INTRODUCTION

1.1 INTRODUCTION TO THE CONCEPT

Health is Wealth. That is old wisdom. We do not know if it is true in today’s world. What can we

do know is that the corollary holds. For, if we lose our health, our treatment can be a major drain

on our resources and leave them severely crippled. Healthcare costs are rising at more than 15

per cent a year.

Health insurance has become a necessity in today’s world considering the rise in the cost of

medical care and treatment and the huge population of the country. World Health Organisation

(WTO) defines Health as complete physical, mental and social well being and not merely the

absence of disease and injury. Commercial Health Insurance in India was started in 1986 in the

form of Mediclaim. India being a highly populated country with a large percentage of people

living below the poverty line, the insurance becomes one of the critical factors for its

development.

Health insurance provides coverage for medicine, visits to the doctor or emergency room,

hospital stays and other medical expenses. Policies differ in what they cover, the size of the

deductible and/or co-payment, limits of coverage and the options for treatment available to the

policyholder. Health insurance can be directly purchased by an individual, or it may be provided

through an employer. Medicare and Medicaid are programs which provide health insurance to

elderly, disabled, or un-insured individuals. There are a number of companies which provide

private health insurance, including Blue Cross, United Healthcare, or Aetna.

The traditional notions of insurance are changing due to modern products, which help to create

wealth, protect health and insure life. Earlier, there was a domination of LIC and GIC schemes

and the ordinary citizens had to work according to the whims and fancies of these companies and

there were no private companies in the field. Health sector is the traditional model of health

funding which enables it to rationalize the ever increasing demand for health security, primarily

due to the increasing service costs which cost of the population cannot afford. Growth of health

insurance sector has been proliferating in the last few decades in India.

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Medical care has become an expensive affair today. Instant catering to huge hospital bills may

not be probable for all. With big diseases like cancer, cardiac problems, severe joint problems,

etc. becoming common, it has become difficult for the common masses to bear the expenses at

ease. As per a survey, less than 10% of the population of India has the ability to pay Rs. 5 lakh or

less in case of a surgical emergency. Mediclaim is the best answer in such a situation. With a

mediclaim, an individual or a family can lead a stress-free and worry-free life and any

inconveniences related to health will be taken care of by the insurer.

A Mediclaim Policy essentially provides a health cover equal to the insured sum. The amount of

the insured sum depends on the premium you pay and the benefits covered vary from plan to

plan and from company to company. Do check the diseases covered while buying a mediclaim

health insurance policy and also check whether it is cashless or not. A cashless policy ensures

hassle-free transactions. The premium amount also varies as per age; the higher your age, the

higher the amount you need to pay. Though most insurance providers do not require you to

undergo medical tests, a senior citizen applicant or mostly those above fifty years of age, need to

undergo a medical test to be able to buy a mediclaim health insurance.

There are numerous companies that offer mediclaim policies and buyers get a variety of choice.

Buy the one that best suits your needs or the needs of your family. There is a vast difference

between individual mediclaim Health Insurance and family mediclaim health insurance.

While an individual policy entitles the insured to avail benefits for self, the family plan covers

the entire family; most companies cover husband, wife, two kids below 12 years and dependent

parents. The premium to be paid will no doubt be more than an individual plan. Do keep the

insured sum a bit higher and look into the terms and conditions of the mediclaim policy, diseases

covered, etc

India is the only country where hospitalization insurance was being sold as Mediclaim Insurance

Policies.

1.1.1 BENEFITS OF MEDICAL INSURANCE

The benefits of a Mediclaim policy are many. Some of which are listed below:

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First and foremost the Mediclaim policy offers you a chance to get your medical expenses

covered under a policy. Thus it takes care of the hospitalization fees. Protects the person or

family (in case of family plan) for hospitalization expenses as a result of any specific injury or

illness which has taken place during the period of insurance and on the advice of a doctor

requires hospitalization

Pre hospitalization expenses for the person or the insurer and also to go with it Post-

Hospitalization Expenses: Post Hospitalization expenses are medical expenses incurred during a

period up to a specific number of days after hospitalization for the particular ailment disease or

injury is over but still needs expenditures in order to completely become normal.

If you have a health insurance policy that supports cashless Mediclaim, it means that you can get

medical treatment just by displaying your insurance card without paying any cash to the hospital.

Most health insurance companies offer this benefit. Sometimes the benefits may be applicable

only to a certain number of hospitals or medical centers.

Some of the insurance policies also provide tax benefits. These tax benefits are provided to the

person under the name of whom the insurance policy has been assigned. Under the Section 80D,

tax benefits are provided to people who get a Mediclaim policy done in their name.

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1.1.2 TIPS WHEN APPLYING FOR HEALTH INSURANCE

When applying for Health Insurance

With rising medical costs, it has now become imperative for everybody to get Health Insurance coverage.

Here are the Top 5 factors to keep in mind:

Adequate coverage amount

 

Take an adequate cover to protect yourself and everyone who is dependent on your income - e.g. your

family members. Hospitalization costs are higher in metros; people living in metros typically should opt

for a higher coverage amount

Re-imbursement or Cash Allowance?

  

Health Insurance comes in various flavors. It is imperative that you understand the difference between re-

imbursement plan and a cash allowance plan. A cash allowance plan cannot replace a re-imbursement

plan (often referred to as "Mediclaim" - because here the amount you get is based on the actual amount of

expense incurred whereas in a cash allowance you get a fixed lump sum for every day you spend in the

hospital - no matter how expensive the treatment might be.

   

Cashless Facility

  

Imagine having to run around to arrange for cash in an emergency situation for getting admitted to the

hospital of your choice! Most insurance companies had launched cashless cards for re-imbursement based

plans - so that you could simply present the card at the time of admission and an administrator would take

care of settling your hospital bills directly from the insurance company. However in mid-2010, several

public sector insurers withdrew support for the cashless facility. Before buying your Health Insurance,

you may want to check with your insurer how many hospitals does he offer support for the cashless

facility and especially about the hospitals in your area. But please remember that just because a hospital is

in the cashless network at the time of taking your first policy it may not remain in the cashless network

when your claim arises. So this cannot be the sole factor for deciding about the health insurance company.

   

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Age until Renewals allowed

  

Most of us will certainly fall ill at some point of our lives - and the chances are that we will fall ill when

we are older. Entering into a new Health Insurance plan is significantly cheaper and easier when one is

young & healthy. The chances of having any major pre-existing disease is lower so most plans are

available and also the insurance company must disclose today the premiums applicable today as well as

the premiums applicable at an older age Ensure that your health insurance plan is renewable after 65 -

because at that age, you don't want to discover that health insurance is difficult to get when you need it

the most.

Co-pay & sub-limits

One of the fears insurance companies nurse is that the customer might opt for unusually expensive

hospital rooms or procedures than are warranted. To overcome this, some insurance companies introduce

a co-pay or sub-limits. In a co-pay you are required to share some of the expenses incurred - regardless of

the amount covered.

E.g. say you have a 3 lacks cover and the bill you want to be re-imbursed amounts to Rs. 2 lacks With a

plan that has a 20% co-pay, you will only get 80% of the bill re-imbursed by the insurer - i.e. Rs. 1.6

lacks and you will have to bear the rest).

For the same coverage amount, a plan with a co-pay should come with a much lower premium than one

without a co-pay. Sub-limits simply restrict the amount of re-imbursement for individual bill items - e.g.

even a Rs1lack bill may not be fully re-imbursed for a Rs 3 lacks coverage amount, if say the sub-limits

set on room rentals/ doctors fees/ OT charges - or even a specific procedure (e.g. cataract/ knee

replacement) is exceeded. Again a plan with sub-limits should have a lower premium for it to be worth

considering.

Temporary and Permanent exclusions

Normally most policies provide coverage for pre-existing diseases only after a waiting period.

Remember pre-existing disease is not just the disease you are suffering from at the time you took

the first policy but also any other disease that is caused due to such pre-existing disease. A

common example is that heart illness will also be treated as pre-existing (even though at the time

you took the first policy you had no heart disease) if you had diabetes when you took the first

policy since the heart illnesses is caused by Diabetes. This single item is responsible for most of

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the disputes between insurance companies and consumers. So make sure you disclose everything

that is required in the form. Please do not sign a blank form and leave it to the agent to fill the

form later. This will ensure that at least at the end of the waiting period you will get the disease

covered. If you do not disclose the disease then you run the risk of your policy being cancelled or

a renewal being denied if this fact is discovered later.

Apart from the above  illness contracted during the first 30-90 days of the first policy is normally

not covered. Some specific diseases/treatment such as cataract , knee replacement, etc. may also

be covered only after a waiting period.

There are permanent exclusions as well such as beauty treatment, sexually contracted diseases,

non allopathic hospitalization expenses etc.  Always read the policy brochure carefully and also

look at the section dealing with permanent exclusions in the policy document.

Keep a copy of all documents submitted to the insurance company for your future reference.

Any promise made by the agent or even an official of the insurance company has no value unless

it is in writing or at least on email.

So if you are basing your decision on any such promise make sure you get it in record in some

form.

1.1.3 TYPES OF HEALTH INSURANCE

There are mainly three types of Health Insurance covers:

Individual Mediclaim: The simplest form of health insurance is the Individual

Mediclaim policy. It covers the hospitalization expenses for an individual for up to the sum

assured limit. The insurance premium is dependent on the sum assured value. Example : If

you have 3 family members you can get an individual cover of Rs 2 lacs each . In this case

each of you are covered for 2 lacs , if 3 members face a need for hospitalization , all 3 of

them can get expenses recovered upto Rs 2 lacs . All the 3 policies are independent .

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Family Floater Policy: Family Floater Policies are enhanced version of the mediclaim

policy. The sum assured value floats among the family members. i.e  each opted family

member comes under the policy, and it covers expenses for the entire family up to the sum

assured limit. The premium for family floater plans is typically less than that for separate

insurance cover for each family member. Example : In this case if suppose there are 3 family

members , you can take a Family floater policy for Rs 6 lacs in total . Now anyone can claim

upto 6 lacs in expenses , but then the cover will go down by that much amount for that year .

So if one of the family member is hospitalised and the expenses are 4.5 lacs . It will be paid

and then the cover will be reduced to 1.5 lacs for that particular year . Next year again it will

start from fresh 6 lacs. Family floater makes sense for a family because that way each one in

family gets a big cover and probability of more than 1 getting hospitalized in same year is too

low untill and unless whole family is travelling together most of the times in a year .

Unit Linked Health Plans: Taking the ULIP route, health insurance companies too have

introduced Unit Linked Health Plans. Such plans combine health insurance with investment

and pay back an amount at the end of the insurance term. The returns of course are dependent

on market performance. These plans are very new and still in development phase. This is

only recommended for people who can handle market linked products like ULIP and ULPP .

For a number of reasons, it is advisable to steer clear of unit linked health plans. The best

way is to treat insurance purely as an expense. So if you are single, opt for an Individual

Mediclaim policy and if you have family, opt for a Family Floater policy. The amount paid

(by cheque or debit/ credit card) for health insurance premium provides tax exemption

under section 80D for a maximum of Rs.15, 000.

Health Insurance provided by Employer

Many employers provide health cover for their employees. Isn’t that sufficient? Three

aspects need to be considered in such a case – Is that cover sufficient? Is the insurer good

enough? What happens if you change your job? Health insurance is provided as a perk to

the employees. So it is important to understand the policy a bit more in detail and to check

for coverage. The best way is to ask the HR Department for policy details. Get into

details , what is covered , what is not covered ? Many times Employees just think that they

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have health Insurance and are just relaxed only to find later that it does not cover X and

covers Y only upto a limit . That can be a painful situation .

Health Insurance for the Aged

Till a few years back, health insurance companies were reluctant to provide cover for the

aged. But nowadays there are a lot of insurance companies providing policies for the

senior citizens. Insurance cover paid for a person of age 65 years and above, can provide

additional tax exemption of up to Rs.20,000. But keep in mind that the premium rates are

higher for senior citizens. For the employed, another option is to approach the employer to

negotiate with the official insurer to provide an option for additional cover to parents.

Since the volumes are high, the insurer can provide such added cover at attractive

premium rates.

Tax Exemption from Health Insurance Premiums

Sec 80D covers Health Insurance . You can get exemptions of

Upto Rs. 15,000 paid for self + spouse + cildren.

Upto Rs 15,000 paid for Parents (Rs 20,000 if parents are senior citizens)

So in total if you pay your health insuance and your parents health Insurance premium ,

you can save upto maximum of 35,000

1.14 HEALTH INSURANCE CLAIM PROCEDURE

The best way to protect your interests when you dealing with Banks, Telephone Companies,

Utility Companies records should be complete. At appropriate time when you are having any

dispute with them, then you have was the payment plan agreed, when the payment was made,

what refundable security deposit was given in the rule.

The same rule applies with respect to Health Insurance to be purchased from Insurance

Company. The steps you should follow are; Maintain systematic files in the following manner:

FILE: 1

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Maintain insurance record file so that following documents are filed as and when received/sent;

Leaflet of Insurance Company from whom the policy is being purchased.

Copy of filled up proposal from submitted to the insurance co.

Receipt received from the Insurance Company.

Any correspondence received or sent to the Insurance Company.

Any correspondence received or sent to the TPA.

Photocopy of ID card.

Insurance policy received from the Insurance company.

FILE: 2

Maintain proper Medical records file of every family member (separately)so that following

document received: All prescriptions from Doctors/Medical Consultants,

All Health check ups reports.

X-Rays.

All Pathological tests reports,

Receipt of Doctors/ bills from Chemist.

If original documents are to be submitted to your office for reimbursement then photocopies

same should be kept. Whether today you decide to buy Health Insurance policy or not you

should maintain this (File 2) because:

Even under normal conditions when you go to Doctor/Consultant for Consultation he

finds the records diagnosis/line of treatment as he basis his treatment on seeing the past

history, suitability of me proneness to side effects due to certain medicines.

After some time when you buy Health Insurance Policy has to be lodged then these

document argued to prove that in the past: No pre-existing disease was diagnosed in the

past.

In the event of claim not being accepted in full

If the insured has to take up the matter with higher authorities in Insurance Company.

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If the insured has to take up the matter with authorities like Consumer Forum then whole

case basis of these documents only.

1.1.5 HEALTH INSURANCE CLAIMS SETTLEMENT PROCESS

A bit on how health insurance claims processing works. In most cases, the Insurance

companies appoint a third part administrator (TPA) for claims processing. That means

once the health insurance policy is sold, the insurer passes on the baton to the TPA. In case

of a claim, the insured has to get in touch with the TPA for all versification and

formalities.

There are 2 ways by which health insurance claims are settled:

Cashless : For availing cashless treatment (only at authorized network hospitals), the TPA has

to be notified in advance (for planned hospitalization) or within the stipulated time limits (for

emergencies). The insurance desk at hospitals usually helps with all paper work. The claim

amount need to be approved by the TPA, and the hospital settles the amount with the TPA/

Insurer. Typically there will be exclusions and such amount will have to be settled directly at

the hospital.

Reimbursement : Reimbursement facility can be availed at both the network and non-

network hospitals. Here the insured avails the treatment and settles the hospital bills directly

at the hospital. The insured can claim reimbursement for hospitalization by submitting

relevant bills/ documents for the claimed amount to the TPA.

The TPA mode of claims settling has its own problems. The TPA is incentivized to limit

insurance claims and they are not the one’s who sells the policy. There are many cases where

the insured had a tough time to claim for his hospital expenses. So before taking health

insurance it would be useful to check who the TPA is and how good are they when it comes

to claims processing. Internet search and a friendly chat with the hospital staff can give you

good insight on the insurer/ TPA. There are also some health insurance providers who do not

employ TPAs and does claims settlement directly (this is called Inhouse TPA).

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1.1.6 TPA (THIRD PARTY ADMINISTRATORS)

TPA stands for Third Party Administrator. TPA is a middleman between Insurer and the

Customer. Customer can directly deal with TPA at the time of claim and TPA will help

with all the process of claim settlement. A TPA is a specialized health service provider

rendering variety of services like networking with hospitals, arranging for hospitalization

and claim processing and settlement. The concept of TPA has been introduced by the

IRDA (Insurance Regulatory and Development Authority of India) for the benefit of both

the insured and the insurer. While the insured is benefited by quicker & better health

service, insurers are benefited by reduction in their administrative costs, fraudulent claims

and ultimately bringing down the claim ratios. An insurance company can have more than

one TPA and a TPA can serve more than one insurance company. Some of the services

TPA provides are

Maintain database of policyholders

Issue of identity card to all policyholders

Provide ambulance service

Provide information to policyholders about hospitals.

Check various investigations

Provide Cashless service

Process claims

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1.2 OBJECTIVES OF THE STUDY

To know the satisfaction level of Mediclaim Policy Holders.

To identify the problems faced by Mediclaim Policy Holders.

To know the benefits attained by the policy holder from the policy provider.

To check whether the policy holders are really aware of insurance schemes.

1.3 SCOPE OF THE STUDY

The study is confined to the Mediclaim policy among the working population in Chennai.

Even though many other insurance companies are available to protect the life, but Medi

claim is the need of everyone. The scope of this study includes the following:

First reason, to know the awareness about the Mediclaim policies and secondly to understand

satisfaction of the customers from the services provided by the Mediclaim Providers.

1.4 IMPORTANCE OF THE STUDY

To learn the people attitude towards the Mediclaim Insurance.

To understand customer perception about Mediclaim Insurance Policies.

To obtain the knowledge of the consumer needs and wants.

Making an analysis of various factors influencing decision making of policy holders.

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1.5 LIMITATIONS OF THE STUDY

1) Sample size selected for this study is 100, which is proportionately less than the city

population.

2) As time was a limiting factor the survey was conducted at convenient places of the

researcher.

3) There is some bias due to ignorance from the respondents as they are not aware of

importance of the study. So vague or unclear answers given by the respondents are also

taken into consideration.

4) Though the respondents are clear about their answers, sometimes they may not be in a

position to explain in the manner related to this study.

5) It would have been an appreciable effort, if the researcher had visited any insurance

company. However, it could not be possible due to time constraint.

6) The data collected from the respondents are not upto the mark. Therefore, one cannot get

absolute facts about the issue.

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REVIEW OF LITERATURE

The health insurance sector has not made headway in India. Only a small percentage of the

Indian population is covered by some form of health insurance. During the last 50 years, India

has made considerable progress in improving its health status. Death rate has reduced from 40 to

9 per thousand, infant mortality rate reduced from 161 to 70 per thousand live births and life

expectancy increased from 31 to 63 years.

Health Insurance India plans provides long term protection and comprehensive medical

coverage, cash free hospitalization across India. Health Insurance India plans also to reimburse

the expenses during Pre-Hospitalization and Post-Hospitalization stages of treatment in India.

Health care costs have witnessed a phenomenal rise in the current times, this has led the

customers to insure not only themselves but their family members for any future medical

expenses and other related requirements. The major reasons cited for major health insures not

entering the country has been the low penetration as also the low spend on insurance as a

component of the total health spend.

2.1 HISTORY OF INSURANCE IN INDIA  

In India, insurance has a deep-rooted history. It finds mention in the writings of Manu

(Manusmrithi ), Yagnavalkya ( Dharmasastra ) and Kautilya ( Arthasastra ). The writings talk

in terms of pooling of resources that could be re-distributed in times of calamities such as fire,

floods, epidemics and famine. This was probably a pre-cursor to modern day insurance.

Ancient Indian history has preserved the earliest traces of insurance in the form of marine trade

loans and carriers’ contracts. Insurance in India has evolved over time heavily drawing from

other countries, England in particular.

 

1818 saw the advent of life insurance business in India with the establishment of the Oriental

Life Insurance Company in Calcutta. This Company however failed in 1834. In 1829, the

Madras Equitable had begun transacting life insurance business in the Madras Presidency. 1870

saw the enactment of the British Insurance Act and in the last three decades of the nineteenth

century, the Bombay Mutual (1871), Oriental (1874) and Empire of India (1897) were started

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in the Bombay Residency. This era, however, was dominated by foreign insurance offices

which did good business in India, namely Albert Life Assurance, Royal Insurance, Liverpool

and London Globe Insurance and the Indian offices were up for hard competition from the

foreign companies.

 

In 1914, the Government of India started publishing returns of Insurance Companies in India.

The Indian Life Assurance Companies Act, 1912 was the first statutory measure to regulate life

business. In 1928, the Indian Insurance Companies Act was enacted to enable the Government

to collect statistical information about both life and non-life business transacted in India by

Indian and foreign insurers including provident insurance societies. In 1938, with a view to

protecting the interest of the Insurance public, the earlier legislation was consolidated and

amended by the Insurance Act, 1938 with comprehensive provisions for effective control over

the activities of insurers.

 

The Insurance Amendment Act of 1950 abolished Principal Agencies. However, there were a

large number of insurance companies and the level of competition was high. There were also

allegations of unfair trade practices. The Government of India, therefore, decided to nationalize

insurance business.

An Ordinance was issued on 19th January, 1956 nationalising the Life Insurance sector and Life

Insurance Corporation came into existence in the same year. The LIC absorbed 154 Indian, 16

non-Indian insurers as also 75 provident societies—245 Indian and foreign insurers in all. The

LIC had monopoly till the late 90s when the Insurance sector was reopened to the private

sector.

 

The history of general insurance dates back to the Industrial Revolution in the west and the

consequent growth of sea-faring trade and commerce in the 17th century. It came to India as a

legacy of British occupation. General Insurance in India has its roots in the establishment of

Triton Insurance Company Ltd., in the year 1850 in Calcutta by the British. In 1907, the Indian

Mercantile Insurance Ltd, was set up. This was the first company to transact all classes of

general insurance business.

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In 1968, the Insurance Act was amended to regulate investments and set minimum solvency

margins. The Tariff Advisory Committee was also set up then.

 

In 1972 with the passing of the General Insurance Business (Nationalisation) Act, general

insurance business was nationalized with effect from 1st January, 1973. 107 insurers were

amalgamated and grouped into four companies, namely National Insurance Company Ltd., the

New India Assurance Company Ltd., the Oriental Insurance Company Ltd and the United India

Insurance Company Ltd. The General Insurance Corporation of India was incorporated as a

company in 1971 and it commence business on January 1sst 1973.

 

This millennium has seen insurance come a full circle in a journey extending to nearly 200

years. The process of re-opening of the sector had begun in the early 1990s and the last

decade and more has seen it been opened up substantially. In 1993, the Government set up a

committee under the chairmanship of RN Malhotra, former Governor of RBI, to propose

recommendations for reforms in the insurance sector.The objective was to complement the

reforms initiated in the financial sector. The committee submitted its report in 1994 wherein ,

among other things, it recommended that the private sector be permitted to enter the insurance

industry. They stated that foreign companies be allowed to enter by floating Indian companies,

preferably a joint venture with Indian partners.

 

 Following the recommendations of the Malhotra Committee report, in 1999, the Insurance

Regulatory and Development Authority (IRDA) was constituted as an autonomous body to

regulate and develop the insurance industry. The IRDA was incorporated as a statutory body in

April, 2000. The key objectives of the IRDA include promotion of competition so as to

enhance customer satisfaction through increased consumer choice and lower premiums, while

ensuring the financial security of the insurance market.

 

The IRDA opened up the market in August 2000 with the invitation for application for

registrations. Foreign companies were allowed ownership of up to 26%. The Authority has the

power to frame regulations under Section 114A of the Insurance Act, 1938 and has from 2000

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onwards framed various regulations ranging from registration of companies for carrying on

insurance business to protection of policyholders’ interests.

 

In December, 2000, the subsidiaries of the General Insurance Corporation of India were

restructured as independent companies and at the same time GIC was converted into a national

re-insurer. Parliament passed a bill de-linking the four subsidiaries from GIC in July, 2002.

 

Today there are 24 general insurance companies including the ECGC and Agriculture

Insurance Corporation of India and 23 life insurance companies operating in the country.

 

The insurance sector is a colossal one and is growing at a speedy rate of 15-20%. Together with

banking services, insurance services add about 7% to the country’s GDP. A well-developed and

evolved insurance sector is a boon for economic development as it provides long- term funds

for infrastructure development at the same time strengthening the risk taking ability of the

country.

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2.2 VARIOUS INSURANCE ACTS

1. The Insurance Act, 1938

It was the first legislation governing all forma of insurance to provide strict state contron over insurance business.

2. Life Insurance Corporation Act, 1956

Even though the first legislation was enacted in 1938, it was only in 19th January 1956,

that life insurance in India was completely nationalized, through a Government

Ordinance, the Life Insurance Corporation Act, 1956 effective from 01.09.1956 was

enacted in the same year to, inter-alia, form LIFE INSURANCE CORPORATION after

nationalization of the 245 companies into one entity. There were 245 insurance

companies of both Indian and Foreign origin in 1956. Nationalization was accomplished

by the government acquisition of the management of the companies.

3. General Insurance Business (Nationalization) Act, 1972

It was enacted to nationalize the 100 odd general insurance companies and subsequently

merging them into four companies. All the companies were amalgamated into National

Insurance, New India Assurance, Oriental Insurance and United India Insurance which

were headquartered in each of the four metropolitan cities.

4. Insurance Regulatory and Development Authority (IRDA) Act, 1999

On the recommendations of the Malhotra Committee, Insurance Sector in India was

liberalized in March 2000 with the passage of the Insurance Regulatory and Development

Authority (IRDA) Bill, lifting all entry restriction for private players and allowing foreign

players to enter the market with some limits on direct foreign ownership.

The Insurance Regulatory and Development Authority (IRDA) to provide greater

autonomy to insurance companies in order to improve their performance and enable them

to act as independent companies with economic motives.

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The main features of the Act are:

It requires the Indian promoters to invest either wholly in an insurance venture or

team up with a foreign insure, with capital of 26% of equity for the foreign

partner. There is proposal to increase this limit to 49 percent.

The Indian promoters is permitted to divest only after 10 years to the Indian

public, through public offering of shares.

2.3 INSURANCE IN INDIA

The Confederation of Indian Industry states that the insurance sector of the country has been

witnessing a consistent growth rate of late and its present worth is 41 billion US dollars.  

The industry has of late achieved a yearly growth rate within 32 and 34 percent and this makes it

the 5th best among emerging economies around the world. The various entities of the industry are

also bringing out newer products on a regular basis to attract their customers. 

As per rules, the upper limit of foreign direct investment permitted in this sector is 26 percent.

However, this has to be done through the automatic route and the investor needs a license from

Insurance Regulatory and Development Authority (IRDA). 

At present there are 22 life insurers in India. The IRDA has recently taken away the tariffs of the

interest rates and this has provided insurers greater independence when it comes to deciding the

price of their insurance policies. The insurance industry has also become more competitive as a

result. 

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India Insurance Industry growth in last few years

The life insurance companies have performed the best when it comes to growth with an increase

of almost 70% in new premium that has been collected in the initial 5 months of 2012. 

As per IRDA data, in April-August 2010 the insurance companies earned $11.73 billion in new

premium - in the corresponding period in the previous year the amount stood at 6.9 billion

dollars. 

LIC, a state held insurer, had been the biggest profit maker at that time with an addition of 88%

to their existing business. The privately owned insurers together had seen a leap of 34% to their

policy sales. 

ICICI Prudential earned 576.60 million dollars at that time. During April-August 2009 SBI Life

had earned $379.20 million in sales of new policies and that figure went up to $531.87 million in

the corresponding period in 2010 making it an increase of 40%. HDFC Standard Life also

experienced a good growth of 54% in new sales. 

IRDA data shows that between April and October 2010 the general insurance industry

experienced a year-on-year growth of 22.76% with regards to underwritten gross premium. 

The total value of that premium was 5.29 billion dollars while the same figure stood at $4.31

billion in April-October 2009. For the public sector companies the year-on-year growth rate was

21.09 percent between April-October 2010 and April-October 2009. 

In the same period the privately held insurers saw an increase of 25.19 percent in terms of

premium collected. Among the publicly owned entities, New India Insurance was one of the

better performers with a premium income of 916.77 million dollars in April-October 2010. 

20

At the same period in 2009 they had earned 770.25 million dollars which implies a growth rate

of 19.04%. The IRDA Summary Report of Motor Data of Public and Private Sector Insurers

2009-10 states that in the same period almost 28.4 million policies were sold and the aggregate

worth of premium collected was $2.31 billion. 

The health insurance sector, according to the RNCOS' research report named "Booming Health

Insurance in India" posted unprecedented growth rates in 2008-09 and 2009-10. The report also

estimates that between the 2009-10 and 2013-14 the sector would see a compound annual growth

rate (CAGR) of at least 25%. 

India Insurance Industry - Market Share of Leading Companies

The following table shows the market share of top insurers in India in the period till April 2011:

Company Approximate market share

LIC 50%

ICICI 10%

SBI 5%

Bajaj 4%

Reliance 5%

HDFC 6%

Birla 4%

Max New York 3%

Tata 2%

Met Life 1%

Kodak 2%

21

Others 8%

(Source: Internet)

India Insurance Industry - Some Key Findings

Following are some important findings from World Bank regarding the condition of insurance

industry in India:

Between 2005 and 2010 the yearly GDP growth was approximately 8.56%

At the same time, the ratio of gross savings to GDP was 33%

Middle class saw the quickest growth

The life expectancy rate of people went up and urban development happened at almost

54%.

In 2010 rate of premium growth came down to 4.2% and compared to global standards the

premium share was pretty low

Major operational issues for insurers were expenditure control, claims settlement

procedures, improving investment yields, and capital requirements

In the 2010-11 fiscal the life insurance industry grew by 4.20% while the general

insurance industry increased by 8.10%.

During that time the paid-up capital (private total) for the life insurance sector was INR

236.57 billion while the paid-up capital (industry total) was INR 236.63 billion.

In 2010-11 the paid-up capital (private total) for the general insurance sector was INR

39.56 billion while the paid-up capital (industry total) was INR 67.06 billion.

In 2010-11 the operating costs of privately owned life insurers was INR 159.62 billion

while the total life insurance industry expense was INR 329.42 billion.

In the same time the privately owned general insurers spent INR 39.32 billion from an

industry total of INR 106.20 billion.

In 2010-11 the privately held life insurers paid benefits and claims worth INR 312.51

billion while the industry aggregate was INR 1425.24 billion.

At the same time the private general insurers paid benefits and claims worth INR 99.37

billion while the industry total was INR 295.36 billion.

22

India Insurance Industry Composition

As per IRDA, the composition of the Indian insurance industry by March 2011 could be

mentioned as such:

General insurance

Category Number of organizations

Publicly owned general insurers 4

Pprivate insurers completely owned by an Indian business organization

1

Specialized general insurers 2

Private insurers' JV with international insurers 14

Specialized health insurers 3

(Source: Internet)

Life insurance

Category Number of organizations

Publicly owned life insurers 1

Private insurers' JV with international insurers 21

Private insurers completely owned by an Indian business organization

2

23

India insurance product composition

Following is an approximate representation of the product composition of India's insurance

industry: 

General insurance

Product Percentage

Engineering 4

Motor OD 27.63

Motor TP 14.94

Health 22.58

Aviation 1.08

Liability 2.40

Personal accident 2.63

Fire 10.91

Marine 5.97

Others 7.37

(Source: Internet)

24

Maximum Renewal Age by Insurance Companies

LIST OF INSURANCE COMPANIES PROVIDING HEALTH INSURANCE

Private Insurance Companies

Apollo DKV Insurance Company Ltd.

Max Bupa Health Insurance Company Ltd.

Star Health and Allied Insurance Company Ltd.

Royal Sundaram Alliance Insurance Company Ltd.

Sriram General Insurance Company Ltd.

Tata AIG General Insurance Company Ltd.

Bajaj Alliance Health Insurance Company Ltd.

Public Insurance Companies

The New India Assurance Company Ltd.

The Oriental Company Ltd.

United India Insurance Company Ltd

National Insurance Company

25

2.4 COMPANY PROFILE

Health Insurance from Private Sector General Insurance Companies

Star Health & Allied Insurance Company Limited 

Star Health and Allied health Insurance Company Limited (Star Health) is a joint venture

between Oman health Insurance Company, ETA Ascon Group and a number of insurance

veterans in the country. It is also the first dedicated health insurance company in India. Known

for its innovation, Star has some very unique products like Diabetes Safe which is for diabetic

patients and Star Netplus which is designed for HIV+ patients. Star Health insurance has an in-

house TPA which increases its efficiency in dealing with cashless cases. They also have a unique

feature where in customers calling a toll free number can get free consultations with a general

physician.

Max Bupa Health insurance

 Max Bupa Health Insurance is a joint venture between Max India Limited and Bupa Group, one

of the international healthcare providers. Formed in 2010, Max Bupa has brought changes in the

health insurance market in India with innovative and customer friendly products. They have a

policy of not loading the customer or handling out ‘no claim bonuses’ and have a region wise

premium. They have no fixed enrollment age which means people of any age group can buy their

policies. These policies also have guaranteed renewal which means you won’t be denied renewal

in your 70s and 80s when you need it most. Their ‘Heartbeat’ product covers maternity also,

albeit after a waiting period.

Apollo Munich

Apollo Munich Health Insurance Co. Ltd. is the new name for Apollo DKV Insurance Co. Ltd.

which is a partnership between The Apollo Hospitals Group, and Germany based Munich Re’s

newest business segment, Munich Health. They also bring a change in terms of customer friendly

features like lifetime renewal and portability benefits for existing policies which means you can

26

buy Apollo’s policy and get the continuation benefits of your existing policy. Apollo Munich

also covers maternity after a waiting period.

Reliance Health insurance

 Reliance health insurance is one of the private general insurance companies in India. They also

have a few good health insurance products, in their ‘Health wise’ policy range; critical illnesses

are covered as a part of the policy. There is also a choice of reducing waiting period for pre-

existing illnesses to 2 years from the industry standard of 4 years. It covers those between the

ages of 5-75.

ICICI Lombard

 ICICI Lombard GIC Ltd. is the largest private sector general insurance company in India. It has

some good health insurance plans - like Health Advantage which covers not only hospitalization

expenses but also outpatient expenses like dental, upto a limit. Maternity cover is also available

under this product. The company has also added Health insurance Guide, an interactive tool to

help the customer select a plan to suit his requirements.

Bajaj Allianz General Insurance

 Bajaj Allianz General Insurance Company Limited is a joint venture between Bajaj Finserv

Limited and Allianz SE. Health insurance policies offered by them include Health Guard

(Mediclaim), Silver health (Senior Citizen) and Star package (Family Floater), there are also

other plans like Hospital Cash which gives an amount on every day of hospitalization and

Critical Illness which gives a lump sum in the event that the insured contracts one of the critical

illnesses listed like cancer during the policy period. Bajaj was the first company to come up with

a captive TPA with ensuing efficiencies. Popular Product: Health Guard

27

Health Insurance from Public Sector General Insurance Companies

Oriental insurance

One of the four public sector units, Oriental insurance offers a number of health insurance

products including Individual mediclaim, Universal health insurance scheme and family floaters

to the customers. Optional benefits like Personal Accident and Life Hardship Survival can be

added with the basic health cover to avail extra benefit. Their Happy Family floater is a popular

product because it doesn’t require medical check-up till the age of 60 (it is mandatory for

everyone over the age of 45 to take a health check-up in other policies).

United India Insurance

Another of the public sector units, United India health Insurance Company Limited also offers a

wide range of health insurance products like Family Medicare- Gold, Platinum, Senior Citizen,

Top-up and Super Top-up. Top-up and Super Top-up products are products which provide

additional cover amount if you find your basic cover insufficient.

New India Assurance

It is one of the first Indian owned companies when it was formed in 1919. It offers different

health insurance products like Mediclaim policy, senior citizen policy and 

Universal health insurance policy. The unique feature of their Mediclaim policy is the

differential rating for major metros vis-à-vis other locations.

National Insurance

National’s Varishta Mediclaim is a popular product, it covers everyone from the age from 6—80

with special features for senior citizens.

28

THIRD PARTY AMDINISTRATOR (TPA)

TPA is an abbreviation for Third Party Administrator. These companies are BPO of insurance

companies and coordinating all aspects of claims due to health insurance policies.

These companies are licensed by IRDA (Insurance Regulatory & Development Authority) and

are having:

Telecom facility generally with phone number starting with

1600 (toll free number)

Computer network having details of all policies holders.

Medical specialists, for assessing need for hospitalization treatment being given in the

hospitals.

ROLE OF THIRD PARTY ADMINISTRATOR

The role of TPA is to co-ordinate with hospitals with respect to treatment and also passes the

bills on behalf of the insurance company. The actual payment is made by the insurance company.

As far as the legal contract is concerned, it is between the company and the person insured.

The individual insured will get an ID card issued by the TPA. This ID card is useful and needed

at the time of:

Interaction with TPA:

In Emergency:

In an emergency, the insured should be taken for treatment to any hospital to save his/her life. At

the earlist insured or his/her relatives/friend to contact the Insurance Company on phone/writing

about the following:

Name of Patient

Policy No.

ID No.

Reason for hospitalization

29

As and when permitted by doctors the patient may have to be moved to appropriate TPA

approved hospital. TPA’s is that treatment should not be in a very small hospital (less than 15

beds) as the facilities may not be proper.

In this case TPA may make direct payment to hospital, where patient was taken in emergency.

OR

TPA may ask you to make payment to hospital and submit the bills for reimbursement.

In case of Planned Treatment:

In the event of an insured going in for Hospitalization for planned treatment/surgery.

Let us assume the insured has to go for surgery after seven days in a specified hospital as it is a

planned hospitalization therefore the insured should inform TPA on phone / in writing

Name

Policy No.

ID NO.

Name of the Doctor Treatment

Hospital where hospitalization is planned.

Reason why hospitalization is required.

Copy of the prescription from the doctor specifying the treatment/surgery.

TPA may also ask you to send this on fax also.

If the Hospital where Hospitalization is planned is on approved list then they will give the

authorization, which is getting the instructions to provide treatment and send the bills for

payment to TPA. It means that this is settlement.

If the Hospital where Hospitalization is planned is not on approved list then they will give the

authorization for treatment at that hospital. In this case insured makes the payment and then

submits the bills to TPA for payment for treatment is approved but is approved but it is not a

case of cashless settlement.

30

LIST OF THIRD PARTY ADMINISTRATORS (TPA’s)

TTK Health Services Pvt. Ltd.

Medi Assist India Pvt. Ltd.

MD India Health Services Pvt. Ltd.

Paramount Health Services Pvt. Ltd.

E-Meditek Solutions Ltd.

Heritage Health Services Pvt. Ltd.

Medicare TPA Services (I) Pvt. Ltd.

Family Health Plan Ltd.

Raksha TPA Pvt. Ltd.

Med-Save Health Care Pvt. Ltd.

Genins India Ltd.

Vipul Med Corp TPA Pvt. Ltd.

Safeway Mediclaim Services.

Dedicated Healthcare Services (I) Pvt. Ltd.

Sri Gokulam Health services TPA Pvt. Ltd.

Parekh Health Management Pvt. Ltd.

31

Common Problems Faced By Medi-Claim Policy Holders Are As Follows:

Generally the main sufferers are those who are individual card holders

Corporate card holder’s atleast have the support of the H.R Dept. to get the processed.

For certain diseases cashless are not given as insurance companies decide it as pre-

existing one.

For doing certain surgeries the policy should have been completed atleast for 3 years.

If it is individual policy the queries raised by insurance companies will be lot and the

policy holder will be vexed before they get cashless approval.

Certain cases though it is genuine considered as Investigation purpose and it is denied for

cashless.

Most of the problems arises from TPA’s that they will not communicate the status of the

pre-authorisation properly. So both individual as well as group card holders will suffer a

lot before they get discharged.

Sometimes insurance companies wrongly give approval to the

pre-auth and later they will apologies. That time the sufferers are both the hospital and

the policyholders.

In some cases both the individual & group card holders have to pay certain percentage as

co-payment which was agreed between insurance company and TPA’s.

32

RESEARCH METHODOLOGY

SAMPLING PLAN

Sampling is a procedure to draw conclusions about large group of consumers by studying a small

sample of the total consumer population. A sample is a segment of the population selected to

represent the population as a whole. Ideally the sample should be an overall representation, so

that the researchers can make an accurate prediction of the thoughts and behavior of the

population at a larger scale.

SAMPLING PLAN

The sampling method used in this study is the “Simple Random Sampling”. A simple random

sampling is a subset of individuals chosen from a larger set. Each individual is chosen randomly

and entirely by chance, such that each individual has the same probability of being chosen at any

stage during the sampling process.

SAMPLE SIZE

Since the total population for the survey is very large, also due to time restrictions a sample size

of 100 is taken for the survey with the help of a questionnaire.

PILOT STUDY

A pilot experiment is a precursor to a full-scale study used to check if all operational parameters

are in check.

A pilot study was conducted to find the relevance of the questionnaire. Initially, a sample of 10

individuals was randomly selected and questionnaire was administered. Based on the feedback

obtained from the pilot experiment essential modifications were made to final questionnaire to

make it clear and understandable to the respondents.

33

DATA COLLECTION PROCEDURE

Data collection technique allows the researcher to systematically collect information about

objects of study (people, objects and phenomena) and about the settings in which they occur. In

the collection of data the researcher has to be systematic. If data are collected haphazardly, it will

be difficult to answer the research questions in a conclusive way.

Primary sources of information allow the researcher to access original and unedited information.

A primary source requires the researcher to interact with the source and extract information.

Secondary sources are edited primary sources, second-hand versions. They represents someone

else’s thinking.

The modified questionnaire was used for collection of primary data from the respondents. Before

administering the questionnaire for the data collection a cordial relationship was established

through a formal introduction and explaining the purpose of the data collection. All the doubts of

the respondents were clarified in order to obtain accurate details. Some more information was

also collected from secondary sources such as books magazines and news articles.

Questionnaire

It is standardized form for collecting information to elicit desired data from the respondents. A

questionnaire consists of set of questions which was presented to a respondent for his/her

answer.

The questionnaire prepared in this study was mainly aimed at reducing the time of the

respondents. It contained open and multi choice questions.

34

STATISTICAL TOOLS

The data collected from the respondents were analyzed by applying various statistical tools, viz.,

Percentages, Pie chart and Bar Diagram.

A] Percentage

Percentage is a way of expressing a number as a fraction of 100. Percentages are useful because

they make it very easy to compute things. The ease and simplicity of calculation, the general

understanding of its purpose, and the universal applicability of the percent statistic have made it

a most widely used tool.

B] Pie Chart

Pie Chart (or a circle graph) is a circular chart divided into sectors, illustrating relative

magnitudes or frequencies of percents. In a pie chart, the arc length of each sector is proportional

to the quantity it represents. Together, the sectors create a full disk. It is named for its

resemblance to a pie which has been sliced.

C] Bar Chart

Bar Chart also known as a Bar Graph is a chart with rectangular bars of lengths proportional to

that value that they represent. Bar Charts are used for comparing two or more values. The bars

can be horizontally or vertically oriented. Sometimes a stretched graphic is used instead of a

solid bar. Since these are of the same width and vary only in heights (or lengths) it becomes very

easy for readers to study the relationship.

D] Chi-Square

Chi-Square is a statistical measure used in the context of sampling analysis for comparing a

variance to a theoretical variance. As a non-parametric test, it can be used to determine if

categorical data shows dependency or the two classifications are independent. It can also be used

to make comparison between theoretical population and actual data when categories are used.

Chi-Square = ∑(O-E)2 /E

O= Observed Frequency, E= Expected Frequency. Is always positive and it ranges from 0 to ∞.

35

DATA ANALYSIS & INTERPRETATION

Gender

Table No: 4.1

GENDER

Frequency Percent Valid PercentCumulative

Percent

Valid Male 91 91.0 91.0 91.0

Female 9 9.0 9.0 100.0

Total 100 100.0 100.0

Figure No: 4.1

91%

9%

GENDER

Male

Female

INFERENCE

The table propounds that 91% are Male and 9% are Female.

36

Age

Table No: 4.2

AGE

Frequency Percent Valid PercentCumulative

Percent25-35 Years36-45 Years46-55 YearsTotal

542719

100

54.027.019.0

100.0

54.027.0

19.0 100.0

54.081.0100.0

Figure No: 4.2

25-35 Years 36-45 Years 46-55 Years0%

10%

20%

30%

40%

50%

60%

54%

27%

19%

AGE

INFERENCE

The table propounds that 54% of the people comes under 25-35 years age group, 27% of the people comes under 36-45 years of age group and 19% of the people comes under 46-55 years of age group.

37

Occupation

Table No: 4.3

OCCUPATION

Frequency Percent Valid PercentCumulative

Percent

Valid Government Employee

22 22.0 22.0 22.0

Private Employee 72 72.0 72.0 94.0

Business 6 6.0 6.0 100.0

Total 100 100.0 100.0

Figure No: 4.3

Government Employee Private

Employee Business

0%10%20%30%40%50%60%70%80%

22%

72%

6%

OCCUPATION

INFERENCE

Above table propounds that 72% of the respondents are Private Con employees, 22% of the respondents are Government Employees and 6% of the respondents are Business People.

38

Annual Income

Table No: 4.4

ANNUAL INCOME

Frequency Percent Valid PercentCumulative

Percent

Valid 0 - 1 Lakh 11 11.0 11.0 11.0

1 - 3 Lakhs 67 67.0 67.0 78.0

3 Lakhs & above

22 22.0 22.0 100.0

Total 100 100.0 100.0

Figure No: 4.4

0-1,00,000 1,00,000-3,00,000 3,00,000 & above0%

10%

20%

30%

40%

50%

60%

70%

11%

67%

22%

ANNUAL INCOME

INFERENCE

Above table propounds that 67% of the respondents are getting 1 Lakh – 3 Lakhs as annual income, 22% of the respondents are getting 3 Lakhs & above as their annual income and 11% of the respondents are getting below 1 Lakh as their annual income.

39

Marital Status

Table No: 4.5

MARTIAL STATUS

Frequency Percent Valid PercentCumulative

Percent

Valid Single 20 20.0 20.0 20.0

Married 80 80.0 80.0 100.0

Total 100 100.0 100.0

Figure No: 4.5

20%

80%

MARITAL STATUS

Single

Married

INFERENCE

Above table propounds that 80% of the respondents are Married and 20% of the respondents are Single.

40

No. of dependents in the family.

Table No: 4.6

NO. OF DEPENDENTS IN THE FAMILY

Frequency Percent Valid PercentCumulative

Percent

Valid 1 - 2 Members 18 18.0 18.0 18.0

2 - 4 Members 53 53.0 53.0 71.0

4 Members & above

29 29.0 29.0 100.0

Total 100 100.0 100.0

Figure No: 4.6

1-2 Members 2-4 Members 4 Members & above0%

10%

20%

30%

40%

50%

60%

18%

53%

29%

NO. OF DEPENDENTS

INFERENCE

Above table propounds that 53% of the respondents have 2-4 members dependents, 29% of the respondents have more than 4 members as dependents and 18% of the respondents have dependents of 1-2 members.

41

What type of Medical Insurance have you taken?

Table No: 4.7

TYPE OF MEDICAL INSURANCE

Frequency Percent Valid PercentCumulative

Percent

Valid Individual Card

31 31.0 31.0 31.0

Group Card 69 69.0 69.0 100.0

Total 100 100.0 100.0

Figure No: 4.7

69%

TYPE OF CARD

Individual

Group

INFERENCE

Above table propounds that 69% of the respondents having Group Card and 31% of the respondents are having Individual Medical Insurance Card.

42

What induced you to take Medical Insurance?

Table No: 4.8

REASON TO TAKE MEDICAL INSURANCE

Frequency Percent Valid PercentCumulative

Percent

Valid Cost of Treatment 37 37.0 37.0 37.0

Future Uncertainties 14 14.0 14.0 51.0

Tax Benefits 34 34.0 34.0 85.0

Others 15 15.0 15.0 100.0

Total 100 100.0 100.0

INFERENCE

Above table propounds that 37% of the respondents took medical insurance for Cost of Treatment, 34% of the respondents took insurance for Tax Benefits, 15% of the respondents took insurance for other reasons and 14% of the respondents took Future Uncertainties.

Figure No: 4.8

43

Cost of Treatment

Future Uncertainties

Tax Benefits

Others

0% 5% 10% 15% 20% 25% 30% 35% 40%

37%

14%

34%

15%

REASON TO TAKE MEDICAL INSURANCE

How did you come to know about the Medical Policies? (Only Individual)

44

Table No: 4.9

MODE TO TAKE MEDICAL INSURANCE

Frequency Percent Valid PercentCumulative

Percent

Valid Agents 13 13.0 41.9 41.9

Advertisements 3 3.0 9.7 51.6

Friends 4 4.0 12.9 64.5

Relatives 7 7.0 22.6 87.1

Doctors 4 4.0 12.9 100.0

Total 31 31.0 100.0

Missing System 69 69.0

Total 100 100.0

INFERENCE

Above table propounds that 42% of the respondents took insurance through Agents, 22% of the respondents took insurance through Relatives, 13% of the respondents took insurance through Friends, 13% of the respondents through Doctors and 10% of the respondents through Advertisement.

45

Figure No: 4.9

AgentsAdvertisements

FriendsRelatives

Doctors

0%

10%

20%

30%

40%

50%

42%

10% 13% 22%

13%

MODE TO TAKE MEDICAL INSURANCE

For how many years you are having Medical Insurance?

46

Table No: 4.10

YEARS

Frequency Percent Valid PercentCumulative

Percent

Valid 0-1 Year 29 29.0 29.0 29.0

1-3 Years 58 58.0 58.0 87.0

3-5 Years 13 13.0 13.0 100.0

Total 100 100.0 100.0

Figure No: 4.10

29%

58%

13%

YEARS

0-1 Year

1-3 Years

3-5 Years

INFERENCE

Above insurance table propounds that 58% of the respondents having insurance for past 1-3 years, 29% of the respondents are having insurance for less than 1 year and 13% of the respondents are having insurance for past 3-5 years.

In which sector do you hold the policy?

47

Table No: 4.11

SECTOR

Frequency Percent Valid PercentCumulative

Percent

Valid Public 65 65.0 65.0 65.0

Private 35 35.0 35.0 100.0

Total 100 100.0 100.0

Figure No: 4.11

65%

35%

SECTOR

Public

Private

INFERENCE

Above table propounds that 65% of the respondents are having Public Sector Medical Insurance and 35% of the respondents are having Private Sector Medical Insurance.

Name the Insurance Company

48

Table No: 4.12

Frequency Percent Valid PercentCumulative

PercentUnited India InsuranceNational InsuranceOriental InsuranceNew India AssuranceBajaj AllianzStar HealthTATA AIGMax BupaRoyal SundaramICICI Lombard

TOTAL

1613127151663012

100.0

16.013.012.07.015.016.06.03.0012.0

100.0

16.013.012.07.015.016.06.03.0012.0

100.00

16.029.041.048.063.079.085.088.088.0100.0

INFERENCE

Above table propounds that 16% of the respondents having United India Insurance, 16% of the respondents having Star Health Insurance, 15% of the respondents having Bajaj Allianz, 13% of the respondents having National Insurance, 12% of the respondents having Oriental Insurance, 12% of the respondents having ICICI Lombard, 7% of the respondents having New India Assurance, 6% of the respondents having TATA AIG, 3% of the respondents having Max Bupa.

Figure No: 4.12

49

United

Indi.

..

Nation

al I...

Orienta

l I...

New In

dia ...

Bajaj A

ll...

Star H

e...

TATA...

Max

...

Royal

Su...

ICIC

I Lo..

.0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

NAME OF THE INSURANCE COMPANY

Do you have TPA’ in your Medical Insurance Policy?

50

Table No: 4.13

TPA

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 73 73.0 73.0 73.0

No 27 27.0 27.0 100.0

Total 100 100.0 100.0

Figure No: 4.13

73%

27%

TPA

Yes

No

INFERENCE

Above table propounds that 73% of the respondents having TPA’s and 27% of the respondents do not have TPA’s.

If yes name the TPA?

51

Table No: 4.14

Frequency Percent Valid PercentCumulative

PercentTTK Health Services Pvt.

Ltd.

Medi Assist India Pvt. Ltd.

MD India Health Services

Pvt. Ltd.

Paramount Health Services

Pvt. Ltd.

E-Meditek Solutions Ltd.

Heritage Health Services

Pvt. Ltd.

Medicare TPA Services (I)

Pvt. Ltd.

Family Health Plan Ltd.

Raksha TPA Pvt. Ltd.

Vipul Med Corp TPA Pvt. Ltd.

TOTAL

22

14

15

7

5

4

8

3

1012

100.0

22.0

14.0

15.0

7.0

5.0

4.0

8.0

3.0

10.012.0

100.0

22.0

14.0

15.0

7.0

5.0

4.0

8.0

3.0

10.012.0

100.0

22.0

36.0

51.0

58.0

63.0

67.0

75.0

78.0

88.0100.0

Figure No: 4.14

52

TTK Hea

lth Se

rvice

s

Med

i Assi

st In

dia

MD In

dia

Param

ount

Hea

lth Se

rvice

s

E-Med

itek

Heritag

e

Med

icare

TPA

Family

Hea

lth Pl

an

Raksh

a

Vipul

Med

Cor

p

0%

5%

10%

15%

20%

25%

TPA

INFERENCE

Above table propounds that 22% of the respondents having TTK Health Services, 15% of the

respondents having MD India, 14% of the respondents having Medi Assist, 12% of the

respondents having Vipul Medcorp, 10% of the respondents having Raksha, 8% of the

respondents having Medicare TPA, 7% of the respondents having Paramount Health Services,

5% of the respondents are having E-Meditek, 4% of the respondents are having Heritage TPA.

Does your policy cover all the members in your family?

53

Table No: 4.15

POLICY COVERS

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 100 100.0 100.0 100.0

Figure No: 4.15

1

POLICY COVERS

Yes

INFERENCE

Above table propounds that 100% of the respondents says that Policy Covers to their entire family.

When does your premium fall due?

54

Table No: 4.16

PREMIUM DUE

Frequency Percent Valid PercentCumulative

Percent

Valid Monthly 14 14.0 14.0 14.0

Quarterly 17 17.0 17.0 31.0

Half yearly 43 43.0 43.0 74.0

Yearly 26 26.0 26.0 100.0

Total 100 100.0 100.0

Figure No: 4.16

Monthly

Quartely

Half-Yearly

Yearly

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

14%

17%

43%

26%

PREMIUM DUE

INFERENCE

Above table propounds that 43% of the respondents pays premium Half-Yearly, 26% of the respondents pays premium Yearly, 17% of the respondents pays premium Quarterly, 14% of the respondents pays premium Monthly.

How much you pay as a premium?

Table No: 4.17

55

PREMIUM

Frequency Percent Valid PercentCumulative

Percent

Valid 1000-3000 19 19.0 19.0 19.0

3000-5000 40 40.0 40.0 59.0

5000 & above 41 41.0 41.0 100.0

Total 100 100.0 100.0

Figure No: 4.17

19%

40%

41%

PREMIUM

1,000 - 3,000

3,000 - 5,000

5,000 & ABOVE

INFERENCE

Above table propounds that 41% of the respondents pays more that Rs. 5,000 as premium, 40% of the respondents pays 3,000-5,000 as premium and 19% of the respondents pays 1,000-3,000 as their premium.

Have you claimed your policy in the past?

56

Table No: 4.18

CLAIM

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 100 100.0 100.0 100.0

Figure No: 4.18

1

CLAIM

Yes

INFERENCE

Above table propounds that 100% of the respondents says that they have claimed before.

If yes how many times have you claimed?

57

Table No: 4.19

NO. OF TIMES CLAIMED

Frequency Percent Valid PercentCumulative

Percent

Valid Only Once 22 22.0 22.0 22.0

Twice 47 47.0 47.0 69.0

More than Twice

31 31.0 31.0 100.0

Total 100 100.0 100.0

Figure No: 4.19

Only Once Twice More than twice0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

22%

47%

31%

NO. OF TIMES CLAIMED

INFERENCE

Above table propounds that 47% of the respondents have claimed Twice, 31% of the respondents have claimed More than twice and 22% of the respondents have claimed Only Once.

If cashless is denied are you having facility to reimburse?

58

Table No: 4.20

REIMBURSE

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 95 95.0 95.0 95.0

No 5 5.0 5.0 100.0

Total 100 100.0 100.0

Figure No: 4.20

95%

5%

REIMBURSEMENT

Yes

No

INFERENCE

Above table propounds that 95% of the respondents says that they have Reimburse option and 5% of the respondents says that they don’t have Reimburse option.

If yes are you getting reimburse amount in full?

59

Table No: 4.21

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 14 14.0 14.0 14.0

No 81 81.0 81.0 95.0

Total 95 95.0 95.0

Figure No: 4.21

14%

81%

REIMBURSE

Yes

No

INFERENCE

Above table propounds that 81% of the respondents says that they don’t get full Reimburse amount and 14% of the respondents says that they get full Reimburse amount.

Have you faced any problems while claiming the medical policy?

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Table No: 4.22

CLAIMING PROBLEM

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 91 91.0 91.0 91.0

No 9 9.0 9.0 100.0

Total 100 100.0 100.0

Figure No: 4.22

91%

9%

CLAIMING PROBLEM

Yes

No

INFERENCE

Above table propounds that 91% of the respondents have problem in claiming and only 9% of the respondents have no problem in claiming.

If yes where do you mostly find the problem?

Table No: 4.23

61

CLAIMING PROBLEM

Frequency Percent Valid PercentCumulative

Percent

Valid Insurance Company 17 17.0 18.7 18.7

TPA's 58 58.0 63.7 82.4

Agents 11 11.0 12.1 94.5

Hospitals 5 5.0 5.5 100.0

Total 91 91.0 100.0

Missing System 9 9.0

Total 100 100.0

Figure No: 4.24

Insurance Company TPA's Agents Hospitals0%

10%

20%

30%

40%

50%

60%

17%

58%

11%5%

CLAIMING PROBLEM

INFERENCE

Above table propounds that 58% of the respondent’s faces problem with TPA’s, 17% of the respondents face problems with Insurance Company, 11% of the respondents face problems with Agents and 5% of the respondents face problems with Agents.

Do you find difficult in finding Network Hospitals?

62

Table No: 4.24

NETWORK HOSPITAL

Frequency Percent Valid PercentCumulative

Percent

Valid Yes 40 40.0 40.0 40.0

No 60 60.0 60.0 100.0

Total 100 100.0 100.0

Figure No: 4.24

40%

60%

NETWORK HOSPITAL

Yes

No

INFERENCE

Above table propounds that 60% of the respondents says that they don’t find problem in finding Network Hospitals and 40% of the respondents says that they find problem in finding Network Hospital.

Satisfaction Level – Insurance Company

Table No: 4.25

63

INSURANCE COMPANY

Frequency Percent Valid PercentCumulative

Percent

Valid Highly Dissatisfied 6 6.0 6.0 6.0

Dissatisfied 17 17.0 17.0 23.0

Neutral 51 51.0 51.0 74.0

Satisfied 22 22.0 22.0 96.0

Highly Satisfied 4 4.0 4.0 100.0

Total 100 100.0 100.0

Figure No: 4.25

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied0%

10%

20%

30%

40%

50%

60%

6%17%

51%

22%

4%

INSURANCE COMPANY

INFERENCE

Above table propounds that 51% of the respondents are Neutral, 22% of the respondents are Satisfied, 17% of the respondents are Dissatisfied, 6% of the respondents are Highly Dissatisfied, 4% of the respondents are Highly Satisfied with the Insurance Company.

Satisfaction Level – TPA’s

Table No: 4.26

64

TPA's

Frequency Percent Valid PercentCumulative

Percent

Valid Highly Dissatisfied 8 8.0 8.0 8.0

Dissatisfied 13 13.0 13.0 21.0

Neutral 54 54.0 54.0 75.0

Satisfied 13 13.0 13.0 88.0

Highly Satisfied 12 12.0 12.0 100.0

Total 100 100.0 100.0

Figure No: 4.26

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied0%

10%

20%

30%

40%

50%

60%

8%13%

54%

13% 12%

TPA's

INFERENCE

Above table propounds that 54% of the respondents are Neutral, 13% of the respondents are Dissatisfied, 13% of the respondents are Satisfied, 12% of the respondents are Highly Satisfied, 8% of the respondents are Highly Satisfied.

Satisfaction Level – Settlement Duration

Table No: 4.27

65

SETTLEMENT DURATION

Frequency Percent Valid PercentCumulative

Percent

Valid Dissatisfied 11 11.0 11.0 11.0

Neutral 23 23.0 23.0 34.0

Satisfied 61 61.0 61.0 95.0

Highly Satisfied

5 5.0 5.0 100.0

Total 100 100.0 100.0

Figure No: 4.27

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0%11%

23%

61%

5%

SETTLEMENT DURATION

INFERENCE

Above table propounds that 61% of the respondents are Satisfied, 23% of the respondents are Neutral, 11% of the respondents are Dissatisfied, 5% of the respondents are Highly Satisfied.

Satisfaction Level – Claim Amount

Table No: 4.28

66

CLAIM AMOUNT

Frequency Percent Valid PercentCumulative

Percent

Valid Highly Dissatisfied

3 3.0 3.0 3.0

Dissatisfied 12 12.0 12.0 15.0

Neutral 61 61.0 61.0 76.0

Satisfied 24 24.0 24.0 100.0

Total 100 100.0 100.0

Figure No: 4.28

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied0%

10%

20%

30%

40%

50%

60%

70%

3%12%

61%

24%

0%

CLAIM AMOUNT

INFERENCE

Above table propounds that 61% of the respondents are Neutral, 24% of the respondents are Satisfied, 12% of the respondents are Dissatisfied, 3% of the respondents are Highly Dissatisfied.

Satisfaction Level – Reimbursement

Table No: 4.29

67

REIMBURSEMENT

Frequency Percent Valid PercentCumulative

Percent

Valid Dissatisfied 77 77.0 77.0 77.0

Neutral 16 16.0 16.0 93.0

Satisfied 7 7.0 7.0 100.0

Total 100 100.0 100.0

Figure No: 4.29

Highly Dissatis-fied

Dissatisfied Neutral Satisfied Highly Satisfied0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0%

77%

16%7%

0%

REIMBURSEMENT

INFERENCE

Above table propounds that 77% of the respondents are Dissatisfied, 16% of the respondents are Neutral, 7% of the respondents are Satisfied.

Chi-Square

H0: There is no significant difference between Type of Insurance and Claiming Problem.

68

H1: There is significant difference between Type of Insurance and Claiming Problem.

Type Problem in Claiming TotalYes No

Individual Card 27 4 31Group Card 64 5 69Total 91 9 100

Let us take the hypothesis that there is no significant difference between Type of Insurance and Claiming Problem.

The table of expected frequencies shall be as follows:

28.21 2.79 3162.79 6.21 6991 9 100

O E (O-E)2 (O-E)2 / E

27 28.21 1.4641 0.0519

64 62.79 1.4641 0.0233

4 2.79 1.4641 0.5247

5 6.21 1.4641 0.2357

Total 0.8356

Chi-Square = ∑ [(O-E)2 / E] 0.8356

V= (r-1) (c-1) = (2-1) (2-1) = 1

V=1, Chi-Square 0.05 = 3.84

The calculated value of Chi-Square is less than the table value. So the hypothesis is accepted. Hence there is no significant difference between Type of Insurance and Claiming Problem.

5.1 FINDINGS OF THE STUDY

The Findings are as follows:

69

72% of the respondents are Private Company employees, 22% of the respondents are

Government Employees and 6% of the respondents are Business People.

67% of the respondents are getting 1 Lakh – 3 Lakhs as annual income, 22% of the

respondents are getting 3 Lakhs & above as their annual income.

53% of the respondents have 2-4 members’ dependents, 29% of the respondents have

more than 4 members as dependents and 18% of the respondents have dependents of 1-2

members.

69% of the respondents having Group Card and 31% of the respondents are having

Individual Medical Insurance Card.

37% of the respondents took medical insurance for Cost of Treatment, 34% of the

respondents took insurance for Tax Benefits, 15% of the respondents took insurance for

other reasons and 14% of the respondents took Future Uncertainties.

42% of the respondents took insurance through Agents, 22% of the respondents took

insurance through Relatives, 13% of the respondents took insurance through Friends,

13% of the respondents through Doctors and 10% of the respondents through

Advertisement.

65% of the respondents are having Public Sector Medical Insurance and 35% of the

respondents are having Private Sector Medical Insurance.

73% of the respondents having TPA’s and 27% of the respondents do not have TPA’s.

43% of the respondents pays premium Half-Yearly, 26% of the respondents pays

premium yearly, 17% of the respondents pays premium quarterly, 14% of the respondents

pays premium monthly.

41% of the respondents pays more that Rs. 5,000 as premium, 40% of the respondents

pays 3,000-5,000 as premium and 19% of the respondents pays 1,000-3,000 as their

. premium.

47% of the respondents have claimed Twice, 31% of the respondents have claimed More

than twice and 22% of the respondents have claimed Only Once.

95% of the respondents say that they have Reimburse option and 5% of the respondents

say that they don’t have Reimburse option.

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81% of the respondents say that they don’t get full Reimburse amount and 14% of the

respondents says that they get full Reimburse amount.

58% of the respondent’s faces problem with TPA’s, 17% of the respondents face

problems with Insurance Company, 11% of the respondents face problems with Agents

and 5% of the respondents face problems with Agents.

60% of the respondents say that they don’t find problem in finding Network Hospitals

and 40% of the respondents says that they find problem in finding Network Hospital.

5.2 SUGESTIONS OF THE STUDY

71

The suggestion is as follows:

Before taking Medi-claim insurance one must clearly wants to verify that his/her policy

covers all types of diseases or not.

They should sum insure according to the strength of the family.

People should not take Medi-claim insurance not for any pre-existing diseases.

They should get opinion from any consultant or any hospitals which is the best health

insurance company.

People should not use their Medi-claim card for any investigation purpose only.

People must inform the insurance co. or any TPA as soon as they get admitted in network

hospitals.

They should check whether they got admitted in network hospital or not. Because medi-

claim insurance card is valid only in network hospitals only.

5.3 CONCLUSION

72

Now a day’s medical expense has become very expensive. So, to meet that expense every

individual should take health insurance. There are many general insurance companies providing

health insurance at an acceptable premium. Unlike life insurance one should have health

insurance also.

The role of Health Insurance Sector in improving the quality of health and emblematic of people

life it is controlled to contribute in future course of time. The Indian Insurance Industry and its

regulators are currently undertaking a number of actions to further India’s goal of developing

strong health insurance market, which would improve the general health status of Indians, ease

the government burden of public care, help families avoid catastrophic losses, and improve the

overall quality of healthcare in India.

This study was aimed at assessing the status of health insurance in India and satisfaction level of

Mediclaim Policy Holders. It was found that there is adequate awareness about health insurance

and ample scope for the insurance providers to expand their market share. The measures

recommended in this report can be successfully adopted by insurance providers in order to

improve their business.

This study helped the researcher to learn about the policies and procedures of medical insurance

and gain insight into the present day scenario and future prospects of insurance in India.

A Study on Satisfaction Level of Mediclaim Policy Holders in Chennai

73

Dear Sir/Madam,

As an M.Com student of Loyola College, Chennai I’m making a study on Satisfaction Level of Mediclaim Policy Holders in Chennai. Your response will be helpful in completing my study. I assure you that all the information provided will be kept highly confidential.

I will be thankful for your association in enabling the successful completion of this academic exercise.

Yours Sincerely,

Selva Kumar PM.Com (Final Year)

QUESTIONNAIRE

1) Name:

2) Gender:

3) Age:

4) Occupation:

( ) Government Employee ( ) Private Employee ( ) Business

5) Annual Income:

( ) 0 – 1, 00,000 ( ) 1, 00,000 – 3, 00,000 ( ) 3, 00,000 & above

6) Marital Status:

( ) Single ( ) Married

7) No. of dependents in the family:

( ) 1 – 2 ( ) 2 – 4 ( ) 4 & above

8) What type of Medical Insurance you have taken?

( ) Individual ( ) Group

9) What induced you to take Medical Insurance?

( ) Cost of treatment ( ) Future Uncertainties ( ) Tax Benefits ( ) Others (Specify)

10) How did you come to know about the Medical Policies? (Only Individual)

( ) Agents ( ) Advertisements ( ) Friends ( ) Relatives ( ) Doctors

11) For how many years you are having Medical Insurance?

74

( ) 0-1 year ( ) 1-3 years ( ) 3-5 years ( ) 5 years & above

12) In which sector do you hold the policy?

( ) Public ( ) Private

13) Name the Insurance Company: __________________________________________

14) Do you have TPA’s in your Medical Insurance Policy?

( ) Yes ( ) No

15) If yes name the TPA: _________________________________________

16) Does your policy cover all the members in your family?

( ) Yes ( ) No

17) When does your premium fall due?

( ) Monthly ( ) Quarterly ( ) Half yearly ( ) Yearly

18) How much you pay as a premium?

( ) 1,000 – 3,000 ( ) 3,000 – 5,000 ( ) 5,000 & above

19) Have you claimed your policy in the past?

( ) Yes ( ) No

20) If yes how many times have you claimed?

( ) Only Once ( ) Twice ( ) More than twice

21) If cashless is denied are you having facility to reimburse?

( ) Yes ( ) No

22) If yes are you getting reimburse amount in full?

( ) Yes ( ) No

23) Have you faced any problems while claiming the medical policy?

( ) Yes ( ) No

24) If yes where you do mostly finds the problem:

( ) Insurance Company ( ) TPA’s ( ) Agents ( ) Hospitals

25) Do you find difficult in finding Network Hospitals?

( ) Yes ( ) No

26) Give me your Satisfaction Level:

75

1 – Highly Dissatisfied, 2 – Dissatisfied, 3 – Neutral, 4 – Satisfied, 5 – Highly Satisfied

PARTICULARS 1 2 3 4 5

Services from Insurance Company

Services from TPA’s

Duration of settlement

Services from hospitals

Claim amount received

During reimbursement of the bill

27) Is there any issues covering your policy which your provider must rectify or improve?

______________________________________________________________________________

______________________________________________________________________________

28) Kindly give your suggestion about your policy providers:

______________________________________________________________________________

______________________________________________________________________________

BIBILOGARPHY

76

Books and Magazine

Dr. V.H. Singh & Dr. Harora Yadhav “Health Insurance in India.” Health Plus, 2012: 21-23

Health Insurance: Concepts and CasesAuthors: Sandipa Lahiri Anand and Vandana ShajanICFAI Books

http://business.mapsofindia.com/insurance/

http://www.jagoinvestor.com/2010/01/introduction-to-health-insurance-in-india.html

http://www.medimanage.com/my-health-insurance/articles/top-health-insurance-

companies-in-india.aspx

http://www.licindia.in/Health_Protection_Plus_features.htm

http://www.licindia.in/jeevan-arogya_features.html

http://doctor.ndtv.com/storypage/ndtv/id/3723/type/feature/

Health_Insurance_in_India.html

http://www.irda.gov.in/Defaulthome.aspx?page=H1

http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?

page=PageNo4&mid=2

http://www.eindiainsurance.com/insurance/irda.asp

http://www.medimanage.com/health-insurance-experts-blog/post/2011/05/15/10-

smartest-things-to-check-before-you-buy-Mediclaim-in-India!.aspx#.UMC44eRtgZo

http://articles.economictimes.indiatimes.com/keyword/health-insurance

http://healthclinics99.com/viewnews.php?cat_id=&news_id=97

http://timesofindia.indiatimes.com/business/india-business/Health-insurance-premium-

set-tocost-15-more-per-year/articleshow/16497019.cms

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