Professional Documents
Culture Documents
CHAPTER 1
INTRODUCTION
How many accident you need to realise that you need Health Cover? It
takes just one visit to a hospital to make us realize how vulnerable we are,
every passing second. For the rich as well as poor, male as well as female
and young as well as old, being diagnosed with an illness and having the
stroke, renal failure, cancer the list of lifestyle diseases just seem to get
longer and more common these days. Thankfully there are more speciality
hospitals and specialist doctors but all that comes at a cost. The super
rich can afford such costs, but what about an average middle class person.
For an illness that requires hospitalization/ surgery, costs can easily run
into five digit bills. A Sundram Health Insurance policy can cover such
important these days compared to Old days Health is a human right, which
population both in rural & urban areas have acceptability and affordability
towards medical care, at the same time cannot be said about the people
who belong to poor segment of the society. It is well known that more than
depends on the sum assured , age, current health condition and your
previous medical history. Higher the sum assured, higher the premium. So
no standard answer or thumb rule for this. If we agree that Sundram Health
Insurance is important, one has to look at his/ her own lifestyle, health
Keep in mind that most insurance companies limit the sum assured to a
charges, etc. for hospitalization. Not only are such benefits superfluous,
they tend to drive the premiums higher. So it is best to avoid such plans
plan.
the Elder Chamberlen from the Peter Chamberlen family. In the late 19th
like modern
disability insurance. This payment model continued until the start of the
insurance. Patients were expected to pay all other health care costs out of
procedures, and also most prescription drugs, but this was not always the
risk of life and property. Under the plan of insurance, a large number of
Sundram Health Insurance . Since the past two decades, there has been a
healthcare insurance coverage not only for themselves but also for their
bynature.
Company among others. Indias fast growing demand for affordable health
cover is attracting greater business attention, with both life and non-life
investors in 2001. Over the past ten years coverage rates across the
populous South Asian country have doubled and the domestic insurance
premiums last year. Sales of medical insurance products have been driven
surging treatment costs, and a lack of other social safety options across
countrys Sundram Health Insurance sector will likely emerge. Over the
observers.
The introduction and increased proliferation of private sector players in
innovative new coverage products and increase service standards for clients
in the domestic market. Of particular note has been how the entrance of
of India, Aviva Life Insurance and Max Life Insurance, has affected the
market recently. These life insurers offer largely savings-based health plans
products have tenures that can last up to 20 years. When the policy expires,
customers are entitled to receive the fund value. Normally this is not a
While life insurer health plans are tied to equity returns, medical insurance
certain affiliated
needs.
market still has many problems to contend with in order to match its true
untapped regions and client bases with more innovative and affordable
frequently citing the low coverage of plans in terms of both the diseases
insurance products, premiums for medical plans are based on the health of
and fraud in the Indian market and increased policy cancellations from
customers who do not find any value in their Sundram Health Insurance
policies.
last Thursday, IRDA chairman J Harinarayan said the industry must now
consumer complaints this year have been directed towards health insurers.
the consumer are areas of concern. Probably, the lack of clarity is reflected
in the increasing number of complaints, IRDA chairman J Harinarayan
just about 2% of the countrys 1.2 billion population, India offers a huge
Health Insurance products in the category offered by both life and non-life
insurers. While ICICI Lombard, Bajaj Allianz and Reliance General are
space, Apollo DKV, Star Health & Allied Insurance are the standalone
the business is a huge challenge for insurers because of the high losses
India. The interesting find about Sundram Health Insurance in India was
Health risks in India are perceived differently than the western population.
Prior planning in health issues is yet to be a major priority The industry is
penetration level in India is very low when compared with the global
bringing together insurance companies and the insured, and their role
Sundram Health Insurance policy does not always cover every possible
health problem someone might encounter in the future. There are certain
agreed to by the insured (person who is taking the plan), and the insurer
(entity that is providing the plan) and the entire procedure happens
The best time to avail a Sundram Health Insurance plan is when the
they do not need such a plan. In reality people can fall prey to a disease or
- nobody can be absolutely sure of a life fully free of such issues. Normally
as someone gets older the problems increase and the possibilities of some
major disease are always there. A problem with trying to get a medical
insurance during old age is that since there are more chances of a medical
condition the premium is often high or the insurer is not ready to cover the
individual in question.
LITERATURE REVIEW
CHAPTER 2
LITERATURE REVIEW
Doorslaer, 2003; Gertler, Levine & Moretti, 2003; Gertler and Gruber,
spend on health care more than 40% of the income available to them after
meeting their basic needs. (WHO Factsheet N320, 2007)Low income and
high medical expenses can also lead to debt, sale of assets, and removal of
can thus contribute to long-term poverty (e.g. Van Damme et al, 2004;
Annear et al, 2006). At the same time, because households often cannot
borrow easily, they may instead forego high-value care. When they do
access care it will often be of low quality (Das, Hammer and Leonard,
Theory suggests that Sundram Health Insurance can address some of these
problems. By covering the cost of care after a health shock, insurance can
help to smooth consumption, reduce asset sales and new debt, increase the
quantity and quality of care sought, and can improve health outcomes.
valid control group for the insured. We cannot simply compare the
outcomes of
example, rich and well educated households typically have both better
(Jtting, 2004; Cameron and Trivedi, 1991), but the positive correlation
between health and insurance status tells us nothing about the impact of
insurance. On the other hand, those in poor health may be more likely to
pay for Sundram Health Insurance (Cutler and Reber, 1998; Ellis, 1989),
but finding that the insured tend to be sicker would not imply that
States data. We follow Levy and Meltzer (2004, 2008) in both our choice
predicts that insurance markets will suffer from adverse selection, which
occurs when less healthy people or people who are more risky with their
the doctor's fees, medicines and related health services can work out to be
a huge sum. In such times, health insurance provides the much needed
1) SOCIAL
Association (SEWA)
3) PRIVATE
a) Individual policy
HEALTH INSURANCE
amount each year for specified services. The premium are usually flat rate
(not income-related) and therefore not progressive. Making profit is not the
purpose of these funds, but rather improving access to services. Often there
involved in defining
with the for profit insurers for the purchase of Custom designed group
This scheme established in 1992, provides health, life and assets insurance
to women working in the informal sector and their families. The enrolment
in the year 2002 was 93 000. This scheme operates in collaboration with
husband too can be covered. Rs 20 per member is then paid to the National
NIC in turn receives premiums from SEWA annually and pays them a
with free care to the poorest. The benefits include discounted rates on both
outpatient and inpatient care, with the VHS functioning as both insurer and
health care provider. In 1995, its membership was 124 715. However, this
adverse selection.
2)SOCIAL INSURANCE OR MANDATORY HEALTH INSURANCE
SCHEMES
in the population and the premiums are determined by income (and hence
ability to pay) rather than related to health risk. The benefit packages are
(ESIS).
Since 1954, all employees of the Central Government (present and retired)
freedom fighters and journalists are covered under the Central Government
Health
and approved private hospitals are also covered. This scheme is mainly
funded through Central Government funds, with premiums ranging from
The CGHS has been criticized from the point of view of quality and
facility when such facilities are not available with the CGHS).
covered did not seek care from ESIS facilities. Unsatisfactory nature of
ESIS services, low quality drugs, long waiting periods, impudent behavior
Apart from the government-run schemes, social security benefits for the
(Amendment) Act 1984, Plantation Labour Act 1951, Mine Mines Labour
Welfare Fund Act 1946, Beedi Workers Welfare Fund Act 1976 and
Building and other Construction Workers (Regulation of Employment and
this and aims to evolve a policy structure, which reduces such inequities
across the social and geographical expanse of the country is the main
company that pools people with similar risks and insures them for health
expenses. The key distinction is that the premiums are set at a level, which
based on an assessment of the risk status of the consumer (or of the group
In the public sector, the General Insurance Corporation (GIC) and its four
Company) and
the Life Insurance Corporation (LIC) of India provide voluntary insurance
schemes.
The Life Insurance Corporation offers Ashadeep Plan IIand Jeevan Asha Plan
II. The General Insurance Corporation offers Personal Accident policy, Jan
November 1986 and it covers individuals and groups with persons aged 5
80 yrs. Children (3 Months 5 yrs) are covered with their parents. This
hospitalization as per the sum insured. There are exclusions and pre-
existing disease clauses. Premiums are calculated based on age and the
1995/96 about half a million Mediclaim policies were issued with about
1.8 million beneficiaries. The coverage for the year 2000-01 was around
7.2 million.
Another scheme, namely the Jan Arogya Bima policy specifically targets
The same exclusion mechanisms apply for this scheme as those under the
Mediclaim policy. A family discount of 30% is granted, but there is no
policy too has had only limited success. The Jan Arogya Bima Scheme had
only covered 4 00
The year 1999 marked the beginning of a new era for health insurance in
private and foreign participation, thereby paving the way for the entry of
a capital of Rs 100 crore along with a business plan to begin its operations.
described briefly.
3) PRIVATE-:
a) Individual policy-
One may obtain a health insurance policy through two different ways:
gets to talk with the health insurance providers one-on-one, in order to get
Individual health insurance is such that one is able to choose what s/he
wants, and is not saddled with any and everything. Many people prefer to
they want to be covered for. In complete honesty they have surrender any
knowledge of
their family history in terms of illness so that their cases can be assessed
more successful and less prone to obstacles; often in-depth checkups are
not conducted as they are with individual health policies. The reason
approach them; they feel that there must be a particular reason for them
INDIA
India has lessons to learn from the experience of Chile. India too has a dual
sector where the providers are salaried. Utilization of insurance under both
disincentives to control
costs as it appears to be a free good for the patient and the provider, often
frivolous use by the patient taking treatment even for a condition which he
hazard). Third, it is only the patients who know their health status. Since it
is normally
those in need of health care who tend to subscribe to health insurance, this
healthy. Risk
loading fee and consequently the cost of premium. This is one reason for
the attractive group discounts being as high as 67%. For these reasons,
poor, young women in the reproductive age group, and the ill.
scheme offered by the public sector. The premium based on the age, risk
and the benefit package opted for, ranged from a minimum premium of Rs
15,000 with discounts for group memberships. In 2001, there were 78 lakh
persons covered under Mediclaim. The subscribers are usually from the
subscribing to Mediclaim.
The standard Mediclaim policy covers only hospital care and domiciliary
The Insurance company (or the TPA, where applicable) administers the
scheme. Being an indemnity scheme, the patient pays the hospital bills and
There is also uncertainty about the amount reimbursed, there are times
when the patient is reimbursed only partially, the usual reason being the
that the GIC was more interested in whether the claim pertained to an
existing disease or whether the facility was qualified or not, but spent little
time on detecting fraud. With claims exceeding 30% a year, more than the
close monitoring.
Second, it was also observed that the GIC sets premium on the filing of
claims and not actual amounts settled, giving it a cushion year on year as
settled claims amounts are always lower than those filed, an amount that
claim, of which only 75% of claims were settled. The claims ratio was
45%. However, of late, the claims ratio is growing at a fast rate, allegedly
From the above discussion, five features that characterize the Health
Insurance system in India emerge:
1. By and large, the system offers traditional indemnity, under which the
insured first pay the amount and then seek reimbursement. Under
also means that those most in need of insurance, i.e. The sick, get excluded
for any financial risk protection against the diseases they are suffering
from.
is advantageous for the provider since he bears no risk for the prices he can
3.Policies provide a ceiling of the assured sum. Such a system, and that too
insured as he gets less value for money, as the provider and the insurer
charge services so long as the amounts are within the assured amount of
4.The system is based on risk-rated premiums. This again puts the risk on
the insured as the premium is fixed in accordance with the health status
and age. Under such a system, women in the reproductive age group, the
old, the poor and the ill get to pay higher amounts and are discriminated
against.
5.The system is voluntary, making it difficult to form viable risk pools for
of life and property. Under the plan of insurance, a large number of people
Since the past two decades, there has been a phenomenal surge in
coverage not only for themselves but also for their family members
and large, Indians are traditionally risk-averse rather than risk lovers by
nature.
Categories
Cashless Hospitalize
Medical Reimbursement
A) CASHLESS HOSPITALIZATION
the time of discharge from the concerned hospital. The settlement is done
TPA (Third Party Administration ) before availing the benefits under this
may vary from case to case. Examples include: FTND (Full Term Normal
B) MEDICAL REIMBURSEMENT
Under this procedure, the insured has to bear the entire expenses incurred
during hospitalization. After getting discharged from hospital, the
benefits under this option, the insured has to approach the concerned TPA
under which he/she is covered, fill the requisite form and satisfy all the
treatment expenses.
A recent survey conducted in 2008 showed that only 3% of the entire Indian
population has availed some sort of insurance policy and enjoys benefits
Since, the general public are by and large ignorant about the benefits of
Also there are numerous fly-by-night agents out to fleece the gullible
numerous players have entered the healthcare segment, but inspite of the
expenditure. These people pay for their medical expenditure from their
family members for years. If the same continues, how will the people of
India pay their medical expenses in the future? How will the efforts of
medical treatment?
Thus, there is a need to increase the number of insured individuals in India.
and every health insurance company should play an active role. It is only
then possible that people would be able to avail quality healthcare in times
The only point that should be brought to light is that people should buy
These products offer much relief to them and their family members at the
scramble for the arrangement of funds at the last hour. Hence, the
Government and all the associated bodies should all offer their support in
Health of its citizen is one of the top priorities of a nation. A nation with
Healthy people would be able to pursue its agenda with dexterity and
execute those with fine see. Total Health care boost economic growth ,
lowers mortality rate. The success of many countries lies in their special
effort to cover the entire population with a scheme of health insurance that
keep them protected against unforeseen health hazards through insurance
per capita, the burden of having to pay for unplanned and expenditure for
The Government should educate people about the rise of medical costs and
guidelines, allowing only the right players to enter the health insurance
health needs of target customers and encourage people to buy them. The
combined efforts of all these bodies will surely bring some improvement.
reach new heights in the coming few years as public and private insurers
market. As per our latest findings, the Indian health insurance industry is
one of the most prolific ones in the world. As the healthcare costs and
awareness are rising in the country, we expect the segment to grow with
gross premiums scaling up at a CAGR of around 32.5% during 2010-11 to
landscape has undergone tremendous changes in the last few years with the
his family against critical ailments like heart failure, stroke and kidney
failure.
designing special policies for such people. India could soon see a national
medical insurance policy for people living with HIV (PLHIV). The
During the health insurance market analysis, researcher found that there
are around 28 active third party administrators (TPAs) in India, and the
TPA infrastructure in the country has witnessed a strong growth with the
health insurance have given rise to a need for maintaining and optimizing
companies while retaining their no-claims benefit. The report also provides
an overview of the rural health insurance segment, and expects that the
framework for the industry. The research also looks into profiles of various
12000
10000
8000
6000
4000
2000
0
2004-05 2005-06 2006-07 2007-08 2008-09 2009-102010-2011
GROWTH DRIVERS:
Research has shown that Indians across all segments and age groups are
previous generations. This fact, undoubtedly negative, stands out as the root
cause for the potential growth of the health insurance sector. Jacob informs,
The growing percentage of middle class citizens in the country and the
balance has brought about a paradigm shift in the attitude of people, who
market has great prospects, but the need of the hour is to identify products
that will suit customers insurance needs and win their confidence. Biggest
target for the insurance companies in the next five years would be to cover
He further adds, Over the past few years, many companies have entered
into the market, and the industry is seeing a lot more innovation with
corporate, low poverty line and affluent class. Information Technology (IT)
has also been one of the significant enablers of growth in the sector. Given
the current health insurance penetration levels in the country, at about three
to four per cent, there is a significant potential and a long way to go.
There will be the number of factors, which will lead to growth for the
under mentioned:
world.
sector in India.
annum.
Along with these other reasons, as why the Health insurance will see a
mentioned:
Easier Financing
The majority of health care services in India are provided by the private
sector & the private sector in India is one of the largest in the world,
having:-
75 percent dispensaries
With the booming economy and High literacy rates, the capacity to spend
along with the capacity of the people to pay has increased. As people
earning & education level increase with it will lead to more spending in
health care. The increase in purchasing power & education will lead to a
mentioned:-
As People are conscious of health care and hence need for Health
20% per year. People have started giving more importance to health
insurance with a life insurance. large number of people are now on the
Health Insurance industry achieve figure of 30% then the portfolio will
Health Insurance industry achieve figure of 60% then the portfolio will
a) People are conscious of health care and hence need for Health
b) Healthcare costs are increasing at 20% per year. People have started
some specific weaker segment of our society- but sooner or later our
social security programme and implement this proposal. This aspect will
become more and more important as the population of senior citizens will
In the light of these facts , Health Insurance has a great future in our
reality.
MARKET DRIVERS
(2012-2015)
Raising Health care
cost Have increased the
need for the health
Insurance
supportive demographic
profile(proposing middle
class, increasing dieses state
population)
Rationalization of the
premium rates (e.g. trends
of the upward revision of 5 10 0
Limited Reach
0 5 10 0 5 10
(IN
( CRORE) PERCENT)
largest private sector non- life insurance Company, with market share of
9.99 per cent. It reported a marginal increase in market share up from 9.52
per cent in 2009-10, Bajaj Allianz , the second largest private sector non-
2,870crore, saw decline in market share from 7.17 per cent in 2009-10 to
6.74per cent during the year under review. Of the 15 private insurers , 12
(reported a negative growth of 16.38 per cent). The other two insurers had
In case of public sector non life insurers, all four companies expanded their
share of these companies, other than for national, however, declined from
their previous year respective levels, which helped to improve its market
share to 14.61 percent in 2010-11(13.36 per cent in the previous year). It
reported growth of 34.50 per cent , which is higher than the industry
average for 2010-11, New India , with insurance premium of 7,097 crore
, remains the largest general insurance company in India with market share
of 16.67 percent.
Source- Irda
2.6 percent.
As against this, the industry settled 85.3 per cent claims of the total
claims lodged and the balance 12.1 percent outstanding at the end of the
year. Overall the number of repudiated claims has been increasing. The
rise is due to the fact that the sector is expanding rapidly and business
crores in the year 2010-11. The number of claims intimations would also
8.7 Budget 2012: Hike Sec 80D limits to boost health insurance
Budget, and both, the common man and industry have always been
retail consumers will get only better with promising measures by the
government. Here are some proposed changes that can help the insurance
industry move to the next level of growth and consolidation. The measures
will also help the industry to render better service to their customers.
Considering extremely low penetration of GI products in our country, there
is a pressing need for concerted effort to make insurance all the more
abolition of the service tax will enable this process. Currently the service
tax stands at 10.3% including education cess and the Government should
consider waiving off the service tax on premiums paid. Alternatively, they
service tax. This move will help to develop health insurance in the country
Currently, the qualifying amounts under Section 80D for self, spouse and
15,000 for the parents. Given the high cost of medical care and to
CHAPTER 9
Penetration of health insurance has been slow and halting, despite the
that explain for the slow expansion of health insurance in the country are
as follows:
proper underwriting and actuarial premium setting. This puts the entire risk
on the insurer as there could be the problems of moral hazard and induced
demand. Most insurance companies are therefore wary about selling health
insurance as they do not have the data, the expertise and the power to
Increased use of services and high claim ratios only result in higher
tend to overestimate the risk and fix high premiums. Besides, the
agent; 5.5% administrative fee to TPA; own administrative cost 20%, etc.
Patients also experience problems in getting their reimbursements.
make it difficult for the insured to know about their entitlements, because
of which the insurer is able to, on one stratagem or the other; reduce the
claim amount, thus demotivating the insured and deepening mistrust. The
benefit package also needs to be modified to suit the needs of the insured.
Exclusions go against the logic of covering health risks, though, there can
be a system where the existing conditions can be excluded for a time
periodone or two years but not forever. Besides, the system entails
equity implications.
the country have barely one or two hospitals with specialist services. Many
with Kerala having 26 beds per 1000 population compared with 2.5 in
Madhya Pradesh.
6. Co-variety risks
High prevalence levels of risks that could affect a majority of the people at
the same time could make the enterprise unviable as there would be no
diseases. A study of claims (Bhat 2002) found that 22% of total claims
Health Insurance
Lack of
underwriting
Diciplin
20%
Lack of product
innovation
Lack of Product
awareness
amoung
Distributores
8%
Lack of customer
53 awarness
%
4%
Increased
Compitation
4%
Increased in
Hospital tariff
(claim cost)
11%
Lack of
more, because of this major problem customers did not get there product in
proper manner.
to take strict action against this issues , because it affect the loyalty of the
customer and
growth oriented firm always looks beyond the existing products or services
and there firm should respond to dynamic environment & offer new
they are not in position to introduce the product to customer it will not be
position to identify the product because of such awareness. The firm has to
customers.
Employed dissatisfied
76%
due to
delayed claim
sattlement 63%
Services from TPA
not up to 24%
mark
Services from broker 22%
not up to
mark
14%
After sales
service 13%
Changes in regulation
(service 13%
tax being imposed)
0% 20% 40% 60% 80%
policy cancellation notice Series 1
changes in
regulation
Figure no.9.3.2 Major Issues in Handling Health Insurance
There are many Indian citizens who are dissatisfied with the services of
health
insurance providers. The main reason for their dissatisfaction is the rejection
of
health insurance claims. Majority of these people do not want to know the
cause behind the rejection, but instead show frustration for not being offered
avoid these confusions. One important point that everybody should keep in
mind is
the associated waiting period. This is the time period before which there is
no coverage offered for the particular ailment. If a person claims for the
same illness before the waiting period elapses, he/she would not be offered
the coverage. The other important point that a person should ponder over is
hospitals without having to pay cash upfront. However, TPAs are also a
Most of the brokers are not provided the services up to mark, after selling
the policy they are not taking care about the after sale service procedure
The study revealed that the satisfaction levels in health insurance plans
was the least. Indicating that the health insurance segment needs to
consumers who use the service. because of the half knowledge of the
customer ,the policy can get not approve and customer get the cancellation
People should remember that this facility can be availed only in network
hospitals and
does not make any sense. The common cause behind all these problems is
that people do not read the terms and conditions of their health insurance
policy carefully and thus, face problems at the time of claim settlement.
Many of these people do not look into their healthcare needs while buying
be a major concern for insurers and business leaders. Insurers will need to
the risk of fraud. Fraud risk in the insurance value chain can emanate from
internal and external factors External fraud risk can arise at various stages,
issue. The million dollar question continues how to reduce fraud , these
there are various types of insurance frauds, which occur in all the areas of
collusion between parties, etc. All insurance fraud can be classified under
Misselling
Collusion Differe
between nt
types
Parties of
frauds
affecti
ng
Insura
nce
Fake Document Compa
nie
s
Commission
Rebetting
Hard fraud : This occurs when people unlawfully obtain money from
insurance companies by a reporting a false injury or accident
Soft fraud: This happens when people either lie to their insurance
companies or hide certain information for their financial gain.
In its quest to restrict unfair practices, IRDA has formulated the insurance
and any failure to do so will attract penalty . Any failure on the part of
insurers to follow this procedure and time frame will attract penalties by
IRDA.
In its bid to check financial fraud , IRDA has made it mandatory for all
insurers
AND
FINDINGS
CHAPTER 6
SAMPLE SIZE-300
Yes No
70%
60%
50%
40%
30%
20%
10%
0%
Figure no.12.1
Parameters Percentage
Yes 54%
No 46%
Table no.12.1
Analysis:-The analysis shows that green symbolize of Insurance 68%
(a)Yes (b) No
Yes No
70%
60%
50%
40%
30%
20%
10%
0%
Parameters Percentage
Yes 68%
No 32%
Table no.12.2
Analysis:-
expenditure. These people pay for their medical expenditure from their
Yes No
70%
60%
50%
40%
30%
20%
10%
0%
Figure no.12.3
Parameters Percentage
Yes 64%
No 36%
Table no.12.3
Analysis:-
Because of lack of product benefit customer are not ready to purchase that
product. Lack of product awareness among distributors ,if they are not in
Yes No
54%
52%
50%
48%
46%
44%
42%
Figure no 12.4
Parameters Percentage
Yes 54%
No 46%
Table no 12.4
Analysis:-
(b) Bajaj
Alliance (c )
Star Allied
Assurance (e)Others
Companies
40.00%
35.00%
30.00%
25.00%
20.00% Compani
es
15.00%
10.00%
5.00%
0.00%
BajajStar
ICICI Allied New India Others
Lombard Alliance Assurance
Figure no.12.5
Parameters Percentage
ICICI
LOMBARD 36%
BAJAJ
ALLIANZE 15%
OTHER
COMPANIES 8%
Table no.12.6
Analysis:-
ICICI Lombard is one of the best health insurance company and Star
customers .Although the premium amount is high but customers still opt
this companies Insurance product. It has created as his own brand image.
and Bajaj Allianz the most target audience are middleclass and lower
insurance company.
Q.6 How did you get this health Policy?
Health Policy
60.00
%
50.00
%
40.00
%
30.00
% Health
Policy
20.00
%
10.00
%
0.00
% Own
Purchase Employer Family Provides
provider
Parameters Percentage
Table no.12.6
Analysis
compare to family floater plan customer will get maximum sum assured.
very few companies are provide health insurance for their employee and in
case of family floater company charge more premium as per the age of the
family member.
Q.7 How much premium do you pay annually?
(a) 1000- 5000 (b) 5001- 10000 (c) 10001 15000 (e) Above 15000
Premium
35.00%
30.00%
25.00%
20.00%
Premiu
m
15.00%
10.00%
5.00%
0.00%
1000- 5000 5001- 10000 10001 15000 Above 15000
Figure no.12.7
Parameter Percentage
1000-
5000 33%
5001-10000 35%
1001-15000 25%
Table no.12.7
Analysis:
of the customer but one most important thing researcher found that as the
coverage and benefit but some middleclass and lower-class customers not
50.00%
40.00%
30.00%
20.00
% Health
insurance plan
10.00
%
0.00
%
Health Tax benefits Recover Future
Expenses uncertainty
recover
Figure no.12.8
Parameters Percentage
Health expenses
Recover 44%
Recover future
Uncertainty 33%
cover their Health expenses ,the number of diseases increases day by day
and peoples are paying high amount for that so to recover that expense
health plan for the tax benefit and recover the future uncertainty.
Q.9. Kindly Rate The Following Factors Important To You In Opting
Health Insurance (More than one)
b) Service of Insurer ( ) ( ) ( ) ( ) ( )
e) Premium Amount ( ) ( ) ( ) ( ) ( )
f) Coverage Amount ( ) ( ) ( ) ( ) ( )
g) Coverage of Diseases ( ) ( ) ( ) ( ) ( )
Important Factors
30
%
25
%
20
%
15
%
10
%
5%
Important
0% Factors
figure no.12.9
Parameters Percentage
Table no.12.9
Analysis:-
For the continued development of the health insurance market, and also to
protect the long-term interests of the insured persons, the prices of health
acceptance and increased reach, while on the other, the insurance industry
requires that this line of business remains commercially viable and better
a) Definitely well-covered
b) Probably well-covered
c) Not well-covered
35
%
30
%
25
%
20
%
15
%
10
% Coverage by current
insurance
policy
5%
0%
figure no.12.10
Parameters Percentage
Table no.12.10
Analysis:-
43% respondents says that their health insurance plan not well covered and
probably not well covered the percentage is quite high. people should
confusions. One important point that everybody should keep in mind is the
associated waiting period. This is the time period before which there is no
coverage offered for the particular ailment. If a person claims for the same
illness before the waiting period elapses, he/she would not be offered the
coverage.
Q.11 Which according to you is the most important aspect that every
a) Hospital care
b) Preventive care
c) Maternity
d) Health specialists
e) Choice of doctors
Plan Cover
35
%
30
%
25
%
20
%
15
%
10
% Plan
Cover
5%
0%
Figure no.12.11
Parameters Percentage
Preventive care 8%
Maternity 13%
Table no.12.11
Analysis:-
Most of the respondents says that they want better coverage of hospitals
and coverage of maternity also because many of the reasons doctors are
taking decision for suzerain so its not affordable for common men and they
want their own family doctors for treatment so this are the main things that
researcher found.
CONCLUSION
AND
RECOMMENDATION
CHAPTER 7
CONCLUSION :
The result of this study shows that the annual premium is the most
plan. This means that households having higher income have higher
probability of buying healthcare plan. Thus, less income groups may not
opt for health insurance plan. Thus there is a need to develop more
products that cater to need of larger and all levels of income groups. Apart
decisions. The decision made for choosing the plan is mainly influenced
by self perceptions. Family and relatives and past experience hold second
position for assisting in the choice of plan. Most people would prefer to
buy healthcare plan from private insurance companies for they provide
better services and innovative products. Thus, there is large scope for
varying risk
Cooperatives would further increase the reach and depth of private health
The analysis clearly shows that there is demand for cash less health
insurers. Even though the insurers are providing need based plans but more
companies that are run on-profit objective. In most the countries life
available at present should be hiked and continued with. The health plans
should be wide based in order to include outpatient care along with in-
patient.
Government and all the associated bodies should all offer their support in
the right to seek quality healthcare without any financial thought. and it
will help to increase the awareness of health Insurance among the people.
RECOMMENDATION
country.
tariff regime. The parameters used to evaluate the hospitals would include
points to customers.
(3) IRDA should engage the services of the Ministry of Health and Family
Other Recommendations
Abolition of the service tax on health insurance products. It has also been
www.google.com
www.mediindia.net
www.healthinsuranceindia.org
www.bimabazar.com
www.timesofindia.com
www.irda.govt.in
www.policymantra.com
QUESTIONNAIRE
QUESTIONNAIRE
Name of Respondent: -
Date: -
Gender
(a) Male (b)
Female Age (in
Years)
(a) 18 - 25 (b) 26 35 (c) 36 - 45 (d) above
45 Qualification
(a) 12th (c) Graduate (d) Postgraduate (e)
Professional Monthly Income (in Rs.)
(a) Below 10,000 (b) 10,001-20,000 (c) 20,001-30,000 (d) above
30,000 Occupation
(a) Student (b) Private Employee (c) Govt. Employee
(a)Yes (b) No
(a) Yes ( b ) No
Q. Do you have any Health Insurance
4 Policy?
(a) Yes (b) No
Q. If yes, which companies plan do you
5 avail?
(b) Bajaj
Alliance (c )
Star Allied
(e) Others
Q.6 How did you get this health Policy?
(a) 1000- 5000 (b) 5001- 10000 (c) 10001 15000 (e) Above 15000
Q.10 How Well Do You Think, You Are Covered By Your Current
Health Insurance Policy?