PROJECT REPORT

On
“CONSUMER AWARENESS AND
PRECEPTION ABOUT HEALTH
INSURANCE”

(SUBMITTED IN PARTIAL FULFILLMENT OF THE MASTER’S

DEGREE IN BUSINESS ADMINISTRATION)

Under the Guidance of: Submitted by:

Rinku Kumar
MBA/05/48

MRDAV INSTITUTE OF MANAGEMENT STUDIES

& RESEARCH

(MAHARSHI DAYANAND UNIVERSITY, ROHTAK)

 Acknowledgement

Market survey is now a day becomes very essential for any M.B.A.
program. It exposes the students to real business situations and the
environmental conditions of a business.

I would like to thank who provides me such a platform to prove myself.

This survey project helps me in gaining confidence & market experience
which will be very helpful in future.

I would like to thank all the respondents for their effective response and
their kind help in completing my project.

I also would like to thank our faculty members Ms Seema for their
effective guidance which helped me a lot in the completion of my
project.

RINKU KUMAR
 Preface

For any organization the most important is to earn returns and become
leader of the market. For this any form needs to be consumer oriented
and take care of competition’s it needs to plan its strategy and anticipate
future needs and requirements. The firm needs to take care of the market
changes, environmental condition and latest technology.

Market strategy is a company’s wide philosophy. In order to be

successful, a firm has to follow some strategy. A proper marketing mix is
needed to be designed.

Survey is an essential part of any management program. It is any

essential part of any business. Today business is totally based on
marketing of any organization. It exposes the student to real business
situation and environmental conditions and also about the latest
technology that affects its working. For the students of M.B.A. program,
getting in touch with practical marking practices of companies is must.
Survey helps the students to develop an insight into practical aspects of
industry and to understand the concepts better.
 TABLE OF CONTENT

ACKNOWLEDGEMENT

PERFACE

CONTENTS Page No.

1. EXECURIVE SUMMARY 1-2

2. INTRODUCTION AND CONCEPT 3-54

3. STATEMENT OF OBJECTIVES 55

4. RESEARCH METHODOLOGY 56-58

5. ANALYSIS OF DATA 59-73

6. OBSERVATIONS 74

7. QUESTIONNAIRE 75-76

8. BIBLIOGRAPHY 77
 EXCUTIVE SUMMARY
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.
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-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 expe nses also for-service business model.Sampling plan This is a stage
where the planning is done about the sample units, sample size, sampling procedure, etc.

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.

Peoples are not so much health conscious in India.

Companies are not promoting health insurance policies.

There is no education regarding health insurance.

Life insurance companies are not allowed to sell health insurance policies.
Privatization was done at very late stage.

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.

Peoples those who have enough funds, they do not feel to buy a health
insurance companies.

This, health insurance concept can take a generation or more time to get
popular in India.
 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 Players

Four PSUs and six pvt. Sector players are in the market today.

PSUs : NIC, OIC, UIIC and NIAC

Royal Sundaram

Bajaj Allianz

ICICI Lombard

Cholamandalam

Reliance

Tata AIG
 PUBLIC SECTOR PLAYERS

1. 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)

2. 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)

3. 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. Bajaj Allianz

 Hospital Cash Daily Allowance Policy

 Health Guard Policy

2. Royal Sundaram

 Accidentshield

 Health Shield Insurance

 Group Personal Accident Policy

 Health Premium Platinum

3. ICICI Lombard

 Group Personal Accident Insurance Policy

 Group Health Insurance Policy

4. Chola mandalam

 Travel Health Insurance

 Travel Health Insurance

5. Reliance

 Personal Accident Policy

6. 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.

Risk Classification :

Normal Risk

Bureaucrats, Doctors, Lawyers, Accountants. Architects, Bankers, Consulting

Engineers, Teachers and Persons engaged in administrative functions,
persons primarily engaged in occupations of similar hazard.

Medium Risk :

Builders, Contractors, Engineers engaged in superintending functions only,

Veterinary Doctors. Paid Drivers and Persons engaged in occupations of
similar hazard and not engaged in manual labour.

All persons engaged in manual labour (except those falling under heavy
risk), cash carrying employees, Garge and Motor Mechanics, Machine
Operators, Drivers of Heavy vehicles, Professional Athletes and Sportsmen
and Wood working Machinist and persons engaged in any occupations of
similar hazard.

Heavy Risk :

Persons working in underground Mines, Explosive, Magazines, Workers involved in

electrical installation with High-tension supply, jockeys, Circus personal, persons
engaged in activities like racing on wheels or Horse back, big game hunting,
Mountaineering, Winter Sports, Ballooming, Hang gliding, River Rafting, Polo
playing and persons engaged in occupations/activities of similar hazards.

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.

Group Policies and Group Discount

Group policies can be issued covering more than one person. Group Discount
shall be granted from 5% onwards for groups consisting above 100 persons.
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. Reimbursement of domilciliary hospitalization, for a period exceeding

three days, which would in the normal course require treatement at a
hospital, but is actually taken at home because of the critical condition of
the patient or non-availability of bed in a hospital. Certain named diseases
are excluded under this head. Premium paid for the policy towards self,
spouse, 2 dependent children and dependent parents are exempt from
Income Tax under Sec. SOD of the I.T. Act

3. Cumulative Bonus-Benefits payable will be increased by 5% each claim

free year, up to a maximum of 50% for continuous policy periods only.
4. 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 self-

injury, 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.

 Naturopathy treatment.
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.

Compensation offered

Plan – C Employment & Study (Excluding USA & CANADA)

Age Limit : One month to 60 years

Trip Limit : Minimum 2 months, Maximum 12 months and for renewals

minimum 1 month and maximum 12 months.

Coverage Limit Deductible Medical expenses US $ 75,000 US $ 100.

Plan – D Employment & Study (Including USA & CANADA)

Age Limit : One month to 60 years

Trip Limit : Minimum 2 months, Maximum 12 months and for renewals

minimum 1 month and maximum 12 months.

Coverage Limit Deductible Medical expenses US $ 75,000 US $ 100.

Exclusions

 Any diseases existing/treated prior to one year of commencement of risk

whether declared or not.

 For children aged 5 and under treatment relating to Mumps, chicken Pox,
measles, German measles, spine bifida, whooping cough, Diphtheria,
Poliomyelitis, manumits and scarlet fever.

 Involving travel against medical advice, travel for treatment, terminal

prognosis/awaiting special treatment.]

 Cosmetic surgery, pregnancy related costs, AIDS.

 War perils, nuclear perils

 Suicide or attempted suicide.

 Benefits recoverable under any other policy like motor, WC or public

assistance scheme.

Examination/treatment in India or expenses incurred outside country of

study/postings (This does not prejudice emergency evacuation on medical
grounds)
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.

Compresation :

The daily allowance can be Rs. 500/- Rs. 1000/- or Rs. 2000/- per day as selected by the

insured.

The policy pays for a maximum single hospitalization period of 30 days and on overall

hospitalization period of 30/60 completed days per policy period per person regardless of

the number of confinements to Hospital/Nursing Home per policy period. The option to

be 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. Officially recognized epidemics

5. Suture of skin.

6. Any expense on Hospitalization incurred during first 30 days of insurance

7. Dental treatment or surgery of any kind unless due to Accident requiring

Hospitalization.

8. Procedures concerned with sterilization or infertility.

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

caesarian section.

10. Voluntary medical termination of pregnancy during first 12 weeks from the
date of conception.

11. Drunken driving

12. Birth defects and congenital anomalies or hereditary diseases.

13. Occupational diseases.

14. War and nuclear perils.

15. Naval or military or Air force operations requiring the use of arms.

16. Natural perils like avalanche, earthquake, volcanic eruptions or any kind of
natural hazard.

17. Epilepsy, fits of any kind

18. Any sanatoriums, spa or rest cures or long term care or hospitalization
undertaken as a preventive measure

19. Racing of any kind

20. Sexual dyfunction, transsexual surgery and related services

21. Physiotherapy

22. Weight reduction, improvement/enhancement therapy

23. Connected with aircraft or watercraft or similar craft other than as a fare
paying passenger.

24. Consequential loss or legal liability of any kind.

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.

 Access to 24-hour help lines and free ambulance referral facilities.

 Cover for outpatient treatment in certain cases.

 Discounts on comprehensive health check-up at 6 hospitals in 6 cities.

 Online access to the medical history of the employee and his family

members, information on hospitals, illness and medicines.

Hospital Cash :

A fixed amount of benefit given for each day of hospitalization.

Convalescence Benefit :

A fixd 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.

 Any claim arising out of or traceable to pregnancy.

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

medicatin.

 Alcoholism and drug abuse and AIDS.

 Dental treatment or surgery unless requiring hospitalizatin

 Cost of spectacles, contact lenses and hearing aids.

Other Extra Benefits :

The following benefits are offered on payment on additional premium

based on claim track record and age profile of the company.

 Inclusion of maternity benefits

 Waiver of 30 day waiting period

 Waiver of first year exclusions

 Hospitalizatin cover :

Employees are covered for all in-patient hospitalization expenses in case

of accidents/illness covered under the policy up to the amount of the sum

insured that you choose. The stay in the hospital should be for more than

48 hours.

Pre and post hospitalization expenses :

All relevant medical expenses incurred 30 days prior to hospitalization

and expenses incurred during 60 days after hospitalization part of the

claim.

Out patient care :

In certain cases such as kidney stone removal, tonsilectomy, eye surgery and

D & C outpatient treatment expenses are also covered.

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 upto 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
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.

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 person’s 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
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.
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.
Publicly Funded medicine
Many countries have made the societal choice to avoid this important
conflict by nationalizing the health industry so that doctors, nurses and other
medical workers become state employees, all funded by taxes; or setting up a
national health insurance plan that all citizens pay into with tax or quasi-tax
payments and which pays private doctors for health care. These national
health care systems also have their problems. Some of these countries have
citizen groups which protest bureaucracy and cost-cutting measures that
unduly delay medical treatment. Similar issues exist with private health
management insurances (HMO) in countries with privately funded medicine.

One result of a mixed system is that insurance for alternative private care
is greatly reduced, as basic needs are met by the NHS. Many choose to have
private care only where it suits (such as to avoid waiting time or improve the
facilities they have access to in a hospital stay). Some proponents of such a
private system claim the benefits of coexisting with nationalized system
compared to countries where it is almost exclusively private except for the
very needy (as in the United States) in that they can enjoy the benefits of
private healthcare but not have to worry about providing the costs of more
basic needs; not have to pay for children; and have a system to fall back on
when they have a chronic illness which would be excluded from a private
policy.

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
insured’s 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 self-
employed 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 employee’s 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.
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 don’t 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 insured’s 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.

Common complaints of publicity funded medicine

1. Price no longer influences the allocation of resources, thus removing a

natural self-corrective mechanism for avoiding waste and inefficiency.

2. Health care worker’s pay is often not related to quality or speed of care.
Thus very long waits can occur before care is received.

3. Because publicly funded medicine is a form of socialism, many of the

general concerns about socialism can be applied to this discussion.

4. People are afraid that they cannot choose their own doctor. The state
chooses for them.

5. Countries which have publicly funded medicine don’t do as much medical

research and development as there is very low payoff to developing new
drugs and medical techniques.
 Review of literature
What is cashless hospitalization all about?

In about two months from now cashless hospitalization is all set to become a
reality and playing a major role in health insurance will be third party
administrators (TPAs) who will take the plunge into insurance once the required
tie-ups are finalized.

About 14 TPAs have received their licences for three years commencing
March 21, 2002, to March end 2005. These include the Mumbai-based Parekh
Health Management Pvt. Ltd, Paramount Health Services Pvt. Ltd and Tower
Insurance Services Pvt. Ltd. Delhi-based – E Meditek Solutions Ltd and Universal
Medi-Aid Services Ltd. And several others such as the Bangalore-based Medi
Assist India Pvt. Ltd, Guardian Health Mangement Pvt. Ltd, the Hyderabad-based
Dawn Services Pvt. Ltd and Family Health plan Ltd., the Kolkat-based Medicare
TPA Services (I) Pvt. Ltd. And Heritage Health Services Pvt. Ltd, the pune-based
MD India Healthcare Services Pvt. Ltd. And ICAN Health Services Pvt. Ltd. And
the Goa-based Medicare Foundation Pvt. Ltd.

So what is cashless hospitalisation all about? Cashless hospitalization means

as a Mediclam policyholder one will not have to run around paying off the hospital
bills and getting a reimbursement later. On the contrary the policy holder will be
able to avail of medical services at designated hospitals and his bills will be settled
through TPAs (third party administrators) who will additionally offer a 24 hours
toll free helpline, access to physicians, specialties, diagnostic centers and
ambulance services.

So far about 10 out of 14 TPAs have already been short listed by state
insurers and the fee for the some has been set at 5.5 per cent for the north and
south zones while for the east and west zone it is 5.4 per cent. In case of private
insueres the fee set is around 10 to 11 percent.

Aimed largely at mediclaim policyholders who constitute about 99 percent, such

developments in the Rs 500 crore health insurance sector it is hoped will reduce the rising
claim ratio that has turned out to be a drain on the finances of general insurers
all these years.

“But says Nayan Shah, Managing Director, Paramount Healthcare

‘claim ratios instead will go higher. How do state insurers expect TPAs to
bring down claim ratios when there are finer details that are to be sorted out.

“Merely flashing an identity card will not enable the policyholder to

avail of medical services. The policyholder will have to firstly get a pre-
authorization letter that will guarantee payment of the bills to the TPA from
the insurance company.

“Besides how will TPAs be able to ascertain whether the policyholder

ahs bought cover for the treatment he needs to undergo.”

It is not as simple as flashing an identity card because every

policyholder would invariably want to go for the best room available and the
best tratment that he can get.

But certain bars need to be applied depending on the size of policy of

the insured A TPA can in no way interfere in the administration of treatment
nor can the insurance company since it is not a part of the contract. So when a
mediclaim policyholder walks in for treatment, and opts for a room that’s
highly priced who can stop him?

Also how can we at out end ascertain the finer policy details such as
policy amount, his coverage of illnesses etc. These issues need to be sorted
out.

TPAs also find the fee structure unfeasible-providing a toll free 24 hours
helpline in addition to other services for a paltry fee of 5.5 percent would not
be feasible at all and hence TPAs are looking forward to further negotiations
to rework the same. In any case for Mediclaim policyholders truly times – are
a changing from the days of yore to cashless transactions.
A new breed of TPAs

The Rs 500 crore health insurance market is all of a sudden seeing a

lot of activity. A new breed of Third Party Administrators (TPAs) will now
enter the insurance scenario to play the role of intermediaries to facilitate
insurance distribution in addition to the other services they offer.

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
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 over-

treatment, 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.

 Role of TPA’s

As per the regulations worked out by Insurance Regulatory Development

Authority (IRDA) a clubbed fee would be charged from the insurer, who
will also be the sole bearer of the financial risk. Each TPA would need
to have and maintain assets worth at least Rs. 25 lakh. This may be
doubled later to avoid frivolous players entering the market. TPAs will
also need to take insurance policies for at least Rs 1 crore to cover their
own business risks.

There are a number of TPAs functioning in different parts of the country,

but these at present cater solely to corporate clients.

 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.

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.

Good Healthcare Solutions – a necessity

The improvements in our health delivery system in the last 50 years have
not kept pace with the needs of a majority of our people. A major reason for this
has been that health services respond to the existing “market demand” and needs
of a majority of the people do not figure as part of this demand.
Inadequate resources

This is compounded by inadequate resource allocation and inequitable

distribution of such resources with a clear bias for urban centers. There has been
little effort to sustain investment to build our healthcare infrastructure. To be
fair, periods of stagnation have been punctuated by sporadic efforts to enhance
public health funding like the National TB and Malaria programmes of the fifties
and sixties and the Primary Health Care Programme in the late seventies and
early eighties.

However even in these cases, most of the gains were frittered away as the
matching investment did not support the initial infrastructure created. The fallout
of the new policies was a cut in budgetary support to the health sector. Cuts were
severe in the first two years of the reforms, followed by some restoration in the
succeeding years bringing them to the levels of the pre-reform period.

Limited funds

The compression of funds has a number of far reaching effects.

Expenditure on salaries and infrastructure constitutes 70-90 percent of
expenditure for most programmes. Faced with limited funds while salaries and
infrastructure still require to be maintained, the burden of cutbacks is placed on
supplies and materials. Ultimately a skeletal structure survives. Today,
prescriptions for restructuring of the health sector are designed to maximize
outputs from greatly reduced government support. At 212 percent, the
government’s share of the total expenditure on health care is one of the lowest in
the world. It may be contrasted with 70-80 percent in North Europe and 44
percent in the US.

Privatization

The government’s new-found fascination with health insurance is designed to

facilitiate privatization of the health sector. Wary that a total collapse of the public health
insfrastructure would also affect the more vocal sections of the people the elite and the
middle class health insurance is seen as a useful ploy to replace the state health sector.
 But such a system addresses the needs of a small fraction because when the state
today talks of health insurance, it means private health insurance. All countries with a
developed health care infrastructure have health insurance, but in most the major share is
made up of by state supported health insurance.

Government’s 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 :

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 :

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.

Women’s role :

Awareness building and empowerment of women through income

generation projects and literacy activities can help to a large extent.

Privat 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.

From curative to managed care

Increase in capital flows, better medical equipments are few of the features
the opening of the insurance sectors holds.

The opening up of the insurance sector will not only increase the number of
people covered by health insurance but will also increase capital flows into this sector
for increased hospitals, better medical equipment etc.

With all this, will come intermediaries like services providers and other
intermediaries like health management organizations. Preferred provider organization.
Third party administrators etc. who would not only assist in increasing the coverage
but also in medical services improving the quality of overall.
 Another change that will come about with the opening up of the sector is the
transition of healthcare from curative to managed care. While pure health care
concentrates on the curative, managed care goes into the aspects of both curative and
preventive healthcare.

Managed care :

The concept of managed care has its roots in the scenario of rising medical
costs and preference for preventive health care by individuals. Managed health care
benefits the insurance companies in two ways. First, by virtue of an almost assured
usage for preventive care, it allows them flexibility to negotiate discounted price
structure with service providers and second in the long term as overall claims cost go
down substantially.

Managed care plans are so popular in the US that they now employ more than
70 percent of all the physicians in the country. Private health insurers will however
target only the affluent section of the society. It remains the responsibility of the
government to ensure that the underprivileged section of its population also has
effective access to healthcare. Given its budgetary constraints, the government
requires to have an effective financing mechanism that ensures that the section of its
population who can afford to pay for healthcare, does so, and at the same time there
exists a safety net for the poor.

It is in this context that an effective social insurance system where mandatory

earmarked taxes are collected from its members provides a good channel to shift a
portion of the public burden of financing health care to the private sector.

A number of countries in Asia like Kore4a, Malaysia, Indonesia,

Thailand have either already implemented or are actively considering
introducing social insurance. In the Indian context there are a number of ways
of mobilizing private resources through social insurance to reduce the
financing burden of healthcare on the government and at the same time
ensuring that the poor and indigent are not deprived of healthcare.
 Mandatory social insurance for people employed in the organized sector, with
appropriate contributions from government, employees and employers.

 Community insurance for rural populations operated at the ‘Panchayat Samiti”

levels.

 Voluntary social insurance to be encouraged for people who are employed in the
unorganised sector.

With the growth of health insurance, the entire structure of the health
industry with the delivery mechanism, quality standards and regulations is
likely to undergo a great change leading to the entire system becoming more
customer focussed. It however needs to be ensured, through legislation that
the cost of healthcare delivery must be kept under control and not allowed to
balloon up, as has been the unfortunate experience of some countries like
Korea.
So, next time one has to get a patient admitted into a hospital in an
emergency, it may no longer be necessary to scramble to collect money to pay
the deposit, call up influential people to arrange for a hospital bed and to
stand in various queues to finish the lengthy paper work before the patient is
admitted. All one may have to do is to carry the identification card provided
by the insurance company, go to a designated hospital and get the patient
admitted.

Moral Hazards within the health insurance sector

The subject of moral hazard inevitably pops up as a reflex when health

insurance is mentioned, be it within IRDA or the foreign insurers’ offices. An
insurance glossary would classify “moral hazard” as the low level of morality
posed by people to its business.

Moral hazards understandby are preventing most global insurers from

entering the health insurance sector in India. Everything from prescriptions to
hospital bills can be fabricated here for a small consideration. And the average
Indian’s mindset that desires instantaneous returns for investment only
compounds the issue beyond sustainable belief.

All an average citizen has to do is pick up a set of facked papers from

his friendly neighbourhood nursing home after a couple of months of paying
his policy premiums and the acrhetypal immorality silhouette develop itself.
The health care and drug dispensation system is so undisciplined in India that
even a toddler can pick up prescription drugs over the counter.

The new insurance companies obviously do not wish to invest their paid-
up capital funds amounting to Rs. 100 crores in such an unregulated scenario.
After spending almost another equivalent amount on the infrastructure, they
also have to wait several years before being able to avail of any returns.

Under Indian law, the insurers will also have to wait for seven years
before they can repatriate any of the profits. Even if they are able to shoulder
the burden, the potential for fraud is simply too large to be ignored. Perhaps,
this is one of the key reasons why despite the opening up of the insurance
sector, few multinational companies have shown interest in health insurance.

Most of the Western insurance companies had set up their offices in India
and started scouting for prospective partners as well as conducting market
research much before the privatization of the insurance industry became official.
Royal and Sun Alliance, Standard Life, All State Insurance, Commercial Union
and Canada Life of Canada besides a Dutch Company, LNG are among those
already here. Yet, none of them is interest in the health sector.

Cigna is a US based company that has operations in 25 countries boasts of

assets of $100 billion and specialises in accident, disability and health insurance.
It is the only one that is here to enter the health segment. Under the mandatory
“social clause” inserted in the IRA, preference will be given to companies
investing in healthcare.
 Moral hazards, apart, the potential size of the health insurance market is
proving too elusive to assess. The magic figure of the 300 million-strong middle
class in India as estimated by the National Council of Applied Economic
Research (NCAER) is a strong lure.

But a realistic assessment of the market will take several other factors into
account. Government and public sector employees provide a substantial chunk of
this middle income group and they are already covered by health schemes of
their own. The General Insurance Company, the only public sector company
dealing in non-life insurance in India has managed to tap just a tiny fraction of
this potential market.

The total number of Mediclaim policyholders does not exceed 2.5 million
and even this includes GTC employees and their dependents for which health
insurance is part of services benefits. While it has some of the lowest premiums
in the world, Mediclaim has a very narrow coverage. It excludes all out-patient
department (OPD) treatment, dental care, pregnancy, childbrith, fertility
treatment and any pre-existing disease like asthma, hypertension, etc.

Any hopes that the policies designed by private companies will be more
attractive than the Mediclaim policy available now are dashed with Cigna’s
decision to stay away from insuring OPD treatment. For inpatient treatment, they
hope to enter into tight contracts with healthcare providers. Under such contracts,
physicians will have to surrender mush of their autonomy to insurance companies
and every activity in the nursing home will be watched over by company
executives, including medical professionals on their payrolls.

Insurance companies also plan to evolve their own standards to judge

nursing homes. Apparently, only 130 of the more than ,1300 nursing homes in
Delhi are registered. Systematizing the healthcare system will be an important
function of insurance companies. As partners in the healthcare managing
system, they will have systematize the haphazard medical system, also
standardize nursing homes and ensure good care at optimum costs.
 Most of the time, when a specialist realizes the patient is insured, he
goes overboard with tests and procedures. Insurers plan to keep a tight leash
on this tendency. Being part of this insurance network may mean that the
policyholder may be spared unnecessary and invasive procedures but it also
means the company will choose the physician or surgeon.

Policyholders are free to go to a nursing home that is not on the

insurer’s panel but then the insurer will decide how much of the cost of the
treatment will the insurer bear. But if a policyholder goes to a nursing home
on the insurer’s list, all the costs and procedures will be taken care of.

Experts are more worried about the consequences of a wider spread of

the private insurance network in India. The upshot will be that most doctors
will be happily opening nursing homes instead of slogging in government
hospitals but the poor will be worse off. Studies estimate that private
expenditure on healthcare is nearly 10 times higher than government
expenditure.

Private insurance companies will also extend loans to small clinics for
up gradation and expansion and then start dictating terms and conditions to
them. The company will then decide how long patients stay in the nursing
home and what their course of treatment should be. The very notion of
authorization by a company in matters medical raises several doubts.

Decision making in Medical Insurance arrangements

For Life Insurance, the premium at a certain age is based on actuarial science, making
use of the probability of survival. However in other fields, there is little awareness of
the data available for use. The result is that most often a semi-intuitive approach is
adopted if not resorting to arbitrariness.

It is not that made-to-order sets of data are ready at hand for use by the insurers. On the
other hand, there is a multiplicity of data sources capable of giving only a dimensional
idea of the issues involved but a deft handling may provide some rational choice of
fixing of premium. There is virtually no effort by insurers to contact the agencies
responsible for collecting data on social and economic aspects.

This indifferent attitude is matched by occasional pronouncements by political stalwarts

of launching any scheme while remaining quite oblivious of the exisiting data Medial
Insurance, for instance is much talked about but examined only cursorily.

Except for the Central Government Health Services and the Employees State Insurance,
only the Mediclaim Policy of the GIC has an upper class urban bias added to the fact
that the success story remains unproven.

The Mediclaim is solely oriented towards hospitalisation, there being too many
preconditions for domiciliary hospitalization to be utilized by the consumers. Besides
leading unnecessarily to use of hospitals, this scheme provides for a lower premium to
benefit ratio for higher premium categories relative to the lower ones making it more
attractive to the rich.

It is clear that such a scheme is bound to have a very limited clientele and must be
supplemented by other schemes relevant for a wider populace. One such scheme to
benefit vulnerable sections of society was announced in the budget proposals of 1996-97.

The Jan Arogya was to have been started by the GIC as a medical insurance cover of
Rs. 20,000/- a year to a family of four for an annual premium of Rs. 240/- For an
individual, the insurance cover would be Rs. 5000/- for an annual premium of Rs. 70/- It is
not know whether the scheme is in operation or how successful has been the
attempt. Going by the indicative dimension of prevalence of morbidity, the
condition indicative of disease (annual morbidity rate of 77 percent and 37
percent respectively for rural and urban sectors) the scheme might not have
covered all types of morbid conditions.

A flat rate of premium as enunciated carries little sense given the wide range
of disaparities in availability and access to health care services and the cost of
treatment in rural and urban areas. Further, it is not clear whether the intention
is to neutralize fully the cost of treatment or set a limit to the expenditure in
monetary terms via the sum assured covering only a part of the cost.

On all counts it is imperative that the existing inforation on the vulnerable

section be utilized to look into the feasibility of the scheme. Certain variables
would assist in examining the implications of wider coverage of Jan Arogya.

 Number of outpatients sand inpatients for rural and urban sectors

 Annual morbidity rates for rural and urban sectors

 Monthly per capita expenditure by percentile groups

 Cost of treatment for outpatients and inpatients by percentile groups

 Proportion of ailing persons getting treatment in rural and urban sectors

 Proportion of outpatients exempted from payment for treatment at public

hospitals

The results of the 42 nd round (1986-87) of the NSSO (National Sample Survey
Organiszation) in particular on morbidity and of other rounds on household
consumer expenditure examine these issues in depth.

The NSSO Report No. 397 gives the percentile values of monthly per capita
expenditure (MPCE) for the 20 th a, 50 th and the 80 th percentiles for the year 1992-92.
Using the series 43 rd to 48th rounds the average annual rates of increase for the rural
and urban sectors help us in arriving the respective MPCE for 1995-96, the direc t
estimates for which were not available (the year 1995-96) was selected as the
budget proposals were made in 1996-97 when the latest NSSO report was
Report No. 397)

Percentile MPCE (RS.) Annual Premium (RS.)

Rural Urban Rural Urban

20 th 190 264 45.60 63.36

50 th 277 428 66.48 102.72

80 th 434 745 104.16 178.80

The budget indicated an average premium of Rs. 70 for individuals for the country as a
whole. As a first approximation, the premium can be fixed at 2 percent of the annual per
capita expenditure because the average for the poor and the lower middle class (20 th and
50th) for rural and urban sectors comes out to be Rs. 69/- The variation in annual premium
across the sectors and strata is to be noted for policy formulation.
The cost of treatment appears to be a meaningful variable for determining the premium
and as the cost differs substantially between acute and ordinary conditions of morbidity,
the existing information from NSSO could profitably be used. The cost of treatment for
the present purpose is taken to be the amount paid to the health care institutions
excluding transport expenditure, special diet and other miscellaneous cost components.

Fractile group Cost of treatment (RS.) at ‘95’96 prices

Urban Rural Urban

10-20 88 785 881

40-50 85 987 1395

70-80 222 1099 2214

The case for separate premium for outpatients and inpatients is as evident as it
is for the rural and urban sectors. However, the 2 percent premium arrived at
for the sectors is proportionate to the cost of treatment separately for the
outpatients and inpatients.

Fractile group Percentage of premium to the cost of treatment

 Urban Rural Urban

10-20 71 6 7

40-50 121 7 7

70-80 81 9 8

This clearly shows the inadequacy of a flat rate of premium for the two conditions of
morbidity. The policy implication for the insurers is to bring down sustantially the
premium for outpatients and raise the one for inpatients. There is no worthwhile
difference in the sectors for the inpatients which implies uniform rates for the rural and
urban sectors. On the other hand, the premium rates for the urban sector within inpatients
should be lower than the rural sector at least at for the poorer sections.
Extent of Health Dilemma

Under certain assumptions on prevalence of morbidity in the country and the proportion of
ailing persons getting treatment in rural and urban sectors based on NSSO results and of
estimated population in the sectors based on the results of the Population Census 1991, the
estimated number of episodes during 1995-96 categorized by outpatients and inpatients is

Sector Estimated number of episodes in millions

Inpatients Total

Rural 17.31 450.17

Urban 3.17 82.51

Total 20.48 532.68

The above shows the huge dimension of the health problem as it was in ‘95-96. No
amount of financing can take care of it. It also points out the possible limitations of other
health insurance schemes, if launched over and above the Mediclaim policy. The sheer
numbers are frightening.

Financial implication of insurance cover for the poor

Obviously, a crude average premium of Rs. 70 and sum assured of Rs. 5000
are meaningless. The ramifications of the variegated pattern of morbidity are
to be taken into account. Since no worthwhile data are available on the
coverage of the existing schemes and more so on the proportion of the
claimants.

Assumptions

Two values 0.5 and 0.8 of the ratio of the number claimed to number covered
for the outpatients. For inpatients this ratio is taken as unity. 50 percent of the
inpatients opt for cover while the maximum value of this ratio for the
outpations could be 20 percent. The sum assured and the premium both are
scaled down the outpatients and moved up for the inpatients.

Proportion Sum Premium No. ClaimedNet

Opting for Assured (Rs.) covered Liability

Cover (RS.) (Crores)

Outpatients 0.2 Rural` 2500 60 0.5 4565

0.8 7962

0.2 (urban) 2000 50 0.5 535

0.8 921

Inpatients 20000 1000 1.0 9728

0.5 14828

0.8 18197

The number of rural and urban outpatients in the 0-50 fractile groups is estimated as the
total projected population multiplied by annual morbidity rate specific for the fractile
group adjusted for the proportion of the ailing population getting treatment. An estimated
69 million rural outpatients and 22 million urban outpatients and roughly 5 million
inpatients for the country as a whole (with the assumptions stated earlier) are taken into
account for computation of the net liability.
Roughly Rs. 18000 crores at 95-96 prices are needed to finance the insurance scheme for
the bottom half of the populations even with low values of the sum assured. Obviously
the Jan Arogya scheme would have serious financing problems unless some innovative
measures are adopted and the possibility of levy of universal health tax explored to garner
the needed revenue combined with screening of items of coverage for insurance. Since
the morbidity rates differ substantially for “sex x age x occupation” categories, the net
liability could further be reduced by excluding the very old and the children below five
from the coverage.

Conclusion

National Health Insurance is a utopian idea, perhaps similar to “Health for All by
2000 A.D.” The financial implications rule out inclusion of outpatients from the ambit of
insurance. Moreover of the exclusion of outpatients from the insurance framework would
reduce the hassles of administering and its cost. However, a part of the outpatients
importantly the elderly should be considered for inclusion.

Paradoxically, the welfare objective of exempting bulk of the population from payment at
public hospitals has only delayed bringing in of the insurance mechanism needed at this
moment as an alternative means of financing instrument. It is not a big deal for the
insurers nor the insured feel interested so long as free services are doled out.

Insurance for the acute conditions that is those requiring hospitalisation is possible as an
extension of the Mediclaim adopting such steps as would rid the scheme fo the urban bias
and its attractiveness for the rich. The possibility of adopting some innovative measures
is to be explored to raise additional revenue for an insurance fund and/or to collect annual
membership fees in lieu of certain health services from the Panchayats on the lines of the
Chinese cooperative medical services for the rural peasants.

.
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 India’s 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 India’s 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,
every family spends up to 10% of annual household consumption towards
healthcare needs.
Health Insurance :
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
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
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
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

 Objectives

 To study the awareness level among customers towards health

insurance.

 To study different health insurance available in the market.

 To study the market potential for health insurance.

 To study the reason that why people are not willing to buy health
insurance.

 To study the channel available in the market for Health insurance

policy.
 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.

DATA SOURCE

The data that is collected from sources, as the first hand information,
which is called as primary data. The sources of primary data for my
research were the doctors and engineers. The secondary data is that, that
was collected the problem other than the hand, is also collected and used
from the internet.
RESEARCH APPROACH

The required information in the form of data is collected through survey method,
with the help of personal interview through questionnaire.

RESEARCH INSTRUMENT

Once the source of data collection is decided then comes the instrument for data
collection or the research instrument. In this survey method a questionnaire was framed
and various type of respondents were asked to report, which includes.

1. Advocates

2. Doctors

3. Shopkeepers

SAMPLING PLAN

This is a stage where the planning is done about the sample units, sample size, sampling
procedure, etc.

a) Sample Units :- This means, who is to be surveyed. So as mentin earlier that

sample units are—

1. Advocates

2. Doctors

3. Shopkeepers

b) Samplie Units :- The sample size means how many peoples should be surveyed. So
the toal sample size is 100 which consists of 25 Advocates, 25 Doctors and 50
Shopkeepers.

C) Sampling Procedures :- I went to the court to contact with the Advocates, I have
visited some nursing homes to get questionnaires filled by the Doctors and I met
Shopkeepers at their shops to get the information regarding the health
insurance policies.

c) Contact method :- Personal interview method is used for collection of

primary data is form of questionnaire from respondents. These are arranged
type of interviews from all groups at their offices, nursing homes and
shops.
 TABLE 1

PEOPLES AWARENESS ABOUT HEALTH INSURANCE

Frequency

Occupation yes No Total

Shopkeepers 8 42 50

Advocates 11 14 25

Doctors 16 9 25

Total 35 65 100

Diagram

Table no one shows that there were 50 shopkeepers out of these only 8 knows
about health insurance, out of 25 advocates only 1 are aware about health
insurance and out of 25 doctors there were only 16 have heard about the
health insurance policy. So the awareness level is very low.
 TABLE 2

TOTAL NO. OF PEOPLES TAKEN HEALTH INSURANCE

POLICY

Frequency

Occupation yes No Total

Shopkeepers 1 7 8

Advocates 1 10 11

Doctors 2 14 16

Total 4 31 35

Diagram

Table no. two depicts that out of thirty five peoples those who know about
health insurance policies only four have purchased the health insurance policy.
This includes one shopkeeper, one advocate and two doctors only.
 TABLE 3

REASON FOR NOT BUYING HEALTH INSURANCE POLICY

Frequency

Occupation Willingness Information Funds Total

Shopkeepers 4 2 1 7

Advocates 8 2 0 10

Doctors 10 3 1 14

Total 22 7 2 31

Diagram

Table no., three reveals that out of thirty five peoples, thirty one have not
purchased health insurance policy and it was mainly due to willingness (22
peoples) , lack of sufficient information (7 peoples) and lack of funds (2
peoples).
 TABLE 4

NOW, ARE THEY WILLING TO BUY HEALTH INSURANCE

POLICY

Frequency

Occupation yes No Total

Shopkeepers 1 6 7

Advocates 0 10 10

Doctors 2 12 14

Total 3 28 31

Diagram

Table no., four tells that out of thirty one peoples only one shopkeeper, none
from the advocates and two from the doctors are now willing to purchase a
health insurance policy and the rest twenty eight are not feeling to buy.
PEOPLES THOSE WHO HAVE PURCHASED THE HEALTH INSURANE
POLICY

There were only four persons those who have taken health insurance policies.
One doctor and shopkeeper have taken policies from National Insurance
Corporation and another doctor has taken from Oriental Insurance Corporation
and the advocate has a policy, he has bought from National India Assurance
Corporation. All the plans are related to personal Accident Insurance.
 TABLE 5

PEOPLES AWARENESS ABOUT TAX BENEFIT RELATED TO

HEALTH INSURANCE POLICY

Frequency

Occupation yes No Total

Shopkeepers 1 0 1

Advocates 1 0 1

Doctors 2 0 2

Total 4 0 4

Diagram
Table no., five shows that one shopkeeper, one advocate and two doctors
means all those who have purchased health insurance policy know about the
tax benefit related to the health insurance policies.
 TABLE 6

SOURCES OF INFORMATION ABOUT HEALTH INSURANCE

POLICY

Frequency

Occupation Agents Relatives Advertisements Total

Shopkeepers 1 0 0 1

Advocates 1 0 0 1

Doctors 1 1 0 2

Total 3 1 0 4

Diagram

Table no., six depicts that what were the sources of information while buying
health insurance policies. And in this table we can see that three peoples have
got information from the agents and only from his relatives, but none of them
got information from the advertisements.
 TABLE 7

THROUGH WHICH CHANNEL THEY HAVE PURCHASED

THE HEALTH INSURANCE POLICY

Frequency

Occupation Agents Directly from co. Total

Shopkeepers 1 0 1

Advocates 1 0 1

Doctors 1 1 2

Total 3 1 4

Diagram

Table no., seven shows that through which channels peoples have purchased
the health insurance policies and three out of four persons bought through the
agents and only one doctor have bought directly from the company.
 TABLE 8

FEASIBILITY OF PREMIUM PAID FOR HEALTH

INSURANCE POLICY

Frequency

Occupation yes No Total

Shopkeepers 1 0 1

Advocates 1 0 1

Doctors 2 0 2

Total 4 0 4

Diagram

Table no., eight reveals that the four persons including one shopkeeper, one
advocate and two doctors, think that the premium they are paying is very
much feasible for the health insurance policy. Premium is not so high.
 TABLE 9

ARE THEY SATISFIED WITH THE COMPANY’S SERVICES

Frequency

Occupation yes No Total

Shopkeepers 1 0 1

Advocates 1 0 1

Doctors 1 1 2

Total 3 1 4

Diagram

Table no., nine tells that one shopkeeper, one advocate and one doctor is very
much satisfied with the services given by the company, but only one doctor is
not satisfied by the company’s services.
 TABLE 10

HAVE THEY EVER REIMBURSED ANY HOSPITALIZATION

EXPENSES

Frequency

Occupation yes No Total

Shopkeepers 0 1 1

Advocates 1 0 1

Doctors 1 1 2

Total 2 2 4

Diagram

Table no., ten reveals that only two persons including one advocate and one
doctor have reimbursed their hospitalization expenses, they have incurred
before.
 TABLE 11

HOW WAS THE PROCEDURE FOR REIMBURSEMENT

Frequency

Occupation Good Bad Moderate Total

Shopkeepers 0 0 0 0

Advocates 0 0 1 1

Doctors 0 1 0 1

Total 0 1 1 2

Diagram

Table no., eleven depicts that out of four persons, two have reimbursed their
hospitalization expenses, and advocate says that the procedure was moderate,
but doctor says that the procedure was bad. No one said that the procedure for
reimbursing the expenses was good.
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. Group Health Insurance Policy

4. Hospital Cash Daily Allowance

 TABLE 12

ARE THEY SEEKING MORE INFORMATION ABOUT

HEALTH INSURANCE POLICY

Frequency

Occupation yes No Total

Shopkeepers 2 5 7

Advocates 2 8 10

Doctors 3 11 14

Total 7 24 31

Diagram

Table no., twelve shows that out of thirty one peoples those who know a little
bit about the health insurance policies, twenty four peoples including five
shopkeepers, eight advocates and eleven doctors are not seeking more
information related to the health insurance policies.
 OBSERVATION

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.

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. Life insurance companies are not allowed to sell health insurance policies.

5. Privatization was done at very late stage.

6. 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.

7. Peoples those who have enough funds, they do not feel to buy a health
insurance companies.

8. This, health insurance concept can take a generation or more time to get
popular in India.
 QUESTIONNAIRE (ANNEXURE)

“STUDY OF CONSUMER AWARENESS AND PERCEPTION ABOUT

HEALTH INSURANCE”

Respected sir/madam,
I am sweety kukreja, pursuing M.B.A. (final year) . I am doing a research project on
“consumer awareness and perception about Health Insurance”, so while giving
information please be true and fair, this will be remain confidential an used only for the
academic purpose.
Thanking You
General Information

a) Respondent’s Name : ____________________________

b) Age : ____________________________

c) Sex : ____________________________

d) Education : ____________________________

e) Occupation : ____________________________

f) Annually Income : ____________________________

Qu. 1. Do you know about Health insurance?

a) Yes [ ] b) No [ ]
Qu. 2. Have you purchased any Health insurance policy?
a) Yes [ ] b) No [ ]

Qu.3. If no. then it was due to lack of :-

a) Awareness [ ] b) Funds [ ]
c) Willingness [ ] d) Any other ________
Qu.4. Do you know feel the need of buying a Health insurance policy?
a) Yes [ ] b) No [ ]
Qu. 5. If yes, then which company’s policy you have purchased?
Please specify ____________
Qu. 6. Do you know any tax benefit related to the Health insurance policy?
a) Yes [ ] b) No [ ]
Qu. 7. From where doyou get the information about these policies?
a) Advertisements [ ] b) Agents [ ]

c) Relatives [ ] 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 [ ]
 BIBLIOGRAPHY

 www.irdaindia.org
 www.google.com
 www.yahoo.com
 IRDA Journal