INTRODUCTION

Health insurance is a type of insurance whereby the insurer pays the

medical costs of the insured if the insured becomes sick due to covered
causes, or due to accidents. The insurer may be a private organization or a
government agency. Market based health care system such as that in the
United States rely primarily on private health insurance.
History and evolution
The concept of health insurance was proposed in 1694 by Hugh the Elder
Chamberlen from the Peter Chamberlen family. In the late 19 th century, early
health insurance was actually disability insurance, in the sense that it covered
only the cost of emergency care for catastrophic injuries that could (and often
did) lead to a disability. This artifact of history persisted right up to the start
of the 21 st century in some jurisdictions (like California), where all laws
regulating health insurance actually refer to disability insurance. Patients were
expected to pay all other health care costs out of their own pockets, under
what is known as the fee-for-service business model.
As the industrial Revolution matured during the middle to late 20 th
century, traditional disability insurance evolved into modern health insurance
as both employers and governments recognized the value of health care by
encouraging patients to seek regular checkups from primary care physicians.
It is usually much cheaper to treat disease like cancer if they are diagnosed
early.
Today, most comprehensive private health insurance programs cover
the cost of routine, preventive and emergency health care procedures, and also
most prescription drugs, but this was not always the case.

Companies and their products

The Major Players
Four PSUs and six pvt. Sector players are in the market today.
PSUs : NIC, OIC, UIIC and NIAC
Pvt. Sector players
Royal Sundaram
Bajaj Allianz
ICICI Lombard
Cholamandalam
Reliance
Tata AIG

PUBLIC SECTOR PLAYERS

1.

2.

3.

National Insurance Corporation

Personal Accident Insurance

Group Personal Accident Insurance

Jan Arogya Bima Policy

Medi Claim Policy

Overseas Mediclaim Insurance (Employment & study)

Overseas Mediclaim Insurance (Corporate Frequent Traveler)

Overseas mediclaim insurance (Business & Holiday)

Oriental Insurance Corporation

Personal Accident Insurance

Group Personal Accident Insurance

Jan Arogya Bima Policy

Medi Claim Policy

Overseas Mediclaim Insurance (Employment & study)

Overseas Mediclaim Insurance (Corporate Frequent Traveller)

Overseas mediclaim insurance (Business & Holiday)

United India Insurance Corporation

Personal Accident Insurance

Group Personal Accident Insurance

Jan Arogya Bima Policy

Medi Claim Policy

Overseas Mediclaim Insurance (Employment & study)

Overseas Mediclaim Insurance (Corporate Frequent Traveller)

Overseas mediclaim insurance (Business & Holiday)

4.

National India Assurance Corporation

Personal Accident Insurance

Group Personal Accident Insurance

Jan Arogya Bima Policy Medi Claim Policy

Medi Claim Policy

Overseas Mediclaim Insurance (Employment & study)

Overseas Mediclaim Insurance (Corporate Frequent Traveller)

Overseas mediclaim insurance (Business & Holiday)

PRIVATE SECTOR PLAYERS

1.

2.

3.

4.

5.

Bajaj Allianz

Hospital Cash Daily Allowance Policy

Health Guard Policy

Royal Sundaram

Accidentshield

Health Shield Insurance

Group Personal Accident Policy

Health Premium Platinum

ICICI Lombard

Group Personal Accident Insurance Policy

Group Health Insurance Policy

Chola mandalam

Travel Health Insurance

Travel Health Insurance

Reliance

6.

Personal Accident Policy

Tata AIG

Group Multi Guard

Group Personal Accident Policy

Secure Income Scheme

Major Plans in Health Insurance

Personal Accident Insurance

Medi Claim Policy

Overseas Mediclaim

Hospital Cash Daily Allowance

Health Premium Platinum

Group Health Insurance Policy

Personal Accident Insurance

Salient Feature
The policy compensates individual against death, loss of limbs, loss of
eyesight, permanent total disablement, permanent partial disablement and
temporary total disablement, solely and directly resulting from accidental
injuries.
Medical Expenses
Reimbursement of medical expenses directly arising out of an accident can be
covered at an additional premium of 20% of the basic premium.
Medical expenses reimbursable shall be 10% of C.S.I. or 40% of the
admissible claim whichever is lower (If no claim is admissible under the basic
cover no medical expenese shall be payable)
Other Benefits
Expenses for carriage of dead body
Expenses incurred for carriage of dead body of the insured (in case of death
due to accident only, to place of residence at 2% of C.S.I. subject to maximum
Rs. 1000/- shall be reimbursed.
Education Fund
10% of C.S.I. per dependent child subject to Rs. 5000/- per child up to
maximum two dependent children.
Culmulative Bonus
5% of C.S.I. per claim free year shall be added to the Capital Sum Insured
subject to maximum of 50% of C.S.I.

Medi Claim Policy

Features :
Hospitalzation for illness, disease or accident, whether including surgery or
not, imposes heavy financial burden on individuals, families, employers and
welfare bodies.
Scope of cover : Mediclaim insurance policy has been devised under the aegis
of the Government of India.
The Policy provides the following benefits.
1. Reimbursement of hospitalization expenses which are reasonably and
necessarily incurred, under the following heads :

Room, boarding expenses as provided by the hospital/nursing home.

Nursing expenses

Fees of surgeon, anesthetist, medical practitioner, consultant and

specialist

Expenses on account of anesthesia, blood, oxygen, operation theatre

charges, surgical appliances, medicines and drugs, diagnostic material,
X-ray,

dialysis,

chemotherapy,

radiotherapy,

cost

of

pacemaker,

artificial limbs and cost of organs and similar expenses.

2. Cumulative Bonus-Benefits payable will be increased by 5% each claim
free year, up to a maximum of 50% for continuous policy periods only.
3. Cost of Health Check up Reimbursement of cost of medical check-up once at
the end of a block of every four continuous policy years which are claim free,
subject to a maximum of 1% of the average sum insured during the period.
Additional Expenses :
The other salient features of the policy are :

1) Family Discount A family discount of 10% in the total premium will be

allowed if a person take cover for himself and any one or more of the
following.
1. Spouse
2. Dependent Children
3. Dependent parents
2) Age Limit : The insurance is available to persons between the age of 5 years
and 75 years. Children aged between 3 months and 5 years can also be covered,
provided that one or both parents are covered concurrently.
3) Treatment anywhere in India The benefit of the policy can be taken anywhere
in India and the claim is payable in Indian Rupees only
4) The sum Insured An insuring person can choose a sum insured between Rs.
15,000/- to Rs. 5,00,000/- presently.
5) Premium premium chart given below, shows that the rate is determined by
the age of the insuring person and the sum insured selected.
6) Pre-hospitalization and Post Hospitalization Expenses Such expenses are
payable up to 30 days prior to hospitalization and upto 60 days after
hospitalization.
Exclusions :
The most important exclusion relates to pre-existing illness. IF the insuring person had a
health condition, existing prior to taking the policy, which required medical treatment,
the same gets automatically excluded in the policy. To ensure that in
subsequent renewals medical conditions incepting since the policy was taken
do not get excluded, the insuring person must renew the policy without break.
The other exclusions for illustrative purposes are :

Exclusion of certain named diseases in the first year of the policy.

Congenital external disease, sterility, veneral disease , intentional selfinjury, use of drugs, alcohol, rest cure etc

AIDS

Charges primarily for diagnostic, laboratory examinations, and not related

to any treatment in hospital. So also for vitamins and tonics unless
prescribed for treatment.

Dental treatment not requiring hospitalization.

Treatment arising from or traceable to pregnancy, childbirth, including

caesarean.

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Overseas Mediclaim Insurance (Employment & Study)

What can be insured ?

This insurance policy is ideal for insuring against any expenditure sustained
owing to any accident or disease during an overseas trip.
Suitable for .
This insurance policy is essential for each and every individual travelling
abroad for employment or studies.
Risks covered
This insurance policy protects the insured party against medical expenses that
might be incurred during the trip.

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Hospital Cash Daily Allowance Policy

What can be insured?
The company pays during the period of Hospitalization a Daily Allowance. The daily
allowance needs to be selected by the insured. Dependant spouse and children can also be
covered under the Policy. The benefits payable to the dependants shall be linked to that of
insured as above regardless of the fact whether they are employed or not
Eligibility:
The minimum age for the children will be 3 months and the maximum age 21 years.
There is no limit on the number of children to be covered.
Compensation:
The daily allowance can be Rs. 500/- Rs. 1000/- or Rs. 2000/- per day as selected by the
insured.
The Hospital Daily Allowance Policy is a comprehensive insurance policy with cash
benefits which payable are according to the selected scheme if the insured person is
hospitalized due to sickness or accident. It provides cash benefit for each and every
completed day of Hospitalization. A day for this purpose may be a period of less than 24
hours reckoned from the time of hospitalization but must include 00:00.

Exclusions:
The normal exclusions under the Policy are
1. Pre existing disease
2. Treatment not carried out by a qualified Medical Practitioner.
3. Cosmetic & plastic surgery, unless resulting from an Accident
4. Any expense on Hospitalization incurred during first 30 days of insurance
5. Dental treatment or surgery of any kind unless due to Accident requiring
Hospitalization.

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6. Treatment arising from or traceable to pregnancy, childbirth including

caesarian section.
7. Drunken driving
8. Natural perils like avalanche, earthquake, volcanic eruptions or any kind of
natural hazard.
9. Racing of any kind
10. Weight reduction, improvement/enhancement therapy

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Health Premium Platinum

Plan details :
Health Premium Platinum is a comprehensive health insurance package that an
employer can buy for his employees and their family members.
The policy covers employees and their family members from hospital and
medical bills that accompany an illness or accident. Family members include
spouse and two dependent children.
Coverage includes :
Cashless facility :
With the Health Card, members get access to the cashless facility from the
Medicare network of hospitals. This means they can walk into any of the
135 hospitals in 25 cities across the country and get treated without
having to pay the medical bills. If they do not get admitted to a networked
hospital, the expenses will be reimbursed within 15 days of receipt of
complete documents.
Hospital Cash :
A fixed amount of benefit given for each day of hospitalization.
Convalescence Benefit :
A fixed amount given if period of hospitalization exceeds 21 days.
Exclusions :

Disease contracted during the first 30 days of commencement of

policy.

All diseases/illness/injury existing at the time of proposing this

insurance.

Certain diseases like hernia, cataract, piles, sinusitis etc are excluded
during the first year of operation of insurance cover.

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Any claim arising out of or traceable to pregnancy.

Any Ayurvedic, Homeopathy, Naturopathy or any other forms of local

medication.

Alcoholism and drug abuse and AIDS.

Dental treatment or surgery unless requiring hospitalization

Cost of spectacles, contact lenses and hearing aids.

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Group Health Insurance Policy

Plan details:
This policy covers reimbursement of hospitalization expenses incurred for
diseases contracted or injuries sustained in India. Medical expenses up to 30
days for Pre hospitalization and up to 60 days for post-hospitalization are also
admissible.
Sum Insured:
Minimum Rs. 15,000/- and Maximum Rs. 5, 00,000/Premium:
Premium chargeable depends upon age of the person and the Sum Insured
selected. Age limit is 5 to 80 years.
Children above 3 months can be covered provided one or both parents are
covered concurrently.
Group Discount:
Policy can be given to Corporate Body, Institution, Association and slab wise
group discount is admissible on standard premium if the group size exceeds
100. Larger the group size higher is the discount.
Bonus/Mauls Clause:
Favorable claims experience is recognized by discount and conversely,
unfavourable claims experience attracts loading on renewal premium.
Extensions:
On payment of additional premium, Policy can be extended to cover
1. Maternity Benefits
2. Pre-existing Diseases

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3. Reimbursement of Cost of Health Check-up after four consecutive claims

free years.
Main Exclusions :
Pre-existing diseases, diseases contracted during first 30 days, cost of
spectacles/contact lenses, dental treatment, AIDS, pregnancy and certain
specified during first year of the policy.

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Private Health Insurance

Health insurance is one of the most controversial forms of insurance
because of the perceived conflict between the need for the insurance company to
remain solvent versus the need of its customers to remain healthy, which many view as a
basic human right. Critics of private health insurance claim that this conflict of interest is
why state and federal regulation of health insurance companies is necessary. Some say
that this conflict exists in a liberal healthcare system because of the unpredictability of
how patients respond to medical treatment. But proponents of regulation argue that too
many health insurance companies put their desire for profits above the welfare of the
consumer or patient.
The following is a hypothetical example of a situation that might confront an
insurance company. Suppose that a large number of customers of a particular insurance
company contracted a rare disease and the hospital charged 10 million dollars a patient to
treat them. The insurance company would then be faced with a choice of paying all
claims without complaint (thus losing money and possibly going out of business) or
denying the claims (thus outraging patients and their families, discouraging potential
customers, and becoming a target for lawsuits and legislation). Since a health insurance
policy is a legal, binding contract between the insurance company and the customer, the
insurance company should pay all valid claims without question. Many insurance
companies purchase re-insurance to protect themselves from a catastrophic loss due to an
unforeseen even. But just like any other business, a health insurance company does not
have a right to shirk its legal obligations just to make a profit or stay in existence. Health
insurance companies and consumer advocates agree that private health insurance faces
unique problems. Health insurance companies use the term adverse selection to
describe the tendency for sick people to be more likely to sign up for health insurance.
Insurance companies say that asymmetry of information about a persons health and
behaviour is likely to lead to adverse selection and (ex-ante) moral hazard.
Health insurance companies say, that is essence, those seeking health insurance
are likely to be those with existing medical problems or those who are likely to have
future medical problems, and that those who take out insurance may engage in risky
behaviour, such as smoking such as smoking and excessive alcohol consumption, which
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an otherwise sane person would not do. Insurance companies say that the cost of
providing health insurance to these bad risk raises the cost of insurance to the good
insurance risks, possibly pricing them out of the market, and could create a situation in a
market where insurance was uneconomical for private insurance companies to provide.
One must also recognize that both public and private health insurance will also suffer
from ex-post moral hazard. This phenomenon is in essence the consequence of reduced
prices for medical care. Since most insurance plans, whether public or private, reduce the
out-of pocket cost of medical care, the behavior of individuals will be affected by those
reduced prices. In the same way that people treat water with little care when it is very
inexpensive, people will also tend to over-use medical care when the out-of pocket costs
are small. Of course, medical care still needs to be financed, and so taxes or premiums
will be higher than the optimal amount. This inflation of taxes or premiums to cover the
choices made under subsidized prices is what is termed ex-post moral hazard, and is a
different phenomenon than the ex-ante moral hazard mentioned above. Critics of private
health insurance state that those who are sick should be able to get health insurance
because they need it the most and that if everyone had health insurance, adverse selection
would not be a problem. With publicly funded health insurance ask, do people of moral
hazard, those who favor public health insurance or drive like maniacs if they have auto
insurance, or do some people just engage in self destructive behaviour for no rational
reason.
Insurance companies explain the economics of insurance by saying that, in
general, if many sick people buy health insurance from a private health insurance
company, but few healthy people buy it, the price of the insurance rises. (Critics of
private health insurance point out that few sick people are allowed to buy health
insurance). Insurance companies also say that if more healthy people buy health
insurance, but few sick people buy it, the price drops. In other words, the price drops
if more money goes in and less is paid out. According to the latest United States
Census Bureau figures, approximately 85% of Americans have health insurance.

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Approximately 60% obtain health insurance through their place of employment or as

individuals, and various government agencies provide health insurance to 25% of
Americans.
Because of advances in medicine and medical technology, medical treatment is more
expensive, and people in developed countries are living longer. The population of those
countries is aging, and a larger group of senior citizens requires more medical care than a
young healthier population. (A similar rise in costs is evident in Social Security in the
United States) These factors cause an increase in the price of health insurance. Some
other factors that cause an increase in health insurance prices are health related:
insufficient exercise; unhealthy food choices; a shortage of doctors in impoverished or
rural areas; excessive alcohol use, smoking, street drugs, obesity, among some parts of
the population; and the modern sedentary lifestyle of the middle classes.
In theory , people could lower health insurance prices by doing the opposite of the
above; that is, by exercising, eating healthy food, avoiding addictive substances, etc.
Healthier lifestyles protect the body from diseases and with fewer diseases, the insurance
companies would pay fewer doctor bills.
Under these circumstances, consumer would hope to benefit from the savings;
however, critics of private health insurance claim that too much of the insurance
premiums are paid out in executive salaries or retained as profits by the company. Before
buying health insurance, a person typically fills out a comprehensive medical history
form that asks whether the person smokes, how much the person weighs, and has the
person ever been treated for any of a long list of diseases. Applicants can get discounts if
they do not smoke and live a healthy lifestyle, which might encourage some people to
quit smoking or make other improvements in their lifestyle. The medical history is also
used to screen out persons with pre-existing medical conditions.

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Common complaints of private insurance

Some common complaints about private health insurance include :
1.

Insurance companies do not announce their health insurance premiums

more than a year in advance. This means that, if one becomes ill, he or she
may find that his premiums have greatly increased. This largely defeats
the purpose of having insurance in the eyes of many.

2.

If insurance companies try to charge different people different amount based on their
own personal health, people will feel they are unfairly treated. Some states require
that insurance companies cover all who apply at the same cost, or that rates vary
only by age of the insured; this rule has the effect that healthy people subsidize sick
ones, and thus frequently only those in poor health buy insurance, making the
premiums very expensive.

3.

When a claim is made, particularly for a sizeable amount, it may be deemed in the
best interest of the insurance company to use paper work and bureaucracy to attempt
to avoid payment of the claim or, at a minimum, greatly delay it. Some percentage of
insureds will simply give up, leading to lower costs for the insurance company.

4.

Health insurance is often only widely available at a reasonable cost through an

employer-sponsored group plan. This means that unemployed individuals and selfemployed individuals are at a disadvantage.

5.

Employers can write some or all of their employee health insurance premiums off of
their taxable income whereas traditionally individuals have had to pay taxes on
income used to fund health insurance. This reduces the employees bargaining power
in negotiating service with the insurance provider and also

increases their

dependence on the employer. In the U.S., COBRA and more recent legislation has
been passed in an attempt to address the latter concern, and full tax deductibility for
health insurance premiums paid by the self-employed has recently been passed by
Congress as well.

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6.

Experimental treatments are generally not covered. This practice is especially

criticized by those who have already tried, and not benefited from, all standard
medical treatments for their condition. It also leads to many insureres claiming or
attempting to claim that procedures are still experimental well after they have
become standard medical practice in many instances. (This phenomenon was
especially seen after organ transplants, particularly kidney transplants, first became
standard medical practice, due to the tremendous costs associated with this
procedure and other again transplantation.)

7.

The health Maintenance Organization (HMO) type of health insurance plan has been
criticized for excessive cost-cutting policies. The least justifiable of these efforts,
according to critics, is having accountants or other administrators
essentially making medical decisions for customers by deciding which
types of medical treatment will be covered and which will not.

8.

As the health care receipient is not directly involved in payment of health

are services and products, they are less likely to scrutinize or negotiate
the costs of the health care received. To care providers, insured care
recipients are essentially seen as customers with relatively limitless
financial resources who dont look at prices. The health care company has
few popular and many unpopular ways of controlling this market force. In
response to this, many insurers have implemented a program of bill
review in which insureds are allowed to challenge items on a bill
(particularly an inpatient hospital bill) as being for goods or services not
received; if this is proven to be the case, the insured is awarded with a
percentage of the amount that the insurer would have otherwise paid for
this disputed item or items, usually 25% or occasionally even 50%. With
a ceiling so that the insured will not truly become wealthy from this
procedure.

9.

Third party Administrators. Who Are They?

Third Party Administrators (TPAs) are the middlemen in the chain of

integrated delivery systems that bring all the components of health care

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delivery such as physicians, hospitals, clinics, home health, long-term

care facilities and pharmacies into a single entity. They will provide
quality health care and services at affordable costs, which hitherto was
unheard of. The role of TPAs will particularly be beneficial to those
sections of society for whom quality healthcare has always remained a
dream.
Advantages :

Affordable Cost:
This new breed is expected to bring about a total transformation in
healthcare management with affordable costs and improved quality
halthcare. It will also bringing about a change in the mindset of the
masses regarding the concept of managed and preventive healthcare.

Improved Quality :
Such a system encourages appropriate treatment, discourages overtreatment, encourages preventive care, and attempts to promote cost
containment and quality health care delivery

Cashless System :
The entry of TPAs means the arrival of a cashless system of payment for
healthcare services. The policyholders would receive every healthcare
facility required depending on their needs and high medical costs will
not be a deterrent.

Existing Players
At present Paramount, Sedgwick Parikh, Ican Medicare, Apollo Family
Health and DMS Lifeline provide such healthcare facilities. About 25-30
new players are likely to enter soon once the regulations are in place.

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The final modalities regarding the role of TPAs and the procedure to be
followed are yet to be worked out. But healthcare companies are
optimistic about the changed scenario and see vast scope in the health
care industry.
Governments Role in healthcare
For instance in Japan, France, Canada, England and Netherlands, majority of the
population is covered by state funded health insurance. The only large country where
private health insurance is dominant is the US, a country that has the most inefficient and
expensive health care system in the developed World. It is foolhardy to argue that health
care delivery would improve in India if the government sector were replaced by the
private sector. In fact there is a need to greatly increase the involvement

of the

government in providing healthcare

.

Challenges in rural healthcare

Insurance penetration levels in India are abysmally low, only 22 percent of the
insurable population has been tapped and the situation in rural areas is even worse.
Educating the rural population about the importance of healthcare and how insurance can
help get the best for them at various stages in life is in itself a challenge particularly
considering the low literacy levels, the traditional mindset, traditional or local healers,
inefficient means of transportation, unaffordability, low importance to healthcare- few of
the harsh realities that need to be tackled first.
Low Importance to healthcare :
With no means to provide for even the basic necessities, scant regard is given
to healthcare. Unless the situation is worse seeking medical help is out of question
Allopathic cure not considered :

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Low educational levels have led to village folks relying on local healers. Their
advice is taken at face value and allopathic cure is only taken up as the last resort.
Hospital care is costly :
Access to affordable medical care is absent. Hospitals are located very far off
and the cost is unaffordable.
Transportation :
An absence of an efficient means of transport has only worsenend the
situation. Bullock carts are the usual mode and any other is unaffordable. Hence a
patient in need of medical help has to travel long distances to reach the nearest
health centre. The following factors will help bring about a change in the situation.
More PHC (Primary Health Centre):
More primary health care centers need to be set up by the government.
Subsidized local transport:
Local transportation to be arranged for at subsidized rates by the panchayat or
the hospital.
Education of village folk :
To spread the message volunteers can build a network of workers who can
identify the problem areas and influence the villagers on various issues. Street plays,
personal approach on a one to one basis or a group approach will go a long
way in educating the rural population.
Tailor made policies :
Insurance companies will have to take into consideration the problem
areas, and create tailor made policies.
Marketing :

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Marketing in rural India is a different ballgame. Emphasis should be on

the traditional media coupled with entertainment. This will go down well with
the village folk. LIC used puppets to educate rural masses about Life
Insurance. The number of inquires at LIC following the performance was
found to be considerably high and the field staff too reported a definite impact
on the business.
Womens role :
Awareness building and empowerment of women through income
generation projects and literacy activities can help to a large extent.
Private health care centers :
Health care centers set up by private institutions at subsidized rates can
ease the problem to a great extent. Insurance companies can play a major role
in educating the masses by spreading the message through health care centers.

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Future Scenario of Health Insurance Industry in India

Background
The Indian constitution lays the principle responsibility for public health at
the doors of the individual state govt. The central govt. provides about 15%
of the funding needs- mostly for national heatlh programs. Given the paltry
state of financing, it is not that surprising, that public health expenditure is
far below the requirement for the hue population of 1030 million about 16%
of the world total.
The family planning and healthcare initiatives of the govt. have however
been effective in reducing birth rates and improve mortality rates from
historic levels. The crude birth rate declined to 25 per thousand in 2002
from 39.9 per thousand in 1951 and the infant mortality rate registered a
dramatic decline in two decades from 134 per thousand live births in 1981
to 66 per thousand live births in 1999 , life expectancy at birth has
increased by about 35 years, from 31 years in 1947 to 66 years in 2002, a
vast and dramatic improvements. According to world health organization
report published in 2002, India ranked 13 t h from the bottom in terms of
public spending on health.
The role of private health expenditure
Although Indias public spending is low, overall health spending is
improved due to higher private spending. In 2002, health spending on
health was estimated to be 4.8% of GDP, over three times public spending.
As a result Indias overall expenditure on health in 2002 was 6.1% of GDP.
Currently, less than 15% of the Indian population has some kind of health
insurance cover. This includes those covered under the central govt. health
scheme (4 million beneficiaries), the railways health scheme (1.2 million)
and the employees state insurance scheme (0.3 million). On an average,

27

every family spends up to 10% of annual household consumption towards

healthcare needs.

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Health Insurance in India :

Health Insurance remains vastly underdeveloped in India. The regulations only permit
general insurance companies to offer stand alone health insurance products, while life
insurers are allowed to offer riders such as critical illness cover attached to basic life
policies although subject to certain restrictions. Health cover premiums, however,
account for less than 1% for life insurers and 10% for general insurers of total premiums.
Health insurance premium collections in 2004-05 amounted to RS. 2,000 cr which in
comparison with the total healthcare spend at around Ts 60,000 cr, pales into
insignificance. The health insurance market is dominated by the four public ector general
insurance companies that have launched what is popularly known as the mediclaim
policy an indemnity benefit arrangement covering in-hospital expenses. While they hold
about 80% of the health insurance market, they face increasing consumer dissatisfaction
and serious issues on product profitabiliy.
The combined new business health premiums of the four public sector companies
accounted for 82% of the total new business health insurance premiums collected by the
non-life insurance industry in the 2004-05 financial year. The private sector companies
increased their combined market share in the health segment to around 18% in 2004-05
financial year from around 10% in the previous year.
The state-owned companies have had little focus upon this developing line of business
on a systematic and profitable basis. They have mainly attempted to market health
insurance cover on a discounted basis to employer groups as an accommodation,
primarily to gain access to the profitable lines of the employers insurance portfolio, such
as property cover, which are subject to state

regulated tariffs that are generally

considered to contain significant margins. The success of this strategy means that group
health insurance constitutes about 35% of the total about 35% of the total health
insurance business.
Historically the public sector companies have also not paid attention to developing proper
underwriting criteria and they are not required to declare the operating results of this
product line separately. Despite of years of experience they have not built proper
databases and do not carry out systematic analysis of amongst other things, disease

29

patterns, regional variations age-related healthcare spending and/or claim distribution

costs.
The health portofolio that had a loss ratio of about 78% in 2003 deteriorated to 98%
in the following year. These deteriorating loss ratios as well as the competition from new
private players, are pressuring these companies to more actively manage their portfolios.
Since public sector insurance firms regard health insurance as a loss leader to gain
foothold in other more profitable lines, they have also not invested adequately in their
customer service proposition. An indication of the low level of satisfaction is large no. of
complaints from customers. According to the figures published by the 12 Insurance
Ombudsmen in the country, 70% of customer complaints relate to health insurance, the
most common point of contention being clauses related to pre-existing illness.
The introduction of new private general insurance companies is, however, beginning
to make some difference. Five of the new private non-life insurance companies sell stand
alone health insurance products. These new companies have introduced a few
innovations, such as direct tie-ups with healthcare providers, providing cashless
settlement as an option, the provision of pre and post hospitalization benefits and
coverage for pre existing illness.
Both state owned and private companies have also tied up with Third Party
Administrators (TPAs) who are licensed by the insurance regulator. Currently, there are
nine TPAs who handle the bulk of the business, with most serving more than one
insurance company. The regulations require a TPA to be exclusively engaged for the
purpose, with minimum capital of Rs. 10 million. At least one director of a TPA should be
a qualified medical practitioner.
The use of UPAs have however given rise to some tension between the healthcare
providers and the health insurance companies. Due to lack of standards and regulations in
India to govern hospitals, nursing home and other healthcare providers, there are
substantial difference in the delivery and cost of healthcare services across India and
amongst service providers. While TPAs attempt to prescribe uniform fees and standards
of service to avoid duplication in diagnostic and other customer care aspects, the service
providers are resisting such moves and tend to form cartels. They have also begun to
30

adopt dual fees schedules. A higher rate for customer preferring to get treatment under
cashless schemes administered through the TPAs and a lower one for direct settlement
and possible reimbursement by the insurer.

Future Sceneario
Despite the above teething problems the Indian economy is showing sings of
liberalization in many areas. Further, the govt. and the insurance regulator seem keen to
encourage health insurance. The obvious solution is to encourage competition by
lowering the entry barrier for new players and to recognize the potential of health
insurance as a stand alone business.
A working group, set up by the insurance regulator to suggest specific measures to
improve the state of affairs in health insurance, has recently submitted its report. One of
its major recommendations is to license exclusive health insurance companies with a
lower minimum capital requirement of Rs 250 million, one-quarte of the minimum
capital required for life and non-life insurance companies.
The group also favoured the introduction of a risk-based capital model of healthware
companies to encourage efficiency in capital allocation and a higher level of tax benefit
for health insurance premium payment for individuals. A key need to allow a higher
equity holding for foreign firms is alo being recognized, with the group favoring foreign
ownership of health insurance companies of up to 51% (compared to the current limit of
26% for insurance companies). This would require an amendment to the insurance Act,
which is a long process, unless the govt. chooses to use its emergency ordinance powers
to intervene more rapidly.
At the same time, there are signs of cooperation between some of the healthcare
providers to subject themselves to a stricter price structure. The major TPAs have
developed a database of the most common surgeries such as heart, cataract, tonsillectomy
and hysterectomy covering the average treatment cost across the primary, secondary and
tertiary hospitals. Since there is no accreditation body in the country for hospitals , the
National center for quality Management has agreed to work out a further classification of

31

hospitals from the data collected by the TPAs. The exercise is carried out in a phased way
and already about 200 hospitals have signed contracts.
Health insurance provides the important benefit of risk pooling to customers,
particularly once insurers have achieved both scale and size. Such coordinated moves
amongst healthcare players are therefore essential to spread the benefit of health
insurance among the whole population. A study by the Indian Planning Commision has,
however, indicated that the lowest earning 20% of the population spend about a fifth of
that of the highest 20% of the population on healthcare, whereas the differences in
disposable incomes is far greater. Further more, the bulk of the healthcare spending by
the lower earners is met by raising borrowings or selling family assets.
Only a purposeful and time bound plan could therefore bring relief to every segment
of the population, enabling access to vital healthcare cover. As a result, there is a
significant opportunity in India for insurers if they can proactively contribute to govt.
initiatives to achieve better and more widespread healthcare provision and funding.
Reference :
Insurance Chronicle
February 2006, Page no. 33-36
By- Rajagopalan Krishnamurth, head,
Distribution consulting in India, Watson Wyatt
Walter de Oude, Senior Consultant
Watson Wyatt, Singapore

32

REVIEW OF LITERATURE
A literature review is a body of text that aims to review the critical points of current
knowledge and or methodological approaches on a particular topic. Literature reviews are
secondary sources, and as such, do not report any new or original experimental work.
Most often associated with academic-oriented literature, such as theses, a literature
review usually precedes a research proposal and results section. Its ultimate goal is to
bring the reader up to date with current literature on a topic and forms the basis for
another goal, such as future research that may be needed in the area. Some information
regarding health insurance is as follow:

NATIONAL HEALTH POLICY - 2002

The public health investment in the country over the years has been comparatively low,
and as a percentage of GDP has declined from 1.3 percent in 1990 to 0.9 percent in 1999.
The aggregate expenditure in the Health sector is 5.2 percent of the GDP. Out of this,
about 17 percent of the aggregate expenditure is public health spending, the balance
being out-of-pocket expenditure. The central budgetary allocation for health over this
period, as a percentage of the total Central Budget, has been stagnant at 1.3 percent,
while that in the States has declined from 7.0 percent to 5.5 percent. The current annual
per capita public health expenditure in the country is no more than Rs. 200. Given these
statistics, it is no surprise that the reach and quality of public health services has been
below the desirable standard. Under the constitutional structure, public health is the
responsibility of the States. In this framework, it has been the expectation that the
principal contribution for the funding of public health services will be from the resources
of the States, with some supplementary input from Central resources. In this backdrop,
the contribution of Central resources to the overall public health funding has been limited
to about 15 percent. The fiscal resources of the State Governments are known to be very
inelastic. This is reflected in the declining percentage of State resources allocated to the

33

health sector out of the State Budget. If the decentralized pubic health services in the
country are to improve significantly, there is a need for the injection of substantial
resources into the health sector from the Central Government Budget. This approach is a
necessity despite the formal Constitutional provision in regard to public health, -- if the
State public health services, which are a major component of the initiatives in the social
sector, are not to become entirely moribund. The NHP-2002 has been formulated taking
into consideration these ground realities in regard to the availability of resources.

A STUDY ON MARKETING PROBLEMS AND PROSPECTS OF HEALTH

INSURANCE POLICIES IN COIMBATORE DISTRICT
Dr.L.Manivannan
Reader & NCC Officer , Erode Arts College, Erode 9.
&
S.A.Senthil Kumar
Lecturer, Department of Management Studies, M.S.University, Tirunelveli 12.
Year December 2007
A commanding proportion, namely 17.9% of the policy holders and those who did not
renew reported that they ran short of funds to pay insurance premium. Policyholders
constituting 31.9% took insurance policies initially just to satisfy the development
officers or agents who pestered them. As they had no intrinsic awareness of health
insurance, later they abandoned the renewal of policy. 21.5% of the policyholders were
not renewing the insurance policies due to dissatisfaction about the services of the
insurance company. 10.8% of the sample policyholders who did not renew, did so as they
did not anticipate risk to their property, a meagre 17.9% of the sample policyholders were
not renewing the insurance policies due to switchover to better policy.

34

OBSERVATION OF A STUDENT IN N.C. COLLEGE, ISRANA ABOUT

HEALTH INSURANCE
This is not so much easy task to give findings because before concluding
anything there should be a long research, the research based only on 100
peoples in not sufficient, so considering it in mind I have reached on some
findings. All of these findings are my own perception and knowledge that I
got while completing this research project.
During the completion of the research project report, I have met many different kind
of peoples includes shopkeepers, advocates and doctors. And out of these advocates and
doctors are known as the most intelligent persons in the society. The concept of the
Health Insurance is very old, it came into picture in 1694 but the awareness level about
the health insurance policies is considerably very low. I have contacted 100 peoples,
including 50 shopkeeper, 25 advocates and 25 doctors, but out of these only 8
shopkeepers 11 advocates and 16 doctors are aware about the health insurance policies.
In the form of percentage it is only 35 percent, this is very much unbelievable

35

HEALTH INSURANCE CLAIMS IN INDIA: A SAMPLE STUDY

V. JAYALAKSHMI

Present Status of Health Insurance coverage in India

Visibly after the insurance sector opened up, the health insurance segment has been
witnessing an annual growth rate of 20 percent, which is commendable. The statistics
published by the annual reports of IRDA also show that during the period between 1995
96 and 2003-04, the number of policies issued significantly increased from half a million
to about 5.5 million policies extending coverage to about 22.2 million beneficiaries. The
Gross Direct Premium from all the companies including the public and private sector
companies also significantly increased from less than Rs. 400 crores in 1999-00 to Rs.
1732 crore in 2004-05, which is also a commendable achievement. This steady increase is
undoubtedly indicative of the fact that the Indians are slowly becoming consciously
aware of the need for insurance and hence are adapting risk management tools for
mitigating the consequences of the financial burden of their health care expenses. But,
sadly health insurance segment still constitutes only about 7 percent of the total insurance
business income today. However, all the various schemes currently existing cover less
than 1 percent of the population. Given the demographic projections and time trends in
health care in India), and keeping in mind the future needs of the altered demographic
composition, the demand for health insurance would be much wider and significantly
large in the years to come, as there is a considerable gap existing between demand and
supply of health insurance.
The reasons for the low penetration levels of health insurance in India as mentioned
earlier, include restrictive coverage, stringent conditions, lack of choice in products and
lastly unaffordable premiums. As a result, majority of people remain uninsured or
underinsured for health. The need o f the hour is to design policies with greater coverage
and that are need based and tailor made for specific groups such as the following:

36

Old age Health care: Medical gerontology to take care of health care problems
associated with ageing

Long term care: for illnesses that require prolonged treatment and care

Disability income insurance to replace loss of income

Mental care / Psychiatric disorders involving long term treatment

Health cover for daily wage earners (seasonal workers, casual laborers, construction
workers, etc)

Juvenile insurance plans - to meet ill health / medical expenses associated with
health related problems of children

Exclusive policies for women for gender related problems

Group cover or plans for identifiable / recognizable groups

Tailor - made rural health policies

Preferred Health Risks policies like the Preferred Life insurance policies

Results of Sample study of Health Insurance Policyholders

A sample study to evaluate the economic and demographic background of mediclaim
insurance policyholders and claimants from one of the public sector general insurance
companies in India has been undertaken. The aim of the study was to examine the profile
of health insurance policyholders and claimants and to evaluate the nature, frequency and
severity of claims. The analysis revealed the facts outlined below:
* Age and Gender profile of the policyholders
Out of the total policyholders, 44 percent of the policyholders were below 35 years of
age. While only 25 percent belonged to the middle-age group of 36- 45 years, another 20
percent were from the higher middle age group of 46- 55 years of age. Only 12 percent of
the policyholders were above 55 years. The sample clearly revealed that it is mostly the
middle-aged people who chose to have health insurance coverage.
The gender composition of policyholders did not show any gender discrimination against
the females. Equal awareness is presumed to be present amongst men and women for
health insurance coverage

37

* Number of persons per policy

About 25 percent of the policies covered only single individuals, while 34 percent
covered couples. Small families consisting of four members constituted 22 percent, while
only 10 percent of the policies covered large families. It was evident that the smaller
families and individuals showed greater preference to have a health policy. Financial
constraints could be the reason for larger families not going in for a cover
* Sum Insured Amount
Sum insured under the policy reveals the maximum liability of the insurer under the
policy. On the other hand, sum insured figures also reveal the financial capacity of the
policyholders. More than fifty percent of the policyholders have sum insured below Rs.
50,000. Only 35 percent policyholders have Rs.100,000 as their cover. Only 15 percent of
the policyholders had sum insured exceeding Rs. 100000 and upto Rs. 250000. Data
clearly indicate that a majority of the policyholders prefer low sum insured amounts.
Sum-insured does not increase proportionately with age and risk. The sum insured chosen
by the policyholders do not reflect a rational judgement for coverage based on age or risk.
An important policy implication that is revealed here is that plans/ policies should be
needbased and affordable. Preference for low sum insured plans also reveals the
willingness to pay (WTP) and low ability to pay (ATP) factor of the policyholders.
* Premium
Premium is the cost of insurance, which depends on age and the sum-insured chosen by
the policyholder among other factors. 21 percent of the policyholders made high
premium payments of over Rs.2000. While one-third of the policyholders paid premium
below Rs. 2000, only 28 percent paid below Rs. 1000. Premiums below Rs. 500 were
paid by only 17 percent of the policyholders. Data reveals low premium payment abilities
of the policyholders. When the correlation between premium and family size was
examined, it was observed that 80 percent of the policyholders belonging to small
families have opted for lower covers with low premium liability of less than Rs.2000.
Sum insured amounts chosen are not commensurate with the size of the family.
Affordability of the coverage seems to be the driving factor rather than the need for
coverage.

38

Results of Sample study of Health Insurance Claims

A health insurance claim under a Mediclaim insurance policy is generally made for
reimbursement of hospitalization expenses incurred for treatment of diseases or injuries.
These claims are sometimes repudiated in case of false claims or inflated billings. The
study in this section analyses the socio-economic profile of the claimants and also the
nature of claims.
* Age & Gender distribution of the Claimants
About 79 percent of the health insurance policy claimants were between 36 to 45 years.
Another 18 per cent of the claimants were in the age group 46 65 years of age and only
3 percent were above 65 years. The sample study revealed predominance of claims from
middle-aged policyholders
* Gender
On the gender front, gender bias was clearly visible in the claims made. While 82 percent
of the claimants are males, only 18 percent are females. Out of the males, again 41
percent of the claimants were below 35 years. Amongst the female claimants, very high
incidence of claims to the tune of 83.33 percent was from females below 35 years.
Surprisingly, there were no claims from older females, generally considered as more risky
group.
Age and gender examination in relation to claims reveals clearly that young and middleaged males make more claims frequently. Therefore, underwriting standards and practices
for the middle-aged policyholders need to be strengthened.
* Duration of Hospitalization
Examination of duration of hospitalization taken by the claimants showed that majority of
the claims almost to the tune of 76 percent were for short-term hospitalization of less than
5 days, for minor ailments out of which males were 76 percent and females comprised 24
percent. 15 percent of the claimants were for hospitalized for 6 to 10 days, all of them
being males. 6 percent of the remaining claimants (all males) were hospitalized for 11-15
days. Only 3 percent of the claimants were hospitalized for more than 15 days again all
males.

39

High incidence of moral hazard is also visible amongst male claimants across all age
groups. Short duration hospitalization claims for less than 5 days were more in number.
Examination of frequent and short duration claims requires greater care (see Table 10).
* Claim amounts
The claims ranged mostly between Rs. 5,000 and Rs. 20,000 amongst males and females.
40 percent of the claims were below Rs. 5,000. Out of these claimants 65 percent were
males, below 35 years. The same trend is seen even amongst the females. 32 percent of
the claims filed were for amounts between Rs. 5,000 and Rs. 10,000, out of which again
about 90 percent were males from age below 45 years. Only 15 percent of the claims
filed were for high amounts above Rs.10,000 Rs.20,000, with 90percent being males.
Claims exceeding Rs.20,000 were made by 14 percent of the claimants, all males.
Claims data clearly show adverse experience from policyholders (mostly males)
belonging to lower age groups, particularly below 45 years. The company experiences
high frequency and low severity cases. Stringent claims evaluations standards can
mitigate the adverse claims experience (see Table 11).
* Sum Insured
Examination of the sum insured amounts of the claimants showed that a very small per
centage of claimants had sum insured below Rs.50, 000. 71 percent of the claimants had
above Rs. 1,00,000 as sum insured. Only 10 percent of the claimants had high covers of
more than Rs. 2,00,000. Barely 7.5 percent of claimants had very high cover policies
above Rs. 3 lakhs. Most of the claimants had low sum insured coverage
* Claims in relation to Premium
Interestingly, the data revealed an inverse correlation between claims and premium
figures. Claimants, who paid premiums between Rs.1000 and Rs. 2000 made more
frequent claims that too for low amounts below Rs.5000. Only 14 percent of the total
claims constituted high claims exceeding Rs. 20,000.
Data revealed significant correlation between low premium payments and claims
incurred. There were no significant claims from persons who paid high premiums. This
implies that low sum insured policies must be underwritten more carefully

40

* Time taken for settlement of claims

Claim settlement constitutes and reflects a very important function of the insurance
company reflecting managerial efficiency. 34 percent of the claims were settled in less
than a month. Majority of the claims were settled within 1 3 months. Only 10 percent of
the claims had taken more than 3 months for final settlement.
The data clearly showed that small claims are settled sooner within a month. Higher
amounts take more than 3 months for final settlement, probably for want of more
evidence, and details (see Table 14).
* Sum Insured and Claims
Evaluation of sum insured amounts of the claimants revealed that 71 percent of them had
Rs.100,000 as sum insured. Another 11 percent of the claimants had Rs. 2 lakhs sum
insured. Claims were made from low sum insured policies of Rs. 50,000 (Table 15).
* Reasons for hospitalization
Close evaluation of the reasons for hospitalization revealed that 27 percent of the claims
were for surgery. 21 percent of claims were for accidental injuries. Another 29 percent of
the claims were for miscellaneous fever. Data showed high frequency of claims for minor
ailments
Observations of the sample study
The analysis of policyholders profile clearly reflects that there is considerable awareness
amongst both males and females across all age groups for health insurance. It is also seen
that the females and males of middle-aged category seem to be more conscious of the
need for health insurance. Most of the policyholders have opted for low sum insured
amounts, which reflects that health insurance is opted only as a risk cover for minor
illnesses, and not for catastrophic illnesses. The policyholders were from the middleincome category, which is reflected in the premium payments.
As for the claims, it is observed that 81 percent of the claimants were males that too from
the lower and middle-aged category. The claims were mostly for short duration
hospitalization of less than 5 days, which reflects a high incidence of moral hazard. Of
the total number, three fourths of the claim amounts were below Rs. 10,000 only. The

41

entire data reflect a high frequency of low claims. The analysis of the demographic
profiles of the claimants also reveals a clear evidence of high incidence of moral hazard
and the tendency of the low-age group members, particularly the males to over utilize the
medical utilities, that too for short duration, and not-so-serious illnesses reflecting their
mentality to simply take back the premium that they have paid. But, fundamentally,
insurance mitigates the financial costs of only pure risks. The lack of understanding of the
essence of insurance is clearly visible in the sample taken. The Adverse selection and
moral hazard factor can be curtailed to some extent by incorporating strict underwriting
guidelines at the time of issue of the policy.

42

Objectives

To study the awareness level & prefrences among customers towards health
insurance.

To study different health insurance schemes available in the market.s

43

RESEARCH METHODOLOGY
PROBLEM STATEMENT
Keeping in view the fact that there is a cut throat competition between
the life insurance companies as well as in the non-life insurance
companies. The companies spent a lot of amount of money in promoting
the health insurance products. But the problem in cities is that peoples are
not so much aware about the health insurance products and moreover they
do not feel any kind of need to buy these products. They say that some for
the life insurance products are now covering the medical expenses also.
The government employees do not buy health insurance products
because they know that any kind of exepenses, they do on the medical
services will be reimbursed by their respective departments. So the
problem was

to know

customers

awareness level

regarding health

insurance products and the attitudes and perception. So that it can help
non-life insurance companies to sell and promote health insurance
products.

Research Objective
Every research project is based on some objectives so for this study
my objective is to find out people awareness about health insurance, and
how they perceive & think about the same.
Research Design
Research design is descriptive type. As this project undertakes to study customer
preferences towards health insurance descriptive research design is adopted in the study.
Sources of Data

44

The research plan calls for gathering primary data i.e. data for a specified purpose
as well as taking help from secondary data. The primary data will collect by personal
interview with the help of questionnaire and secondary data will collect from the books
and magazines, journals & internet.
Instrument of Research
In collecting primary data questionnaire is use. Structured questionnaire will prepare
with the help of close-ended question.
Sampling Plan
This decision includes a careful consideration of the following dimensions:
Sample Size
In this research project sample size consist of 100 respondents.
Sample Area
It consist 100 respondents in Hisar city.
Sampling
Random sampling will be used.
Data Collection
The data collection method use for the study is survey through questionnaire method.
Data Analysis
45

After undergoing through the above steps in the research process the last step is to
express finding from the collected data. Data will present in tabular and graphs form. The
statistical tools will use percentage and average.

46

ANALYSIS OF DATA

TABLE 1
ARE PEOPLE AWARE ABOUT HEALTH INSURANCE POLICY
Yes

No

89

11

DIAGRAM

Table no. one depicts that out of 100 peoples those who know about health
insurance policies are 89 & those who are not aware are 11.

TABLE 2
47

TOTAL NO. OF PEOPLES TAKEN HEALTH INSURANCE POLICY

Yes

No

18

82

DIAGRAM

Table no. two depicts that out of 100 peoples those who have health insurance
policies are only 18 & those who have not purchased this policy are 82.

TABLE 3
REASON FOR NOT BUYING HEALTH INSURANCE POLICY
48

Awareness

Funds

Willingness

Any Other

11

61

25

DIAGRAM

Table no., three reveals that out of 100 peoples, many people have not
purchased health insurance policy and it was mainly due to willingness (25
peoples), lack of sufficient information (11 peoples) and lack of funds (61
peoples) & 3 have not purchased due to any other reasons.

49

TABLE 4
DO THEY FEEL THE NEED OF BUYING HEALTH INSURANCE
POLICY
Yes

No

78

22

DIAGRAM

Table no., 4 reveals that out of 100 peoples, 78 people feel the need of buying
policy and 22 did not feel of purchasing of health insurance policy.

50

TABLE 5
SOURCES OF INFORMATION ABOUT HEALTH INSURANCE POLICY
Advertisement

Agents

Relatives

Others

20

74

DIAGRAM

Table no., 5 depicts that what were the sources of information while buying
health insurance policies were or will be? And in this table we can see that 74
peoples have got information from the agents and only 6 from his relatives,
but 20 will get information from the advertisements.

51

TABLE 6
THROUGH WHICH CHANNEL HAVE YOU PURCHASED OR WILL
PURCHASE THIS POLICY
Directly from Co.

Agents

94

DIAGRAM

Table no., 6 depicts that only 6 people are interested I purchasing or

purchased directly from Co. & 94 will purchased or have already purchased
from agents.

52

TABLE 7
FEASIBILITY OF PREMIUM PAID FOR HEALTH INSURANCE
POLICY
Yes

No

82

18

DIAGRAM

Table no.,7 reveals that the 82 persons think that the premium they are paying
is very much feasible for the health insurance policy. Premium is not so high.

53

TABLE 8
ARE THEY SATISFIED WITH THE COMPANYS SERVICES

Yes

No

79

21

DIAGRAM

Table no.,8 tells that 79 people are very much satisfied with the services given
by the company, but 21 are not satisfied by the companys services

54

TABLE 9
HAVE THEY EVER REIMBURSED ANY HOSPITALIZATION
EXPENSES
Yes

No

16

84

DIAGRAM

Table no., 9 reveals that only 16 persons have reimbursed their hospitalization
expenses, they have incurred before.

TABLE 10

55

HOW WAS THE PROCEDURE FOR REIMBURSEMENT

Good

Bad

Moderate

19

23

58

Table no., 10 depicts that out of 100 persons, 19 persons says that the
procedure was good 23 said it was bad & 58 says that it was moderate.

56

WHICH ONE MAJOR HEALTH INSURANCE PLANS ARE YOU AWARE

OF
This questions was framed to know that to what extent peoples are aware
about the health insurance policies. Out 35 persons who know were asked to
fill up this question. And there are more than 30 peoples, those who know two
or more than two health insurance policies. Peoples are more aware about
these policies :1. Personal Accident Insurance
2. Mediclaim Policy
3. Overseas Mediclaim

57

TABLE 11
ARE THEY SEEKING MORE INFORMATION ABOUT HEALTH
INSURANCE POLICY

Yes

No

83

17

DIAGRAM

Table no., 11 shows that out of 100 peoples 17 are not interesting in seeking
more information related to the health insurance policies.

58

SUGGESTION REGARDING HEALTH INSURANCE, IF ANY

Mostly people suggest that

Procedure should be simple.

Premium should be feasible so that every person can purchase it.

There should be more advertisements of these policies.

59

SUGGESTIONS
This is not so much easy task to give findings because before concluding
anything there should be a long research, the research based only on 100
peoples in not sufficient, so considering it in mind I have reached on some
findings. All of these findings are my own perception and knowledge that I
got while completing this research project.
During the completion of the research project report, I have met many
different kind of peoples includes shopkeepers, professors and doctors. And
out of these professors and doctors are known as the most intelligent persons
in the society. The concept of the Health Insurance is very old, it came into
picture in 1694 but the awareness level about the health insurance policies is
considerably very low. I have contacted 100 peoples, out of these 89 are aware
about health insurance policy but only 18 have purchased the health insurance
policy. The reasons may be like these :1. Peoples are not so much health conscious in India.
2. Companies are not promoting health insurance policies.
3. There is no education regarding health insurance.
4. India is not so much rich country, so peoples do not have enough funds to
purchase health insurance policies in fact there are only less than 10
percent population is having life insurance.
5. Peoples those who have enough funds, they do not feel to buy a health
insurance companies.
6. This, health insurance concept can take a generation or more time to get
popular in India.

60

QUESTIONNAIRE (ANNEXURE)
AWARENESS AND PERCEPTION ABOUT HEALTH INSURANCE
HISAR
Qu. 1. General Information
a) Respondents Name

: ____________________________

b) Age

: ____________________________

c) Sex

: ____________________________

d) Education

: ____________________________

e) Occupation

: ____________________________

f) Annually Income

: ____________________________

Qu. 2. Do you know about Health insurance?

a) Yes

[ ]

b) No

[ ]

Qu. 3. Have you purchased any Health insurance policy?

a) Yes

Qu.4.

[ ]

[ ]

If no. then it was due to lack of :a) Awareness

[ ]

c) Willingness
Qu.5.

b) No

[ ]

b) Funds

[ ]

d) Any other ________

Do you know feel the need of buying a Health insurance policy?

a) Yes

[ ]

b) No

[ ]

Qu. 6. If yes, then which companys policy you have purchased?

Please specify ____________

61

IN

Qu. 7. From where doyou get the information about these policies?
a) Advertisements
c) Relatives

[ ]
[ ]

b) Agents

d) Others

[ ]
[ ]

Qu. 8. Through which channel have you purchased this policy?

a) Directly from the company

[ ]

b) Agents

[ ]

Qu. 9. Do you find the premium is feasible?

a) Yes

[ ]

b) No

[ ]

Qu.10. Are you satisfied with the services given by the co.?
a) Yes

[ ]

b) No

[ ]

Qu.11. Have you ever reimbursed the hospitalization expenses done by you?
a) Yes

[ ]

b) No

[ ]

Qu. 12. IF yes, then how was the procedure?

a) Good

[ ]

b) Bad

[ ]

c) Moderate

[ ]

Qu. 13. Which one plans of Health insurance are you aware of?
a) Personal Accident Insurance

[ ] b) Overseas Mediclaim

[ ]

c) Medi Claim Policy

[ ] d) Hospital Cash Daily Allowance [ ]

e) Health Premium Platinum

[ ] f) Group Health Insurance Policy[ ]

Qu. 14. Are you seeking more information about Health Insurance?
a) Yes

[ ]b) No

[ ]

Qu. 15. Suggestion regarding Health Insurance, if any

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

62

BIBLIOGRAPHY

www.irdaindia.org
www.google.com
www.yahoo.com

karhfw.gov.in/.../NATIONAL%20HEALTH%20POLICY%202002

www.medvarsity.com/vmu1.2/st/lp/.../Dr.%20Savitha.html

63