out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. (2) Any person making default in complying with the provision of this Section shall be punishable with a fine, which may extend to 500 rupees.

What Does Life Insurance For Women Cover? Life insurance for women covers what it does for men it is a way of ensuring that in the event of women death, women will leave women family or dependants with a lump sum that will allow them to continue with a standard of living that they enjoyed while women were still here. As more women than ever are now the main breadwinners in the family, making sure women have life cover is essential, because if women were to die unexpectedly or are taken seriously ill, women income the main source of income would cease. This would cause significant problems for women loved ones, who would potentially find themselves out of the family home if they could no longer afford to meet the mortgage payments. Despite this, many women still fail to get life cover to protect their family, in some cases it is because they are staying at home to care for their family and dont see their role at home as having any monetary value. But what many stay-at-home mums forget is that the role they have is worth a lot of money, even if they are not specifically getting paid for doing the work. It could impact on the household finances further as the main breadwinner could find themselves taking time off work to look after the children, which means that not only would women family lose the value of the work of one parent, the second parent may also see their income reduced as they need to reduce the hours they are working. Save money on women life insurance

What types of life insurance is there for women? Both men and women can get term assurance and whole of life cover. Term assurance is a policy which is in force for a specific period of time and is usually sold alongside a mortgage. Lenders will generally want a way of getting their money back if women die, and that is why one of the conditions is that women have life cover alongside the mortgage. Term assurance is perfect for this as it can be in force for as long as the

mortgage term. So often, these policies are in place for 25 years if women die within this time, women will get a lawwomen. But if women live longer than the policy is in place, it will simply expire and women will no longer get a lawwomen if women die. There are two types of term assurance: level term and decreasing term. Level term means the lawwomen that is made if women make a claim within the period the policy is in force stays the same throughout the entire policy term. Decreasing term means the lawwomen will reduce over the term of the policy, usually this is in line with how the mortgage it is written alongside is reducing over time. The premiums should also fall as the lawwomen falls. an I take out life insurance during pregnancy Life insurance during pregnancy will be no different to a policy women would get without being pregnant. But women may need to consider some of women answers to the questions that the insurer bases the premium calculations on. Women weight, for example, will be higher than normal if women are pregnant. So women should give the weight that women were immediately before women became pregnant. The amount of alcohol women drink and whether women smoke or not may also is different women would probably not be doing either while women are pregnant so women need to take that into consideration too. How women deal with it will depend on the questions women are asked, as some policies will be specific about whether women have recently been advised for medical reasons to give up alcohol. This will allow women to explain the reason. If this is not an option, women should speak to women insurer directly to make sure women give all of the information that is needed. Not doing so could result in women policy being deemed invalid. Once women have children, women may also want to consider taking out a joint life policy so that if women or women partner or spouse dies, women children will

be taken care of. Joint policies are usually cheaper than buying two separate policies, and women can have joint life first death or, more rarely, joint life second death. With the former, the payment will be made when the first of the two people named on the policy dies. The latter will only lawwomen when the second person named on the policy dies, which is why it is rarer. The difference in premiums for men and women Historically women have paid less for life insurance than men because statistically they are likely to live longer and therefore have more time to pay the premiums for an equivalent lawwomen. However, from December 2012, a ruling from the European Court of Justice will be enforced which will mean it is no longer legal for insurers to base premium costs solely on gender differences. Will the cost of life insurance for women rise?

As yet, it is not clear whether prices for women will rise, or they will fall for men, or they will meet somewhere in the middle. But if women had a policy in place before December 2012 with fixed premiums, women should not see any premium increases as a result of the change in the law. How to reduce the cost of womens life insurance? The measures can take as a woman are the same as those taken by a man. Changing some of the risk factors that insurers base their premium calculations on will help to cut costs. For example, if women are obese and women lose weight, women premiums

should fall. Similarly if women drink less alcohol, or stop smoking and lead a healthier lifestyle, these will all be looked favorably on by women insurer. Alcohol consumption, weight and smoking all increase the amount women pay, so changing any or all of these will cut costs.

HDFC LIFE SMART WOMAN PLAN

HDFC Life Smart Woman Plan, a life insurance policy for women that gives wings to your aspirations. The plan ensures your savings grow leaving you free to pursue your career and continue making a difference to those around you.

Women always wanted to make a difference in the lives of their loved ones. This is what gives true happiness. In their own way, women did what it took to keep them happy with their satisfaction always being a priority for you. Now that you are independent and have complete charge of your finances, some amount of planning can go a long way in fulfilling dreams for yourselves and your loved ones. Presenting, HDFC Life Smart Woman Plan, a life insurance policy for women that give wings to their aspirations. The plan ensures their savings grow leaving them free to pursue their career and continue making a difference to those around them. It also provided options which cater to specific life events of women with respect to their health, career and marriage.

FEATURES

Options to choose from 5 funds to suit risk appetite: 1. Short-term Fund: Low capital risk as exposure is only to the short term instruments (Max 3-year residual maturity) 2. Income Fund: Higher potential returns due to higher duration and credit exposure 3. Balanced Fund: Dynamic equity exposure to enhance the returns while the debt allocation reduces the volatility 4. Blue chip Fund: Investments in large cap equities 5. Opportunities Fund: Investments in mid-cap equities You can select any of the 3 Benefit Options, each created to meet specific needs such as: 1. Pregnancy complications or birth of child with congenital disorder 2. Diagnosis of malignant cancer of female organs 3. Death of spouse (Only with Elite option) Classic Under this option you can avail of premium waiver benefit with funding of next 3 years premiums. Premier Under this option you can avail of premium waiver benefit with funding of next 3 years premiums and periodic cash payouts of 100% of next 3 years premiums. Elite Under this option you can avail of premium waiver benefit with funding of next 3 years premiums and periodic cash payouts of 100% of next 3 years premiums along with coverage for death of spouse. Flexibility to choose the sum assured Convenience to choose policy tenure of 10/15 years.
ADVANTAGES

Uninterrupted savings with waiver and funding of premiums for next 3 years on the following events 1. Pregnancy complications or birth of child with congenital disorder 2. Diagnosis of malignant cancer of female organs 3. Death of spouse (Only with Elite option) Additional periodic cash payouts under Premier and Elite options Flexibility to make partial withdrawals to meet contingencies

Avail of hassle-free annual premium payment option Tax benefits subject to provisions contained under sections 80C and 10(10D) of the Income Tax Act 1961 Paying premiums is convenient with access to multiple modes credit card, internet banking, cheque, auto debit facility.
ELIGIBILITY

ligibilityMin-Max proposer entry age

18-none years

Min-Max entry 18-45 years ages for female life to be assured Min-Max entry ages of spouse for elite option Min-Max maturity age for female life to be assured Min-Max age of risk cessation for spouse in elite option Min-Max annual Premium Min-Max sum assured to (age less than 45 years) 21-50 years

28-60 years

31-60 years

Rs.24,000Rs.1,00,000 10x - 40x annualized premium

Min-Max sum assured to (age equal to 45 years) Min-Max Policy Term

7x - 40x annualized premium 10-15 years

Age has to be taken as of "last birthday" basis

Womens Health Insurance Coverage

Health insurance coverage is a critical factor in making health care accessible to women. Women with health coverage are more likely to obtain needed preventive, primary, and specialty care services, and have better access to new advances in womens health. Among the 98 million women ages 18 to 64, most have some form of coverage. However, the patchwork of different private sector and publicly-funded programs in the U.S. leaves one in five women uninsured. The Affordable Care Act (ACA) of 2010 includes several measures that are changing the profile of womens coverage as the law is implemented fully.

Sources of Health Insurance Coverage

Figure 1: Womens Health Insurance Coverage, 2012

Employer-sponsored insurance covers 58% of women between the ages of 18 and 64 (Figure 1). Women are less likely than men to be insured through their own job (35% vs. 43% respectively) and more likely to be covered as a dependent (23% vs.15%).1 Medicaid, the statefederal program for the poor, covers 12% of non-elderly women. Typically, only very low-income women who are pregnant, have children living at home, or who have a disability have been able to qualify for the program. Individually purchased insurance, which people buy on their own, is used by just 7% of women. Medicare and

other government health insurance cover a small fraction (4%) of women under age 65. For non-elderly women, coverage is limited to women who either have a disability (Medicare) or are covered through the military (TRICARE). Uninsured women account for 19% of women ages 18 to 64. They typically do not qualify for Medicaid, do not have access to employer-sponsored plans, and either cannot afford or do not qualify for individual policies. Employer-Sponsored Insurance: Approximately 57 million nonelderly women in the U.S. receive their health coverage from their own or their spouses employer. Historically, full-time employment has provided the greatest opportunity for obtaining job-based coverage. Women in families with at least one full-time worker are more likely to have job-based coverage (71%) and less likely to be uninsured (15%) than women in families with only part-time workers (33%) or without any workers (28%). Women are more vulnerable to losing their insurance compared to men, as they are more likely to be covered as dependents. This places a woman at greater risk of losing coverage if she becomes widowed or divorced, her spouse loses a job, or her spouses employer drops family coverage or increases premium and out-of-pocket costs to unaffordable levels. In 2013, annual insurance premiums averaged $5,884 for individuals and $16,351 for families, nearly doubling in cost over the past ten years. Workers currently pay for an average of 18% of premiums for individual coverage and 29% for family coverage. Individual Insurance: Nearly 7 million women purchase insurance on their own. This type of insurance often provided more limited benefits than job-based coverage and was costly. In many states, insurers charged women more than men for the same coverage levels, a practice known as gender rating. Also, pre-existing medical conditions triggered coverage denials in the individual market, depending on the insurer and state regulations. Historically, these plans did not cover certain services that are important to women, such as maternity care, prescription medications,

or treatment for mental health conditions such as depression. It is expected that many people currently covered in these plans will purchase coverage in Health Insurance Marketplaces newly opened under the ACA, which require plans to cover all of these services to some degree and offer subsidies to purchase this coverage for those who are income eligible. Furthermore, in 2014 plans available in Marketplaces will be prohibited from gender rating and denying coverage based on pre-existing conditions. Medicaid: According to Medicaid program statistics, in 2010, 19.3 million low-income women (18 to 64 years) were enrolled in Medicaid.3 Women make up two-thirds of the adult Medicaid population, but only low-income women who are pregnant, mothers of children who are 18 years or under, disabled, or over 65 can qualify for Medicaid. Women without children and disabilities typically have not been eligible regardless of how poor they were, but this will change in many states in 2014 when Medicaid eligibility is broadened to more people. Among all insurers, Medicaid disproportionately carries the weight of covering the poorest and sickest population of women. Approximately 82% of non-elderly women on Medicaid have incomes below 200% of the Federal Poverty Level (FPL). One in three (33%) women on Medicaid rate their health as fair or poor, compared to 10% of lowincome women covered by employer-sponsored insurance and 15% of low-income, uninsured women. Medicaid finances nearly half of all births in the U.S. ,accounts for 75% of all publicly-funded family planning services and nearly half (43%) of all long-term care spending. Over the past decade, several states (31 states) have expanded programs that use Medicaid funds to cover the costs of family planning services for low-income women and all states have established Medicaid programs to pay for breast and cervical cancer treatment for certain low-income uninsured women.7 Uninsured Women: Approximately 19 million women are uninsured. Uninsured women are more likely to have inadequate access to care, get a lower standard of care when they are in the health system,

and have poorer health outcomes. Compared to women with insurance, uninsured women have lower use of important preventive services such as mammograms and Pap tests and are two to three times as likely to forgo medical services due to cost (Figure 2)

Figure 2: Womens Access to Care, by Insurance Coverage, 2010

Women who are younger, poorer, and of color (especially Latinas) are particularly at risk for being uninsured (Figure 3).

Figure 3: Women at Greatest Risk for Being Uninsured, 2012

The ACA included a provision allowing dependents to be covered up to age 26, and it is estimated that more than 3 million young adults have been insured as a result of this policy. Approximately six in ten (59%) uninsured women are in families with at least one adult working full-time and 77% of uninsured women are in families with at least one part-time or full-time worker. There is considerable state-level variation in uninsured rates across the nation, ranging from 30% of women in Texas to 4% of women in Massachusetts.

The ACA and Womens Coverage Expanding Coverage: One of the ACAs primary goals is to expand access to insurance coverage, significantly reducing the number of uninsured. The law requires that nearly everyone carry health insurance by 2014, through a combination of changes in private and public coverage. The ACA was written with the intention that individuals with very low incomes (< 138% of the federal poverty level) would qualify for Medicaid through an expansion of the program in all states, and that other uninsured individuals would be able to purchase policies through Marketplaces offering a choice of private plans. Individuals with incomes between 100% and 400% of poverty can receive assistance with the premium costs of plans in these Marketplaces through a graduated system of tax credit subsidies. These tax credits are not available to individuals with incomes below 100% of poverty. However, in July 2012, the Supreme Court issued a ruling that effectively made the Medicaid expansion optional for states. As of October, 2013, 26 states including Washington D.C. are moving forward with Medicaid expansion, and 25 states have decided not to expand Medicaid at this time. As a result of these policy choices, it is estimated that 2.4 million currently uninsured women who had been expected to gain Medicaid under the original design of ACA will not qualify because their state is not expanding the program and they also do not qualify for subsidies in the Marketplaces. Addressing Affordability: Affordability of care is a concern for many women, not just those who are uninsured. In 2013, one in three privately insured women reported she or a family member postponed needed healthcare in the past year due to cost.The new law includes some measures directed at limiting consumer costs that will affect women. These include caps on out-of pocket spending for certain low-income individuals and coverage for many preventive services without costsharing. Scope of Coverage: The ACA mandates that plans in state-based exchanges cover broad categories of essential benefits, including outpatient and hospitalization care, maternity care, prescription drugs,

rehabilitation, and mental health care. The law also requires that new private plans cover preventive services and vaccines recommended by federally-sponsored committees without co-payments or other cost sharing. This includes pap tests, mammograms, bone density tests, as well as the HPV vaccine. As of August 2012, new private plans were also required to cover an additional set of preventive services for women, including contraceptives as prescribed by a provider, breastfeeding supplies and supports such as breast pumps, screening for domestic violence, well woman visits, and several counseling and screening services. Some religious employers (houses of worship) are exempt from the contraceptive coverage requirement. With health reform implementation under way, it is important for women to understand their coverage options. For those joining Medicaid, they will need to understand their states policies regarding specific benefit levels and the network of available providers. Women enrolling in the Marketplace plans will have to evaluate their plan choices based on a number of factors, including whether plans cover the full range of womens health services, the plans premium charges and other out of pocket costs, and the reach of the plans network of providers. The decisions that federal and state policy makers, insurance companies, and individuals make today and in the future will shape access to coverage and care for millions of women across the nation in the years ahead.