While emerging market governments are investing more in healthcare, there is still a large gap between demand and supply.  The gap can be primary cover in some countries; while in others, it can be healthcare services or costs that are not covered publicly.  Private health insurance is stepping in to bridge some of this gap. We studied private health insurance across major emerging markets in Asia, Latin America and Africa to understand current situation and future trends. We found that private health insurance is growing across these markets. Its main role has been to extend primary cover to certain segments of the population. In most cases, these are the relatively affluent or employed segments. However, we also see the emergence of community based private health insurance as well as public subsidization of private insurance to cover the less well off. However, several barriers prevent private insurance from significantly increasing health coverage. These are the lack of information to properly assess actuarial risks and make proper claims settlements, moral hazard, adverse selection and the non-coverage of pre-existing conditions. We then studied specific innovative examples which have tried to address some of these barriers.  For example, Roche is partnering with Swiss Re to provide actuarial expertise to local insurance companies to enable affordable premium for cancer medicine coverage in China. India’s Yeshasvini community-based health insurance programme provides coverage to rural poor through well-specified procedures for enrollment, treatment and claim settlement and monitoring. GSK Brazil increased reimbursement of oncology drugs with some health insurance companies through risk-sharing agreements.  Learning from such cases, we developed specific guiding principles on how private insurance can be used to provide increased and effective access to healthcare in emerging markets. These principles can help inform appropriate policy setting on private health insurance in emerging markets.