Project Report

On
Study of Growth of Healt Insurance Provided by HDFC

SEMESTER-VI

A Project submitted to

University of Mumbai for partial completion of the degree

Of Bachelor in commerce (Accounting and Finance).

Under the Faculty of commerce

By

Dipali Suresh Bavdane

Roll No: 119

Under the Guidance of

Mrs. Preety Upadhyay

K.M AGRAWAL COLLEGE OF ARTS, COMMERCE AND SCIENCE

GANDHARI, KALYAN (W).

2023-2024
 Project Report
On
Study of Growth of Healt Insurance Provided by HDFC

SEMESTER-VI

A Project submitted to

University of Mumbai for partial completion of the degree

Of Bachelor in commerce (Accounting and Finance).

Under the Faculty of commerce

By

Dipali Suresh Bavdane

Roll No: 119

Under the Guidance of

Mrs. Preety Upadhyay

K.M AGRAWAL COLLEGE OF ARTS, COMMERCE AND SCIENCE

GANDHARI, KALYAN (W).

2023-2024
 DECLARATION BY LEARNER
I, the undersigned Miss Dipali Suresh Bavdane hereby, declare that the
work embodied in this project work titled Study of Growth of Healt
Insurance Provided by HDFC forms my own contribution to the
research work carried out the guidance of Mrs. Preety Upadhyay is a
result of my own research work and has not been previously submitted to
any other University for any other Degree/ Diploma to this or any other
University.

Wherever reference has been made to previous works of others, it has been
clearly indicated as such and included in the bibliography.

I, here by further declare that all information of this document has been
obtained and presented in accordance with academic rules and ethical
conduct.

Name and Signature of the learner

Certified by

Name and signature of the Guiding Teacher

 K. M. AGRAWAL COLLEGE.
GANDHARE, PADGHA RD, KALYAN (W) 421-301, DIS- THANE
CERTIFICATE

This is to certify that Miss. Dipali Suresh Bavdane has worked and duly
completed her/his project work for the degree of Bachelor in Commerce
under the faculty of commerce in the subject of Accounting
and her project is entitled Study of Growth of Healt
Insurance Provided by HDFC" under my supervision.
I further certify that the entire work has been done by the learner under
my guidance and that no part of it has been submitted previously for any
Degree or Diploma of any University.
It is her own work and facts reported by her personal finding and
investigations.

Name and Signature of Internal Examiner :

Guiding Teacher
Mrs. Preety Upadhyayri

Coordinator : External Examiner :

Mr. Mahendra Pandey

Self Finance In charge :

Mr. Sujeet Singh

Principal :
Date of Submission : Dr. Anita Manna
 ACKNOWLEDGEMENT

To list who all have helped me is difficult because they are so numerous and the
depth is so enormous.

I would like to acknowledge the following as being idealistic channels and fresh
dimensions in the completion of this project.

I take this opportunity to thank the University of Mumbai for giving me chance to do this
project.

I would like to thank our principal Dr. Anita Manna (Education) and the Principal
for providing the necessary facilities required for the completion of this project.

I take this opportunity to thank our Coordinator, Mr. Mahendra Pandey & Self-
finance In charge Mr. Sujeet Singh for his moral support and guidance.

I would also like to express my sincere gratitude toward my project guide

Miss. Preety Upadhyaywhose guidance and care made the project successful.

I would like to thank my College Library, for having provided various reference
books and magazines related to my project.

Lastly, I would like to thank each and every person who directly or indirectly helped
me in the completion of the project especially Parents and Peers who supported me
throughout my project.
 INDEX

Chapter No. Chapter Name Page No.

1 Introduction 2-32

2 Literature Review 33-36

3 Research Methodology 37

4 Data Analysis , Interpretation and presentation 38-50

5 Conclusions and Suggestions 51-56

References 57

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 CHAPTER NO.1

Introduction To The Study

What Is Mediclaim?

Medical insurance or ‘Mediclaim’ as it is commonly known in India provides

financial cover to individuals for treatment of medical conditions, diseases and
accidents. Medical insurance is offered by non-life insurers (also known as health
insurers) as well as life insurers.

Following are the two main categories of mediclaim:

 Individual Mediclaim: - The most basic form of Medical Insurance is the

individual mediclaim. If there are four family members with individual covers of Rs
1 lakh each, each member can claim reimbursement for up to a maximum of Rs 1
lakh. Each individual mediclaim policy is capped at the sum assured which is the
maximum the insured can claim towards treatment.

 Family Floater Policy: - The best family health insurance plans do away with the
biggest shortcoming of the individual policy – the fixed sum assured. There is a
floating sum assured for each member with a cap for the family as a whole. Going
by the previous illustration – a family floater policy for Rs 4 lakhs allows any
family member to claim medical benefit for more than Rs 1 lakh so long as it is
within the overall sum assured of Rs 4 lakhs. This way if two family members
need medical treatment in a year amounting to Rs 4 lakhs, the family floater with Rs

4 lakhs sum assured proves useful. With independent mediclaim the members would
have been eligible only for Rs 2 lakhs benefit and would have had to fork out the
balance Rs 2 lakhs on their own.

2
 Objectives of the Study:

o To know the features of mediclaim policy.

o To study the advantages and disadvantages of mediclaim policy.
o To get instant of challenges faced by the customers in mediclaim policy.
o To study the customer preference towards mediclaim policy.
o To understand factors affecting consumer’s preference while
choosingmediclaim policy.

Limitations of the Study:

o The project was constrained by time limit of three months.

o Moreover the topic requires a very depth research whereas here only 100
respondents have taken so it may not be enough for the study.
o Some respondents didn’t show their interest to fill the questionnaire.
o Restricted to Mumbai area.

Research methodology:
Tools for data collection: Primary data and secondary data have been used.

Primary data was collected through the structured questionnaires and the secondary
data was collected from various articles, newspapers and relevant websites. The data
collected has been further analyzed by using statistical tools.

Period of study: The data collected for the month of February 2018 to March 2018.

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 Review of literature:-

1. Management of Claims and Reimbursements: The Case of Mediclaim Insurance

Policy: - Published by Ramesh Bhat, Elan Benjamin Reuben on October 1, 2002.
Abstract: The Mediclaim scheme run by the government- owned General Insurance
Corporation (GIC) of India is currently the only private voluntary health insurance
scheme available in India. This scheme has been in operation since 1986 and from
time to time a number of revisions have been made to address the needs of its clients.
The analysis of claims and reimbursements under this scheme is scanty. This paper
analyses 621 claims and reimbursements pertaining to policy initiation years 1997- 98
and 1998-99 of the Ahmedabad branch of GIC's subsidiary. The study estimates that
about a third of claims amount increase is due to the problems of adverse selection or
provider- induced demand. The analysis of breakup of reimbursements suggests that
more than one-third of reimbursements are made towards doctor's fees, followed by
diagnostic charges which account for about one-fourth. The findings also suggest that
the insurance company took on an average 121 days to settle the claim.

2. Financial protection in health insurance schemes: A comparative analysis of

mediclaim policy and chat scheme in India: - Published by Dr. Pranam Dhar, Sudipta
Halder on August 2015.

Abstract: Household out-of-pocket spending for health care occupies 90 per cent of
private health expenditure in the year of 2007 in India. This alone may push 2.2 per
cent of the population below poverty line each year; 24 per cent of the people fall
belowthe poverty line because they are hospitalized; 28 per cent in rural and 24 per cent
in urban areas of those who had illnesses, have cited financial constraint as the
reason for not having used health care. Further, there is a growing preference for
private health care where more than 80 per cent of the people prefer to utilize private
sector health care facilities. Despite massive and enormous efforts to scale up health

4
insurance as a mechanism to reduce financial burden due to health care, the health
insurance penetration is still very low in India. Let us look at one fundamental
question is this regard, which is the main focus of this study: Do prevailing health
insurance schemes offer necessary financial protection during illness? To the
knowledge of this author, there has been no study till date that has examined whether
prevailing health insurance schemes in India meet the preferences of clients and hence

offer necessary financial protection during illness. The present study has examined the
abovequestion by analyzing the level of financial protection to low income people

during illness in ‘private health insurance’ and ‘people’s preferred health insurance’, by
exploring the effective financial protection (reimbursement) of the pro-poor
version of the Mediclaim policy in comparison to the ‘CHAT scheme’.

3. A conceptual distributed framework for improved and secured healthcare system:

-Published by Bikash Kanti Sarkar & Shib Sankar Sana.

Abstract: In the twenty-first century, healthcare information technology has created

the ability to electronically store, maintain, and move data across the world in a matter
of seconds. It allows each healthcare provider to possess its own database of patient’s electronic
medical record (EMR). The concept of ‘big data’ is now treated from different points
of view covering its implications in many fields, including the healthcare sector.
To achieve the wealth of health information, integrating, sharing, and availing data
are the essential tasks that ultimately demand the concept of a distributed system.
However, privacy and security of data are the matter of concerns, as data need to be
accessed from various locations and users in the distributed system. The purposes of the
present study are to provide an overview of big data and the effectiveness of big data
in healthcare and to introduce a secured distributed e- healthcare system to provide
better and secured health services across the nation.

4. Implications of big data analytics in developing healthcare frameworks – A review: -

Published by Venketesh Palanisamy, Ravikumar Thirunavukarasu.

5
Abstract: The domain of healthcare acquired its influence by the impact of big data
since the data sources involved in the healthcare organizations are well-known for their
volume, heterogeneous complexity and high dynamism. Though the role of big data
analytical techniques, platforms, tools are realized among various domains, their impact
on healthcare organization for implementing and delivering novel use-cases for
potential healthcare applications shows promising research directions. In the
context of big data, the success of healthcare applications solely depends on the
underlying architecture and utilization of appropriate tools as evidenced in pioneering
research attempts. Novel research works have been carried out for deriving
application specific healthcare frameworks that offer diversified data analytical
capabilities for handling sources of data ranging from electronic health records to
medical images. In this paper, we have presented various analytical avenues that exist in
the patient-centric healthcare system from the perspective of various stakeholders. We
have also reviewed various big data frameworks with respect to underlying data sources,
analytical capability and application areas. In addition, the implication of big data tools
in developing healthcare eco system is also presented.

5. Role of development officers in the marketing of public sector health insurance

policies in India: - Published by S.A. Senthilkumar, Bharatendra K. Rai, and Angappa
Gunasekaran & Laura Forker.

Abstract: Health insurance is the fastest growing portfolio in Indian insurance. Due to its
rapid growth, health insurance is treated now as a separate category by the
Insurance Regulatory and Development Authority of India (IRDAI). However in
India, only 18% of people are covered under any health insurance policy. Hence, there
is great opportunity for further growth of the health insurance market in India.
Marketing health insurance policies involves unique practices compared to marketing
any other product, because health insurance policies are service products and
intangible by nature.

6
Introduction to Health Insurance: -

Health insurance is probably the most important benefit that employers provide to their
employees. For workers, employer-provided health coverage gives them some security
about their own and their family’s health in a way that is typically more affordable than
individual insurance. For employers, offering health coverage is often a necessary
compensation form to remain competitive in the marketplace.

The landscape of employer-provided health insurance is impacted by laws at the

federal and state level, as well as the marketplace for insurance plans. The Health
Insurance section covers:

• Form 5500 Series;

• Types of insurance plans;

• Dental coverage;
• Vision coverage; and

• Multiple Employer Health Plans.

The following are major federal laws that impact employer-sponsored group health
plans:

• CHIPRA
• COBRA
• ERISA

• FMLA

• GINA
• HIPAA

• Mental Health Parity Act

• Mental Health Parity and Addiction Equity Act

• Michelle’s Law

• Newborns’ and Mothers’ Health Protection Act

• Patient Protection and Affordable Care Act

• USERRA
7
Types of Health Insurance: -

Health insurance coverage means benefits consisting of medical care (provided

directly, through insurance or reimbursement, or otherwise) under any hospital or
medical service policy or certificate, hospital or medical service plan contract, or
HMO contract offered by a health insurer. Health insurance coverage includes group
health insurance coverage, individual health insurance coverage, and short-term,
limited-duration insurance.

1. Dental Plans

Many typical medical plans do not provide dental coverage, which often must be
purchased separately. As a result, dental plans can be a highly attractive employee
benefit. The four main types of dental coverage are:

• Dental Health Maintenance Organization (DHMO). Like a Health

Maintenance Organization, a DHMO features a primary care dentist. Patients
must generally see dentists within the DHMO network to receive coverage.

• Preferred Provider Organization (PPO) or Participating Dental Network

(PDN). Dental patients in a Preferred Provider Organization or Participating
Dental Network may generally see any licensed dentist; however, patients pay
lower costs for choosing a dentist within the PPO or PDN network.

• Dental Point of Service (POS). Patients in a dental POS plan have the choice of
seeing a dentist either in or outside of a network. Out-of-pocket costs are
usually greater for visits to a dentist who is not within a network.

• Dental Indemnity. Dental indemnity plans permit patients to see any licensed
dentist. Patients pay a deductible and sometimes copayments or coinsurance.

A Table or Schedule of Allowance Plan is a type of plan that provides a list of

covered services with an assigned dollar amount. That dollar amount represents the
amount the plan will pay for those services that are covered. The patient pays the
difference.

8
 2. Multiple Employer Health Plans
In regulating employee health plans, federal law recognizes employee welfare benefit
plans, multiple employer welfare arrangements (MEWA), and other health plans that

may be subject to fiduciary duties imposed by the Employee Retirement Income Security

Security Act of 1974 (ERISA).

Introduction to Health Insurance-Related Laws: -

Employers are not generally required by law to provide their employees with health
insurance (with the exception of many Hawaii employers). Nonetheless, health
insurance is one of the most common employer-provided benefits that attract and
retain workers. When employers do sponsor a company health plan, the health
coverage becomes subject to a vast and complex matrix of federal and state
regulation. Finally, starting in 2014, certain employers with 50 or more employees
that do not sponsor a health plan may face tax penalties for employees receiving
subsidies under the Patient Protection and Affordable Care Act.

i. The Federal Family and Medical Leave Act: -

The Family and Medical Leave Act (FMLA) provide certain employees with up to 12
weeks of unpaid, job-protected leave per year. It also requires that their group health
benefits be maintained during the leave.

The FMLA is designed to help employees balance their work and family
responsibilities by allowing them to take reasonable unpaid leave for certain family
and medical reasons. It also seeks to accommodate the legitimate interests of
employers, and promote equal employment opportunity for men and women.

ii. Health Coverage and GINA: -

The Genetic Information Nondiscrimination Act of 2008 (GINA) was signed into law on
May 21, 2008. GINA prohibits discrimination in health care coverage (as well as
employment) based on genetic information.

9
What’s covered in the Health Insurance Marketplace

These essential health benefits include at least the following items and services:

1. Outpatient care—the kind you get without being admitted to a hospital

2. Trips to the emergency room
3. Treatment in the hospital for inpatient care
4. Care before and after your baby is born
5. Mental health and substance use disorder services: This includes behavioral
health treatment, counseling, and psychotherapy
6. Your prescription drugs
7. Services and devices to help you recover if you are injured, or have a

disability or chronic condition. This includes physical and

occupational therapy, speech-language pathology, psychiatric rehabilitation,
and more.

8. Your lab tests

9. Preventive services including counseling, screenings, and vaccines to keep
you healthy and care for managing a chronic disease.
10. Pediatric services: This includes dental care and vision care for kids

Specific health care benefits may vary by state. Even within the same state, there can be
small differences between health insurance plans. When you fill out your
application and compare plans, you’ll see the specific health care benefits each plan
offers.

What is Mediclaim?

Mediclaim is an insurance product that reimburses the expenses you incur in the event
of hospitalization or domiciliary care. It can either reimburse your expenses when you
submit relevant bills, or enable you to have an entirely cashless hospitalization where
your insurer will directly deal with the hospital – letting you focus on treatment and
healing.

10
Ever increasing cost of healthcare and lifestyle diseases has made it necessary for
individuals to have health insurance in India. Mediclaim policy is health insurance
policy that offers health cover up to the sum insured in the case of an illness or
accident leading to hospitalization. Mediclaim policy in India is issued for a specific time
period. The policy has to be renewed for continued benefits.

• Premiums – that are payable on Mediclaim policies differ between insurers

but are based on certain criteria like age of the proposer, geographical area of
treatment, sum insured, term of plan, etc.

• Age – of insured persons can range from 5 years to 80 years, although age
criteria and range insurable varies between companies.

• Family cover – You can provide Mediclaim cover for your entire family with
the payment of one master premium. This may also make you eligible for
discounts on your premium, depending on your provider.

• Overseas Mediclaim Policies – A large number of insurance companies offer

Mediclaim policies that cover you in India and overseas, subject to certain
predetermined conditions.

• Claims – are administered largely through Third Party Administrators

(TPAs)these days, but a few insurers deal with claims in-house.

• Types – Mediclaim policies are available in a range of types, depending on the

need and the category of those to be insured. You can get individual policies,
group policies, senior citizen policies, critical illness policies and special
maternity policies.

• Tax benefits – under Section 80D are available up to Rs.15, 000

on mediclaim premiums for you, spouse and dependent children. An additional
Rs.15, 000 of tax exemption is available if you insure your parents, and the
amount goes up to Rs.20, 000 if they are senior citizens.

11
Medical insurance or ‘Mediclaim’ as it is commonly known in India provides
financial cover to individuals for treatment of medical conditions, diseases and
accidents. Medical insurance is offered by non-life insurers (also known as health
insurers) aswell as life insurers.

Following are the two main categories of mediclaim:

1. Individual Mediclaim

The most basic form of Medical Insurance is the individual mediclaim. If there are
four family members with individual covers of Rs 1 lakh each, each member can
claim reimbursement for up to a maximum of Rs 1 lakh. Each individual mediclaim
policy is capped at the sum assured which is the maximum the insured can claim
towards treatment.

2. Family Floater Policy

The best family health insurance plans do away with the biggest shortcoming of the
individual policy – the fixed sum assured. There is a floating sum assured for each
member with a cap for the family as a whole. Going by the previous illustration – a
family floater policy for Rs 4 lakhs allows any family member to claim medical
benefit for more than Rs 1 lakh so long as it is within the overall sum assured of Rs 4
lakhs. This way if two family members need medical treatment in a year amounting to
Rs 4 lakhs, the family floater with Rs 4 lakhs sum assured proves useful. With
independent mediclaim the members would have been eligible only for Rs 2 lakhs
benefit and would have had to fork out the balance Rs 2 lakhs on their own.

• Tax Benefit

The amount paid towards medical insurance premium for self/spouse/children

provides tax exemption under Section 80D for a maximum of Rs 25,000. There is an

12
additional benefit of Rs 25,000 on mediclaim premium for parents (Rs 30,000 if
parents are senior citizens).

• Exclusions

Exclusion is a disease or medical condition not covered by medical insurance. Usually

mediclaim becomes valid after 30 days of applying for the policy. So diseases
contracted within the first 30 days are not covered by the medical insurance.

Some medical conditions and treatments that are not covered by mediclaim at any
stage include:

a. Pregnancy and child birth

b. Sexually transmitted diseases (STD)
c. HIV/AIDS
d. Dental treatment except as a result of accidents
e. Cosmetic surgery
f. Cosmetic, aesthetic and obesity related treatment

g. Plastic surgery unless required to treat injury or illness

h. Vaccination and inoculation

Although, this is how exclusions work broadly, they differ across insurers and it is a good
idea to ask a lot of questions before finalizing the medical insurance policy. If you do
not have a precise idea of how exclusions work, you will end up paying for the medical
expenses, if it falls under exclusion.

o Reimbursement for hospitalization due to disease/surgery.

o Reimbursement for domiciliary hospitalization expenses in lieu
ofhospitalization.
o Pre Hospitalization expenses up to 30 days.

13
 o Post Hospitalization expenses up to 60 days.
o Age Limit: 5 years to 80 years. Children between the ages of 3 months to 5
yearscan be covered provided one or both parents are covered concurrently.

One point to note is that your mediclaim health insurance may exclude some health
concerns if they fall under the category of pre-existing diseases. Also, depending on the
plan, some other specific ailments too may not be covered. As per some medical
insurance policies 24 hours’ hospitalization may be compulsory for a claim to be
settled. You need to, therefore, read the fine print carefully, so that you understand
what benefits you can claim for and what you can’t.

How is Mediclaim Different from Health Insurance?

Insurance companies offer health insurance products under two broad categories –
indemnity policies and benefit policies:

• Benefit policies are mostly traditional health insurance policies which pay out a pre-
determined “sum insured” amount on the occurrence of an accident, or
diagnosis of any of the illnesses, diseases, conditions, etc. that have been insured
against. Traditional insurance policies work this way, offering you a financial
benefit up-front and not necessarily requiring you to submit hospital bills, etc.

• Indemnity policies compensate or reimburse you for the expenses incurred during
your hospitalization or domiciliary care, on the submission of necessary proofs, up to
the limiting amount mentioned in the policy. Mediclaim is an example of such a
product. Although with recent advancements, mediclaim enables cashless
hospitalization facilities wherein the insurer pays the hospital directly.

The most important difference between mediclaim and health insurance is that
mediclaim will only reimburse your expenditure, and not provide you with a large-
sum financial benefit in case you are rendered unable to earn.

14
Types of Mediclaim Policies in India: -

• Individual Mediclaim - where you basically insure yourself against

the financial liabilities of hospitalization.

• Family Floater - where you can provide additional coverage for your entire
family, and be tension-free in matters of hospital bills and related expenses.

• Group Mediclaim - where an employer or person in charge of a group of

people wishes to add to their remuneration the benefits of cashless
hospitalization and / or reimbursement on hospitalization expenses.

• Overseas Mediclaim - where all your hospitalization and related expenses

aretaken care of during your stay (or travel) outside India.

• Low-cost Mediclaim - is for the underprivileged masses. Employers of small-

scale and medium-scale industries insure their employees and their dependants
for as low as Rs. 1,600 per annum.

• Senior Citizen Mediclaim - while this type of mediclaim requires testing

and/or special provisions, it’s a huge step forward for the industry as they can safely
insure senior citizens at competitive premium rates.

• Critical Illness Mediclaim - among the most expensive treatments in the field
today are those incurred on treatment of critical illnesses. Critical Illness
Mediclaim policies usually offer a higher claimable amount, and include some of
(but are not strictly limited to) the following:

1. Aorta graft surgery.

2. Cancer.

3. Coronary artery by-pass surgery.

4. First heart attack.

5. Kidney failure.
6. Major organ transplant.
7. Multiple sclerosis.

15
 What does a Best Mediclaim Policy Cover?

Mediclaim policies offer excellent benefits and coverage for a wide range
of expenses, depending on your insurance provider. Mediclaim policies in general offer
the following benefits and cover:

• Hospital charges – all direct charges that you incur as a result of hospitalization
like OT charges, medicines, blood, oxygen, diagnostic material, x-rays,
chemotherapy, radiotherapy, pacemakers, donor expenses during organ transplants,
etc.

• Day-care treatment – expenses towards specified technologically-advanced

treatments where 24-hour hospitalization is not needed.

• Pre and post-hospitalization expenses – for a period of 30 days before and up to 60

days after hospitalization and may include assistance in availing emergency
services like ambulance, etc.

• Hospital accommodation charges – in regular wards or in ICUs are

fully reimbursed, or taken care of with the cashless hospitalization facility.

• Medical professional’s fees – like doctor’s fees, nurse’s fees, anesthetist's

charges,etc.

• Investigation charges.

What Does Mediclaim Policies not cover?

Different providers have different exclusions in their policies; some may not even
consider the standard exclusions and provide benefits anyway. Nevertheless, a
standard Mediclaim policy would not cover you for treatment or expenses arising
from or attributable to the following:

• All pre-existing diseases, medical conditions and injuries that are present
before the policy comes into force.

16
 • All diseases and medical conditions (unless otherwise specified in your policy
document) that arise within the first 30 days of your policy commencement
date.

• Injuries or medical conditions caused by war (whether it be declared or not),

hostile foreign invasion or attack, war-like operations, etc.

• Plastic surgery and circumcision (which is not necessary as treatment for

illness or accident), cosmetic or aesthetic treatments of any kind.

• Cost of spectacles, hearing aids, contact lenses, etc.

• Dental treatment and surgery whether it is corrective, cosmetic or aesthetic –

unless it arises due to an accident and requires hospitalization.

• Intentional self-injury and attempted suicide.

• Alcohol / drug abuse.

• STDs like HIV / AIDS, human T cell lymph tropic virus type III (HTLB III),
lymphadenopathy associated virus (LAV) or their variations.

• X-rays, laboratory tests and other expenses incurred not in direct relation to
the treatment.

• Injury or disease arising from nuclear radiation or exposure to

nuclear weapons and materials.

• Pregnancy, childbirth, miscarriage, abortions, caesarean section, etc. or any

complication arising from these.

How do I Claim the Benefits of My Mediclaim Policy?

I. Reimbursement:

It is important to keep the insurer or the TPA informed of your hospitalization as and
when it happens. This is important because insurers and TPAs have a very strict
definition of the term “hospital” and will not honour claims for treatment received in
medical facilities that fall outside their definitions. It’s important to know which
hospitals are in their list, before being admitted.

17
Upon hospitalization, you must keep a careful tally of all expenditures and maintain
records of all bills that you have been given. Don’t take a high-end room and lavish
hospital facilities if you can’t afford it without insurance (as insurers will scrutinize
these claims and judge whether that extra-comfortable hospital bed was a vital

18
requirement for your recovery). Avoid listing personal comfort items as they will
most likely not be honoured.
Fresh approval needs to be sought for changes in treatment. If you are being treated
for an injured leg, the insurer will reimburse the x-ray costs for your leg, but if you
develop a headache and require a CT scan, another approval will be required for this.

You will need to fill up a claim form clearly and without any ambiguity or falsehoods
(as any of these could set your reimbursement back by weeks, even months). Keep
your hospital bills available upon request and attach the same to you claim form and
submit it to your insurer. A clean and duly filled up claims form with all necessary
attachments easily available will help you a lot.

There are instances where insurers do not honour claims and give very vague reasons for
the same. In case your claim is denied for any reason, ask the insurer for a detailed
explanation as to why it was rejected with specific clause numbers and details. This
will help you take the matter up in a relevant consumer forum or even legal court, if
necessary.

II. Cashless claims:

In order for the insurer to process your claim, you will need to fill in a detailed
“preauthorization request form” and submit the same to the company.

III. Cashless Planned Hospitalization:

If you have time to plan your admission to the hospital, you need to send you’re
preauthorization at least 72 hours before your actual hospitalization. This results in a
smooth, cashless mediclaim experience.

IV. Cashless Emergency Hospitalization:

In an emergency like a car accident, there won’t be time to send a preauthorization,

etc. In such a situation, you need simply produce your Medi Assist ID Card at the
network hospital. This will facilitate cashless hospitalization and get you four hours in
which you must send your preauthorization request. As we can see here, it’s important to carry
your Medi Assist ID Card with you at all times.

19
What should I look for when choosing the Right Mediclaim Policy?

Choosing the right insurance policy today means navigating a maze of providers and
heavily scrutinizing the hundreds of plans available. There are plans which provide
the best and most comprehensive cover, but will cost you a high premium, and those
which give you skeletal cover for a paltry premium, primarily used for securing
benefits on income tax. In addition to this, there are riders that provide different
covers and benefits but may overlap in their features, making you pay more per rider, for
overlapping benefits. It’s important to look at sub-limits in your policy documents. A
sub-limit is a method by which insurers are limiting their liability in a world of rising
healthcare costs. For example, if your sum insured amount is Rs.1 lakh and your sub-
limit for room rent is 1%, the insurer will only cover Rs.1,000 under your “room rent”
expense heading. If your room costs, say, Rs.1,400 – you will have to pay that extra
Rs.400 from your own pocket.

Tick off parameters in the following checklist:

• Sum assured and coverage required.

• Do you need maternity benefits?
• Do you want to pay regular premiums or a single premium?
• What are the sub-limits specified for various expenditures?
• Do you want a traditional health insurance lump sum benefit, or just want
yourhospital bills reimbursed?

• Up to what age do you want to renew your policy?

• What is the range of eventualities you want covered in terms of critical
illnesses?
• Does it have enhanced features like cashless claims, quick processing, etc.?

• How does it rank in terms of customer service?

• What is their claim settlement ratio?

Your answers to these simple questions could help you make your decision based on
your personal requirements.
20
Compare and Buy Mediclaim Policies Online:

It is strongly recommended that you take a Mediclaim policy for every member in
your family, including children (perhaps through a family floater), as it is one large
policy that covers everyone under it. It’s an excellent alternative to taking
separate health insurance policies, as Mediclaim requires the payment of only one
premium.

It is important to note that Mediclaim is not an alternative for a life insurance policy as
it will not provide a benefit in case the earning member of the family is rendered unable
to earn anymore. Look for the right balance between benefits offered, ease of claim
settlement, and cost of premiums to find the right policy for you.

Benefits of Buying a Mediclaim Policy:

Medical expenses can put a dent in your pocket if you don't have a suitable health
cover to pay your hospitalization costs. Mediclaim policy is the most common health
insurance policy available in India. Your health insurance policy can ensure you
receive timely and adequate healthcare without worrying about putting a huge dent in
your pocket. Here are some benefits of purchasing a mediclaim policy:

• It is a cost-effective solution to afford adequate healthcare.

• It reduces the financial burden faced by an individual in the event of a sudden
illness or accident that leads to hospitalization.
• Mediclaim policy offers cashless hospitalization wherein the insured member
doesn't have to pay for medical expenses upfront. The insurer will pay for the
treatments received at a network hospital.

• Cashless mediclaim policy ensures you don't have out-of-pocket medical

expense. Instead, the medical expenses will be paid for by the insurance
company.

• You can get tax deductions on premiums paid towards a mediclaim policy for
self, spouse, and children under Section 80D of the Income Tax Act, 1961, for a
maximum of Rs.15, 000. You can get another Rs.15,000 tax benefit on
premium paid towards a mediclaim policy for parents, Rs.20,000 if parents are
senior citizens.
21
Points to Consider When Buying a Mediclaim Policy:

To choose the right mediclaim policy, keep the following points in mind:
• Health insurance coverage: Selecting the right mediclaim policy is important

so as to avoid ending up with insufficient health cover. Pick sufficient sum

insured to cover all your medical expenses.

• Co-payment: A health insurance policy with a co-pay clause is one where the
policyholder agrees to pay a part of the medical expense out of his or her
pocket while the insurance company pays the rest. Co-pay can reduce the
insurance premium of your mediclaim policy. It is a common feature in senior
citizen health insurance policies.

• Treatment specific limits: Insurers levy limits on certain medical treatments like
cardiac treatments or cataract. Before purchasing the policy check for any
treatment specific limits.

• Waiting period: Health insurance policies have an initial 30-day waiting

period for all illnesses except in the case of an accident that leads to
hospitalization. Pre-existing disease cover usually begins after a 4-year
waiting period. During the waiting period, policy benefits can't be availed.
Therefore, it is important to check waiting period clause of the policy.

• Network hospitals: Cashless hospitalization facility can be availed only at a

network hospital of the insurance company. Check the list of network
hospitals in your location.

• Maternity cover: Pregnancy related medical expenses are usually not covered
by regular health insurance policies. Therefore, check if you’re insurance
providers offers maternity cover and what is including in the coverage.

• Exclusions: Read the policy document carefully, especially the exclusions of the
policy. Exclusions usually include suicide attempts, dental treatments, self-
inflicted injuries, alcohol or drug abuse, etc.

22
 • Free-look period: Go through the terms and conditions of the policy during
the free-look period, if you have any objections, you have the option to return the
policy within the free-look period, and get a refund on the premium paid after
certain deductions.

How Does a Mediclaim Policy Works?

Many organizations in India offer mediclaim policies to their employees as an

incentive to retain talent in the company. Mediclaim policy basically covers the
hospitalization costs during the policy term. The insurance premium depends on the
sum assured of the policy. In addition to hospitalization costs, mediclaim policy also
covers domiciliary hospitalization.

Most insurers offer customized mediclaim policies to suit the size and requirements of
the organization. In addition to group mediclaim policy, there are mediclaim policies for
individuals, couples, and families. Mediclaim policies can be purchased by paying the
cost of the insurance plan upfront or in instalments.

Checklists before Buying a Mediclaim Policy:

Here is a 10-point checklist before buying a mediclaim policy:

1. Buy a health insurance policy before it's too late: It is advisable to purchase a
health insurance policy with a lifelong renewability option when you are young
and in good health so that you may be covered when you need it the most.
You can accumulate no-claim bonus with every claim-free renewal over the
years. There is an age limit on purchasing a health insurance plan.
Moreover, senior citizen health insurance plans can be restricting compared to
regular health insurance plans.

2. Assess who in your family needs health cover: In the case of a family
insurance plan, the sum insured is shared by the entire family which is why it is
important to assess who needs health cover and their health condition at the time
of purchasing the policy. The insurance premium of a family floater plan
depends on the age of the eldest member of the family. If there are members with a

23
 medical conditions and are aged above 50 years, there can be certain time- bound
exclusions in the policy.

3. Keep a check on your health and lifestyle: There is an increase lifestyle

disease due to an individual lifestyle choices and habits like smoking,
drinking, and eating out often. Exercise regularly and keep a check on your
diet. Avoid a sedentary lifestyle. It can protect you from contracting an illness.

4. Determine whether you require an individual cover or a family floater

plan: Though a family floater plan is cost-effective, having a high-risk family
member as a part of the cover can lead to other members being left without
any cover when they need it.

5. Choose sum insured on a long-term perspective: When choosing the sum

insured don't consider just the current costs of healthcare. A healthcare cost
keeps increasing rapidly, therefore consider your insurance requirement on
long-term basis, and choose a sufficient sum insured.

6. Sub-limit on room rent: Check if your chosen health insurance policy comes
with a sub-limit on room rent. For instance, for a health insurance policy with a
sum insured of Rs.2.5 lakh, you can stay in a room with a rent of Rs.2, 500. Any
additional cost on room rent has to be paid by the policyholder out of his or her
pocket. The reason for setting a sub-limit is to reduce the liability of the insurer
to the policyholder.

7. Check for co-pay clause in your chosen policy: If you have an existing
policy, review the insurance coverage and determine whether you require
additional coverage. If you are dissatisfied with the current insurer, you can
transfer your mediclaim policy to a new insurer at the time of renewal.

8. Network hospitals of your insurer: Cashless facility can be availed only at

one of the network hospitals of the insurer. The list of network hospitals can
be found on the insurer's website. Check for the network hospitals in your
location.

9. Opt for top-up plans: To get a high sum insured for a longer policy term,
youcan opt for a super top-up plan. For instance, you can choose a base
cover of Rs.5 lakh and a super top-up cover of Rs.15 lakh. This can help you save
24
 on insurance premium. Ensure you purchase the super top-up plan along with the
base policy tenure and same renewal dates.

10. Review your existing policy: If you have an existing policy, review the
insurance coverage and determine whether you require additional coverage. If
you are dissatisfied with the current insurer, you can transfer your mediclaim
policy to a new insurer at the time of renewal.

Mediclaim Policy FAQs:

1. How to port a mediclaim policy?

Health insurance portability allows a mediclaim policy to be ported from the existing
insurer to another insurer at the time of renewal without losing benefits such as
waiting period and no-claim bonus. Portability is advisable if no claims have been
made and the insurance premium is high or the claim process is challenging with the
existing insurer. Only similar policies can be ported. Mediclaim policy can be ported
with same insurer. The portability request has to be submitted 45 days prior to the
policy expiry date.

2. How to get a mediclaim policy?

Visit a third-party comparison website like BankBazaar.com to compare various

mediclaim policies across the top insurance providers. Choose one that offers
sufficient coverage at an affordable premium. Go to the chosen insurer's official
website and apply for the policy, premium payment can be made online through the
website using net banking, credit card or debit card.

3. How to renew mediclaim policy of National Insurance?

Visit the National Insurance website and click on ‘Renew Existing Policy’. It will
redirect you to a page where you can renew the policy by entering the policy number and
registered email ID. You can view the renewal notice and total renewal premium
to be paid. You will be directed to a secure payment gateway where you can make

25
premium payment using net banking, credit card or debit card.

4. How to choose a mediclaim policy?

Before purchasing a mediclaim policy, determine whether you require an individual
policy or a floater plan for your family, the renewability age criteria given by the
insurance company, and if the chosen policy will cover pre-existing diseases. In order to
select the right policy, compare the features and benefits of various mediclaim policies
on an online comparison website like BankBazaar.com.

5. How to calculate mediclaim policy premium?

Most insurance providers have an online insurance premium calculator on their

websites. All you have to do is enter few personal details, the number of insured
members, chosen sum insured, and the age of the eldest member in the online
premium calculator. Click on ‘Proceed’ and the tool will display the insurance
premium of your policy.

6. Why choose a mediclaim policy?

Mediclaim policy will cover all your medical expenses in the case of hospitalization or
domiciliary care during the policy term. With the rise in healthcare costs and
lifestyle diseases, having a mediclaim policy is useful. You don’t have to pay for the
medical expenses out of your pocket. With a mediclaim policy, you and your family
canget timely and adequate healthcare.

7. What is mediclaim policy for employees?

Employers in India offer a group health insurance policy to their employees as an

incentive to retain talent in the company. Government employees receive health cover
via central and state government insurance-based schemes. Employees can include
their family members in the health cover. Mediclaim policy also gives tax benefits to the
assessee on premiums paid towards a health insurance policy under Section 80D of the
Income Tax Act, 1961.

8. What is cashless mediclaim policy?

In the case of a cashless mediclaim policy, all medical expenses are paid by the
insurance company directly to the network hospital where the treatment is received.
26
Cashless claim is subjected to the sum insured limit. The insured member doesn’t
have to pay the medical expenses out of his or her pocket. Mediclaim cashless facility
can be availed only in a network hospital of the insurer.

27
 9. What is group mediclaim policy?

A group mediclaim policy covers the all employees of an organization and their
beneficiaries in the case of a hospitalization or domiciliary care during the policy
term.

10.What is floater mediclaim policy?

In the case of a floater mediclaim policy, the sum insured can be shared by any or all
members of the family for any number of claims during the policy term subject to the
specified sum insured limit. A family floater mediclaim policy covers all the members
of your family which includes self, spouse, children, and parents under one plan.

11.What is overseas mediclaim policy?

Overseas mediclaim policy covers medical expenses incurred due to an accident or

sudden illness when traveling overseas. Your regular health insurance policy may not
cover medical expenses incurred on a foreign soil. The healthcare costs in foreign
countries are exorbitant; having an overseas mediclaim policy can be beneficial.

12.What is innovative mediclaim policy?

Health cover is a dynamic concept which keeps changing with time and the varying
needs of the customers. Innovations in health insurance over the years are as follows:

o Health insurance portability: Your mediclaim policy can transferred from one
insurer to another without losing out on the policy benefits such as waiting period
and no-claim bonus at the time of policy renewal.
o Family floater plan: One policy will cover all the members of your family
including self, spouse, children, and parents.
o Add-ons or riders: Critical illness cover, personal accident insurance cover,
hospital cash benefit, and maternity benefit cover are some of the riders that can be
attached to your base health insurance policy for an enhanced health cover.
o Lifelong renewability: Choose plans with a lifelong renewability option so that you
can get health cover when you need it the most. Nowadays, most health insurance
policies come with a lifelong renewability option.

28
o Top-up health insurance plans: You can opt for a top-up health plan with a
health cover of Rs.7-8 lakh and attach it to your base policy health cover of Rs.2- 3
lakh to get a higher sum insured at a cost-effective rate.

o Conditional cover replenishment: If no claims have been made, the health

cover will be doubled for the following year at no extra cost.

o Unit-Linked Health Insurance plans: These mediclaim policies offer health

cover combined with investment. However, the returns will be affected a claim is
made.

13.What is individual mediclaim policy?

An individual mediclaim policy covers only one person in the case of hospitalization or
domiciliary care due to sudden illness or accident during the policy term.

14.What is national mediclaim policy?

National mediclaim policy covers hospitalization expenses incurred for treatment of

illness or injury of the insured member during the policy term. Individuals between 18
to 65 years of age are eligible for this policy. You can get coverage for children
between the ages of 3 months to 18 years along with a parent. Over 140 day-care
procedures are covered. You can avail cashless facility, tax benefits, and family
discounts.

15.Which is the best mediclaim policy for parents in India?

Listed below are some of the top mediclaim policies for parents in India:

o Red Carpet Health Insurance Policy by Star Health and Allied Insurance for
senior citizens aged between 60 to 75 years.

o Silver plan Health Insurance Policy by Bajaj Allianz for senior citizens till 75
years of age.

29
o Easy Health Insurance Policy by Apollo Munich for senior citizens till 65 years of
age.

o Heartbeat Health Insurance Policy by Max Bupa for senior citizens with no age
restriction.

o Rishtey Health Insurance Policy by ICICI Lombard General Insurance for senior
citizens till 70 years of age.

Which mediclaim policy covers pre-existing diseases?

Most insurers offer cover for pre-existing diseases after a 4-year waiting period.
Group health insurance plans cover pre-existing diseases from day one.

o Red Carpet Health Insurance Policy for senior citizens from Star Health and
Allied Insurance covers pre-existing diseases from first year.

o Silver Health by Bajaj Allianz covers pre-existing diseases from second year.
o SBI Life Smart Health Insurance covers pre-existing diseases after completion of
2 years.
o ICICI Lombard Complete Health Insurance with coverage of Rs.3 lakh or more
will cover pre-existing diseases after 2 years.

16.Which cashless mediclaim policy is the best?

Listed below are some of the top mediclaim cashless policies available in India:

o Easy Health Standard by Apollo Munich

o Bajaj Health Guard by Bajaj Allianz

o Medi classic by Star Health and Allied Insurance

o Health Companion by Max Bupa

o Health Care Supreme by Bajaj Allianz

o Optima Restore by Apollo Munich

17.Which mediclaim policy covers LASIK surgery?

30
 Cosmetic procedures like LASIK surgery are usually not covered under regular health
insurance policies.

18.Which mediclaim policy covers dental treatment?

Dental treatments are usually not covered by health insurance plans in India.
However, special dental cover plans can be attached to the base policy to get dental
cover. Here are lists of health insurance policies that cover dental expenses:

o Bajaj Allianz Health Guard Policy

o Apollo Munich Maxima Health

o Bharti Axis Smart Health

o ICICI Prudential Health Saver
o SBI Life Smart Insurance

Why Mediclaim is important and why you must have a Mediclaim?

Mediclaim is one of the most important insurance investments that an individual

should make in his/her life. If you haven’t or think otherwise, this post will tell you why you
must have a mediclaim policy.

Often come across people who are only interested in investing or putting money in things that
will have returns – monetary returns. Then there are some who feel that certain things happen
only after certain age or time in life and hence they postpone things like health cover or
mediclaim and life insurance and instead run after products that give returns. My simple question
to them is, even if we assume that one may not develop a critical illness based on their family
history or age or good lifestyle or whatever (which is actually unpredictable), still what will
they do if they had a sudden bout of weakness due to over work and exhaustion
and have to be hospitalized? Or What if they have an accident and break a leg or have to
be in the hospital for a day or two? Will they always have instant cash available to settle at the
hospital? Some may, some may not, and in today’s day and age the expenses of hospitalization
31
 do not take time to shoot up each passing day. Hence it is important for you to have a mediclaim
policy.
Mediclaim policies in India or Health cover provides a facility by which you caneither have a
cashless treatment done in the hospitals or if the hospitalization is anemergency, you will be
reimbursed for the expenses provided you inform the insurerwithin the stipulated time frame.
All those feeling the need ‘NOT’ to have aMediclaim just because it is ‘NOT’ needed or
doesn’t give ‘Monetary Returns’, Irequest them to please broaden their minds and think clearly
for once. Agreed Mediclaim policy does not give you monetary returns, but the cushion they
give you in case you do need hospitalization, is worth every penny of the premiumpaid.

32
 CHAPTER NO. 2
Review Of Literature

A literature review is an evaluative report of information found in the literature

related to your selected area of study. The review should describe, summarize,
evaluate and clarify this literature. It should give a theoretical base for the research
and help you (the author) determine the nature of your research.

A literature review surveys books, scholarly articles, and any other sources relevant to a
particular issue, area of research, or theory, and by so doing, provides a description,
summary, and critical evaluation of these works in relation to the research problem
being investigated.

A literature review are able to critically summaries the current knowledge in the area
under investigation, identifying any strengths and weaknesses in previous work, so
helping you to identify them in your own research and thus eliminate the potential
weaknesses, whilst bringing to the fore the potential strengths. In addition, a good and
full literature search will provide the context within which to place your study.

It is stressed that undertaking a literature review requires developing a complex set of

skills and this you can only do by undertaking literature reviews. Therefore, before
commencing writing your research proposal, you will need to allocate time to read the
literature that is relevant to your proposed research study.

1. Management of Claims and Reimbursements: The Case of Mediclaim

Insurance Policy: - Published by Ramesh Bhat, Elan Benjamin Reuben on
October 1, 2002.

Abstract: The Mediclaim scheme run by the government- owned General Insurance
Corporation (GIC) of India is currently the only private voluntary health insurance
scheme available in India. This scheme has been in operation since 1986 and from
time to time a number of revisions have been made to address the needs of its clients.
The analysis of claims and reimbursements under this scheme is scanty. This paper
analyses 621 claims and reimbursements pertaining to policy initiation years 1997- 98
and 1998-99 of the Ahmedabad branch of GIC's subsidiary. The study estimates that
about a third of claims amount increase is due to the problems of adverse selection or
33
provider- induced demand. The analysis of breakup of reimbursements suggests that
more than one-third of reimbursements are made towards doctor's fees, followed by
diagnostic charges which account for about one-fourth. The findings also suggest that
the insurance company took on an average 121 days to settle the claim.

2. Financial protection in health insurance schemes: A comparative analysis of

mediclaim policy and chat scheme in India: - Published by Dr. Pranam Dhar,
Sudipta Halder on August 2015.

Abstract: Household out-of-pocket spending for health care occupies 90 per cent of
private health expenditure in the year of 2007 in India. This alone may push 2.2 per
cent of the population below poverty line each year; 24 per cent of the people fall
belowthe poverty line because they are hospitalized; 28 per cent in rural and 24 per cent
in urban areas of those who had illnesses, have cited financial constraint as the
reason for not having used health care. Further, there is a growing preference for
private health care where more than 80 per cent of the people prefer to utilize private
sector health care facilities. Despite massive and enormous efforts to scale up health
insurance as a mechanism to reduce financial burden due to health care, the health
insurance penetration is still very low in India. Let us look at one fundamental
question is this regard, which is the main focus of this study: Do prevailing health
insurance schemes offer necessary financial protection during illness? To the
knowledge of this author, there has been no study till date that has examined whether
prevailing health insurance schemes in India meet the preferences of clients and hence
offer necessary financial protection during illness. The present study has examined the
above question by analyzing the level of financial protection to low income people
during illness in ‘private health insurance’ and ‘people’s preferred health insurance’, by
exploring the effective financial protection (reimbursement) of the pro-poor
version of the Mediclaim policy in comparison to the ‘CHAT scheme’.

3. A conceptual distributed framework for improved and

securedhealthcare system: - Published by Bikash Kanti Sarkar & Shib
Sankar Sana.

Abstract: In the twenty-first century, healthcare information technology has created

the ability to electronically store, maintain, and move data across the world in a matter
of seconds. It allows each healthcare provider to possess its own database of patient’s
34
electronic medical record (EMR). The concept of ‘big data’ is now treated from
different points of view covering its implications in many fields, including the
healthcare sector. To achieve the wealth of health information, integrating, sharing,
and availing data are the essential tasks that ultimately demand the concept of a
distributed system. However, privacy and security of data are the matter of concerns,
as data need to be accessed from various locations and users in the distributed system.
The purposes of the present study are to provide an overview of big data and the
effectiveness of big data in healthcare and to introduce a secured distributed e-
healthcare system to provide better and secured health services across the nation.

4. Implications of big data analytics in developing healthcare frameworks – A

review: - Published by Venketesh Palanisamy, Ravikumar Thirunavukarasu.

Abstract: The domain of healthcare acquired its influence by the impact of big data
since the data sources involved in the healthcare organizations are well-known for their
volume, heterogeneous complexity and high dynamism. Though the role of big data
analytical techniques, platforms, tools are realized among various domains, their impact
on healthcare organization for implementing and delivering novel use-cases for
potential healthcare applications shows promising research directions. In the
context of big data, the success of healthcare applications solely depends on the
underlying architecture and utilization of appropriate tools as evidenced in pioneering
research attempts. Novel research works have been carried out for deriving
application specific healthcare frameworks that offer diversified data analytical
capabilities for handling sources of data ranging from electronic health records to
medical images. In this paper, we have presented various analytical avenues that exist in
the patient-centric healthcare system from the perspective of various stakeholders. We
have also reviewed various big data frameworks with respect to underlying data sources,
analytical capability and application areas. In addition, the implication of big data tools
in developing healthcare eco system is also presented.

35
5. Role of development officers in the marketing of public sector health
insurance policies in India: - Published by S.A. Senthilkumar, Bharatendra K.
Rai, and Angappa Gunasekaran & Laura Forker.

Abstract: Health insurance is the fastest growing portfolio in Indian insurance. Due to its
rapid growth, health insurance is treated now as a separate category by the
Insurance Regulatory and Development Authority of India (IRDAI). However in
India, only 18% of people are covered under any health insurance policy. Hence, there
is great opportunity for further growth of the health insurance market in India.
Marketing health insurance policies involves unique practices compared to marketing
any other product, because health insurance policies are service products and
intangible by nature.

57

36
 CHAPTER NO. 3

Research methodology:

Tools for data collection: Primary data and secondary data have been used.

Primary data was collected through the structured questionnaires and the secondary
data was collected from various articles, newspapers and relevant websites. The data
collected has been further analyzed by using statistical tools.

Period of study: The data collected for the month of February 2018 to March 2018.

37
 CHAPTER NO. 4
Data Analysis
Data analysis, also known as analysis of data or data analytics, is a process of
inspecting, cleansing, transforming, and modelling data with the goal of discovering
useful information, suggesting conclusions, and supporting decision-making. Analysis
refers to breaking a whole into its separate components for individual examination.
Data analysis is a process for obtaining raw data and converting it into information
useful for decision-making by users. Data is collected and analyzed to answer
questions, test hypotheses or disprove theories. Data analysis is a process used to
inspect, clean, transform and remodel data with a view to reach to a certain conclusion
for a given situation. Data analysis is typically of two kinds: qualitative
or quantitative. The type of data dictates the method of analysis.

Data analysis has multiple facets and approaches, encompassing diverse techniques
under a variety of names, in different business, science, and social science domains.
Data mining is a particular data analysis technique that focuses on modeling and
knowledge discovery for predictive rather than purely descriptive purposes,
while business intelligence covers data analysis that relies heavily on aggregation,
focusing on business information. In statistical applications data analysis can be
divided into descriptive statistics, exploratory data analysis (EDA), and confirmatory
data analysis (CDA). EDA focuses on discovering new features in the data and CDA on
confirming or falsifying existing hypotheses. Predictive analytics focuses
onapplication of statistical models for predictive forecasting or
classification, while textanalytics applies statistical, linguistic, and structural
techniques to extract and classifyinformation from textual sources, a species of
unstructured data. All are varieties ofdata analysis.

Data integration is a precursor to data analysis, and data analysis is closely linked to
data visualization and data dissemination. The term data analysis is sometimes used as a
synonym for data modeling.

38
Which category people are using mediclaim insurance policy more?

:100 responses

• Males : 48

• Females : 52

Gender: 100 responses

48% Female

52%

Male

Interpretation:

• The above diagram explains that there are 100 people who had
responded to the gender.

• In the 100 responses, there are 52 females and 48 males.

• It means that the females are more than males to use mediclaim policy.

39
Which age group people are using mediclaim insurance policy?: 100
responses

• Below 18 : 0

• 18-25 : 64

• 26-50 : 34

• Above 50 : 2

ge: 100 responses

Below 18

0%

2%

34%
18-25

26-50
64%

Interpretation:

• The above diagram explains that there are 100 people who had responded
theage.

• In the 100 responses, there is no single person who is below 18 years, in 18-25

years there are 64 people, in 26-50 years there are 34 people and there are only
2 persons who is above 50 years of age.

• By this we can easily understand that the youth are using the mediclaim
insurance policy more as compared to other age groups.
40
People are aware of mediclaim insurance policy : 100 responses

• Students : 49
• Services : 25
• Business : 8

• Professional : 8

• Any other : 10

Occupation: 100 responses

Student

10%

8%

Service
8%
49%

Business

25% Professional

Interpretation:

• The above diagram explains that there are 100 people who had responded
forthe occupation.

• In the 100 responses there are 49 people are under the student category, 25

people are under service category, 8 people are under the business category, 8
people are under the professional category and 10 people are under the any
other category.

41
 • Due to this, the student responses are more than the service, business,
professional and any other categories.

Do you have the mediclaim policy? : 100 responses

• Yes : 87
• No : 13

People having mediclaim policy: 100 responses

13%

Yes

87%

No

Interpretation:

• From the above diagram, we can understand that most of the people are
havingmediclaim insurance policy.

• There are 87 people who are having their mediclaim insurance policy and
remaining 13 people are not having their mediclaim insurance policy.
42
Who is your insurer? : 100 responses

• Public company : 48
• Private company : 33
• Any other : 19

Insurer of the customers: 100 responses

19% Public company

48%

Private
company
33%

Any other

interpretation:

• The above diagram explains that there are 100 people who had responded to
who is their insurer.

• There are 48 persons whose insurer is under public company, 33 people whose

insurer is under private company and the remaining 19 people are under any
other category i.e. other than public and private company.

• Here, we get to know that there are many people under public company
insurer as compared to private and any other companies.

43
What type of mediclaim policy you have?: 100 responses

• Individual mediclaim policy : 44

• Family floater mediclaim policy : 56

Type of mediclaim policy: 100 responses

Individual
mediclaim
44% policy

56%

Family
floater
mediclaim

policy

Interpretation:

• Above diagram explains that there are 100 responses who had responded for
which type of mediclaim insurance policies are having with them.

• It shows that there are 44 people who are using individual mediclaim policy

and there are 56 people who are using family floater mediclaim insurance
policy.

• It explains that the family floater mediclaim insurance policy is greater than
the individual mediclaim insurance policy.
44
Who persuaded you to purchase the policy?: 100 responses

• Insurance officials : 13

• Relatives : 32
• Friends : 19
• Advertisement : 27

• Others : 9

Persuaded to purchase the policy: 100 responses

Insurance officials

9% Relatives
13%

27%
Friends

32%

Advertisement

19%

Others

Interpretation:

• The above diagram is about who persuaded the customers to take the
mediclaim insurance policy.

• There is 13% from insurance officials, 32% from relatives, 19% from
friends,27% from advertisement and 9% from others.

45
What are the reasons for going in for mediclaim insurance policy? :
100 responses

• Employers contribution : 9
• Existing illness : 2
• Avail good quality medical treatment: 21
• Risk coverage against future illness : 68

What are the reasons for going in for

mediclaim insurance policy?: 100 responses
Employers contribution

2%

9%

Existing illness

21%

68% Avail good quality

medical treatment

Risk coverage against

future illness

Interpretation:
• The above diagram is about the reasons that had gone for mediclaim

insurancepolicy.

• There are 9 people, 2 people, 21 people and 68 people who has gone through
employers contribution, existing illness, avail good quality medical treatment and
risk coverage against future illness respectively.

• By this we get to know that there are more people who mainly go for
mediclaim policy is risk coverage against future illness.

46
Do you agree that the services provided by the insurance companies aredelivered effectively? 100
responses
• Agree : 71
• Disagree : 7

• Neutral : 22

Services provided by insurance company: 100

responses

22%
Agree

7%

Disagree

71%

Neutral

Interpretation:
• The above diagram is about the services that are provided by insurance

company are delivered effectively or not.

• There are 71 people who had agreed, 7 people who do not agree and 22
peoplewho are confused to give whether it is good or not.

• Due to this we get to know that there are many people who are getting good
services by the insurance company.
47
What is the chance of renewing the services after the expiry of present insurance
policy? 100 responses

• 100% : 57
• 50% : 29
• 25% : 14
• 0% : 0

Services after expiry of present policy: 100 responses

0%

14%

29% 57%
3

nterpretation:

• The above diagram is about the chance of renewing the services after the
expiry of present insurance policy.

• There many people who had given their response under 100% categories as
compared to 50%, 25% and 0%.

48
Do you think the promotional efforts being taken by insurance company aresufficient? 100 responses

• Yes : 86
• No : 14

Efforts by insurance company: 100 responses

14%

Yes

No

86%

Interpretation:
• The above diagram is about the promotional efforts taken by

insurance company are sufficient are not.

• From the above diagram we can understand that there are many people who
had responded for yes as compared to no.

49
How you would like to pay mediclaim insurance premium amount?
100 responses

• Half monthly : 2

• Monthly : 18
• Quarterly : 10
• Half yearly : 12
• Yearly : 58

Basis of payment: 100 responses

2% Half monthly

18%
Monthly

Quarterly
10%
58%

Half yearly
12%

Yearly

Interpretation:

• The above diagram is about the basis of payment whether it is half monthly,
monthly, quarterly, half yearly or yearly.

• There are 2 persons, 18 persons, 10 persons 12 persons and 58 persons who

pay their premium on half monthly, monthly, quarterly, and half yearly and
yearly basis respectively.

• There is more number of customers who do their payment only one in a year.
50
 FINDINGS
• I had found that many customers in cities are easily using the mediclaim
insurance policy.

• The customers who live in villages are not aware of mediclaim insurance

policy because there are many people who are illiterate or lack of awareness
and there are many problems which they face while paying their premium.

• And I found that the people who are minors are also not using the mediclaim

insurance policy because they are young and there is less chance of risk to
youngsters.

• I had found that females are having their mediclaim policy more as compared
to males.

• After 2 or 3 years teenagers will also start to open their mediclaim

insurancepolicy because future is unpredictable.

• More than 50% of people are using mediclaim insurance policy for their risk
coverage against future illness.

• I found that the customers are paying their premium atleast once in a year
andmany people are paying their premium by cheque.

• I also found that the many people who are using mediclaim insurance policies
are not faced any frauds.

• I had observed that many people are benefited by mediclaim insurance policy.

51
 CHAPTER
NO.5
CONCLUSION

• From the study we can conclude that there are many customers i.e. 90% are
who have satisfied with the mediclaim insurance policy.

• There are many customers who are benefited by the mediclaim insurance
policy i.e. 89 people had benefited.

• And by this study I got to know that there are less people who had faced
barriers while paying their premium.

• There are many people who pay their premium on once a yearly basis.

• Many customers are paying their premium by cheque as compared to cash

andother modes of transactions.

52
 ANNEXURE
Questionnaire
Survey on a study on customer’s preference towards mediclaim policy in Mumbai.

1. Email address*

2. Name*

3. Gender* • Male

• Female

4. Age*

• Below 18 • 18-25

• 26-50

• Above 50

5. Occupation* •
Student

• Service

• Business

• Professional

• Any other

6. Do 6. you ha6. Do you have the mediclaim

policy? *

 Yes
 No

53
7. Who is your insurer?
• Public company

• Private company
• Any other

8. Which type of mediclaim policy you have?

• Individual mediclaim policy

• Family floater mediclaim policy

9. Who persuaded you to purchase the policy?

• Insurance officials

• Relatives

• Friends
• Advertisement

• Others

10. What are the reasons for going in for mediclaim insurance policy?
• Employers contribution

• Existing illness

• Avail good quality medical treatment

• Risk coverage against future illness

11. Do you agree that the services provided by the insurance companies are
delivered effectively?

• Agree

54
• Disagree
• Neutral

12. What is the chance of renewing the services after the expiry of present
insurance policy?

• 100%
• 50%

• 25%

• 0%

13. Do you think the promotional efforts being taken by insurance

companyare sufficient?

• Yes
• No

14. How you would like to pay mediclaim insurance premium amount?
• Half monthly

• Monthly

• Quarterly
• Half yearly

• Yearly

15. How much premium do you pay?

• Below 50,000

• 50,000-1,00,000
• Above 1,00,000

55
16. What are the sources of your payment?
• Cash

• Cheque

• Others

17. While doing your payment have you faced any barriers?

• Yes

• No

18. Do you think mediclaim policy has benefited?

• Yes

• No

19. Are you satisfied with the mediclaim policy?

• Yes

• No

20. How do you rate the mediclaim policy?

1 2 3 4 5

100% 0%

56
 CHAPTER NO. 8
REFERENCES AND BIBLIOGRAPHY
REFERENCES
Webliography
• https://www.hdfchealth.com/health-insurance-plans.aspx

• https://www.hdfchealth.com/knowledge-center/choosing-right-policy/best- family-floater-
health-insurance.aspx

• http://stepupmoney.com/5-must-have-insurance-covers-in-india/

• https://www.policybazaar.com/health-insurance/health-insurance-
india/?utm_source=organic&utm_medium=articles&utm_campaign=withint extlink

• https://www.bharti-axagi.co.in/health-insurance/dedicated-claim-handler
• https://healthexecnews.com/health-care-reform
• https://www.nerdwallet.com/blog/health/health-insurance-guide/

• http://healthaffairs.org/blog/2017/01/11/get-health-insurance-repeal-
will-affect-you-too/

57
• https://www.bankrate.com/loans/medical-financing
• https://www.nerdwallet.com/blog/health-insurance/

• https://www.softwareadvice.com/medical/medical-billing-
software-comparison/

• https://healthitanalytics.com/news/as-icd-10-grace-period-ends-ehr-data-
quality-reclaims-attention

• http://www.amednews.com/article/20130715/business/130719992/5/

• http://www.apexedi.com/why-many-medical-claims-are-rejected-on-first- submission/

• http://www.medicalbillingandcodingonline.com/medical-billing-errors/

58
Bibliography

• AivivaRoh, Brain Abel Smith, and GivanniTrmburi . Health

Insurance indeveloping countries, Hall of India
Private Limited, Fifth Edition, New Delhi,
• Health Insurance in India-Opportunities, challenges and
concerns by Ramesh Bhat, Dileep Mavalankar, Indian
Isutitute of Management Ahmedabad

• Rohit Kumar, K. Rangarajan and Nagarajan

Ranganathan, ―Health Insurance in India - A
Study of Provider‘s Perceptions in Delhi&
the NCRǁ, Journal of Health Management September
2011, Vol.13 no. 3259- 277.

• Siddhartha Sarkar, ―Health Insurance for the Poor in

Informal Sectorǁ,Indus Journal of Management
& Social Sciences, Vol. 1, No. 2: 129-
146 (Fall2007).
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59