Professional Documents
Culture Documents
Undertaken at
Submitted to
By
Pranav Sawhney
(HRD1815339)
SBS- Finance
FACULTY MENTOR
COMPANY MENTOR
1
CERTIFICATE
2
DECLARATION
3
PREFACE
This project report attempts to bring under one cover the entire hard work and
dedication done by me in the completion of the project work in “Study on
Products and performance of Star health” of Star health and allied. I have
made sincere attempts and taken every care to present this matter in precise and
compact form, the language being as simple as possible. I am sure that the
information contained in this volume would certainly prove useful for better
insight in the scope and dimension of this project in its true perspective. The
task of completion of this project though being difficult was made quite simple,
interesting and successful due to deep involvement and complete dedication of
my colleagues. All constructive feedback is cordially invited.
4
ACKNOWLEDEGEMENT
I take this opportunity to thank all the people who have helped me through the
course of my journey towards completing this report. I sincerely thank my
mentor, Mr. Kadir (sales manager) for his guidance and encouragement in
carrying out this project work.
I also wish to express my gratitude to Mr. Kashish (branch manager), who was
always there with me whenever I needed during the course of the project. I
would also like to thank all the other employees at Star health and allied who
rendered their help during the period of my project work.
I would like to thank Prof. Dr. G. Gopalakrishnan, Director, BIMHRD for their
assistance and continuous help towards successful completion of this project. At
last I would like to acknowledge the support and encouragement of my friends
and family. This project would not have been possible without the confidence,
endurance and support of them.
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TABLE OF CONTENT
2. Introduction 8
4. Research methodology 27
5. Literature reviews 28
6. Swot analysis 32
9. Findings 38
10. Limitations 41
11. Recommendations 42
12. Bibliography 43
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EXECUTIVE SUMMARY
This project report is based on financial products and growth of star health,
effective planning and management are the key to run a successfully stable
business, for identifying trends over time and for measuring the state of business.
Health insurance market in India has become the fastest growing segment in
non –life insurance sector in India. The health insurance business in India saw a
24% growth in FY 17 with a premium of INR 30,765 Cr and a market share of
24%. It has been the fastest growing market segment registering a CAGR of
23% for the past 10 years. Health insurance industry is in a nascent stage with
25% of the population under its coverage. There exists a huge potential for
growth and penetration of health insurance to a large population. Going forward
there are both opportunities and obstacles in marketing and distribution of
health insurance products in India. This paper attempts to uncover the prospects
of successful marketing of such products from the standpoint of insurance
marketers and look at issues of impeding the growth of health insurance market
in India.
India with 1.34 billion population is facing unique health care delivery problems
particularly regarding the poor spending on health, access, quality, safety, lack
of accountability, corruption, etc. Inequalities and health-related expenses
resulting in impoverishment further marginalises the poor, underprivileged and
outreach. The government of India has come up with a highly ambitious
initiative Ayushman Bharat - National Health Protection Mission (AB-NHPM)
as a shift from traditional health planning approaches towards a comprehensive
healthcare vision
7
INTRODUCTION TO INSURANCE
1818 saw the advent of life insurance business in India with the establishment
of the Oriental Life Insurance Company in Calcutta. This Company however
failed in 1834. In 1829, the Madras Equitable had begun transacting life
insurance business in the Madras Presidency. 1870 saw the enactment of the
British Insurance Act and in the last three decades of the nineteenth century, the
Bombay Mutual (1871), Oriental (1874) and Empire of India (1897) were
started in the Bombay Residency. This era, however, was dominated by foreign
insurance offices which did good business in India, namely Albert Life
Assurance, Royal Insurance, Liverpool and London Globe Insurance and the
Indian offices were up for hard competition from the foreign companies.
In 1968, the Insurance Act was amended to regulate investments and set
minimum solvency margins. The Tariff Advisory Committee was also set up
then.
This millennium has seen insurance come a full circle in a journey extending
to nearly 200 years. The process of re-opening of the sector had begun in the
early 1990s and the last decade and more has seen it been opened up
substantially. In 1993, the Government set up a committee under the
chairmanship of RN Malhotra, former Governor of RBI, to propose
recommendations for reforms in the insurance sector.The objective was to
complement the reforms initiated in the financial sector. The committee
submitted its report in 1994 wherein , among other things, it recommended that
the private sector be permitted to enter the insurance industry. They stated that
foreign companies be allowed to enter by floating Indian companies, preferably
a joint venture with Indian partners.
9
The IRDA opened up the market in August 2000 with the invitation for
application for registrations. Foreign companies were allowed ownership of up
to 26%. The Authority has the power to frame regulations under Section 114A
of the Insurance Act, 1938 and has from 2000 onwards framed various
regulations ranging from registration of companies for carrying on insurance
business to protection of policyholders’ interests.
Today there are 31 general insurance companies including the ECGC and
Agriculture Insurance Corporation of India and 24 life insurance companies
operating in the country.
DEFINITION OF INSURANCE :-
Insurance is defined as the equitable transfer of the risk of a loss, from one
entity to another, in exchange for a premium, and can be thought of as a
guaranteed small loss to prevent a large, possibly devastating loss.
Insurance is nothing but a system of spreading the risk of one onto the shoulders
of many. While it becomes somewhat impossible for a man to bear by himself
100% loss to his own property or interest arising out of an unforeseen
contingency, insurance is a method or process which distributes the burden of
the loss on a number of persons within the group formed for this particular
purpose.Basic Human trait is to be averse to the idea of risk taking. Insurance,
whether life or non-life, provides people with a reasonable degree of security
and assurance that they will be protected in the event of a calamity or failure of
any sort.Insurance may be described as a social device to reduce or eliminate
risk of loss to life and property. Under the plan of insurance, a large number of
people associate themselves by sharing risks attached to individuals. The risks,
which can be insured against, include fire, the perils of sea, death and accidents
and burglary. Any risk contingent upon these, may be insured against at a
premium commensurate with the risk involved. Thus collective bearing of risk
is insurance.
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INSURANCE INDEMNIFIES ASSETS & INCOME
Every Asset has a value and generates Income to its Owner. There is a normally
expected Life-time for the Asset during which time it is expected to perform. If
the Asset gets lost earlier, being destroyed or made Non-functional through an
Accident or other unfortunate event the Owner is Prejudiced. Insurance helps to
reduce CONSEQUENCES of such Adverse Circumstances which are called
Risks.
INSURANCE IS THE SCIENCE OF SPREADING OF THE RISK
It is the system of spreading the losses of an Individual over a group of
Individuals
INSURANCE IS A METHOD OF SHARING OF FINANCIAL LOSSES
Of a few from a common fund formed out of Contribution of the many who are
equally exposed to the same loss.What is uncertainty for an Individual becomes
a certainty for a Group. This is the basis of All Insurance Operations. Thus
insurance convert uncertainties to certainty
11
Life insurance
This sector deals with the risks and the accidents affecting the life
of the customer. Alongside, this insurance policy also offers tax planning and
investmentreturns. There are various types of life Insurance Policy India: -
a. Endowment policy
b. Whole Life Policy
c. Term Life Policy
d. Money-back Policy
e. Joint Life Policy
f. Group Insurance Policy
General Insurance
This sector covers almost everything related to property,vehicle, cash,
household goods, health and also one's liability towards others. Themajor
segments covered under general Insurance Policy India are:
a. Home Insurance
b. Health Insurance
c. Motor Insurance
d. Travel Insurance
The concept of health insurance was proposed in 1694 by Hugh the Elder
Chamberlain from the Peter Chamberlain family. Accident insurance was first
offered in the United States by the Franklin Health Assurance Company of
Massachusetts. This firm, founded in 1850, offered insurance against injuries
arising from railroad and steamboat accidents. Before the development of medical
expense 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.
12
During the middle to late 20th century, traditional disability insurance evolved
into modern health insurance programs.
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 is not always the case.
The basic concept of health insurance is population solidarity. There are inherent
risks in a population but the population absorbs the cost of risks to an individual
by spreading the impact of incurred costs amongst the insured population.
However, if the population is split into insured and uninsured groups, or into
selectively groups (as with private insurance with pre-insurance selection either
by the insurance company or the insured) the concept of population solidarity
breaks down. The insurance balances costs across a large, random sample of
individuals. For instance, an insurance company has a pool of 1000 randomly
selected subscribers, each paying Rs.100 per month. One person becomes very ill
while the others stay healthy, allowing the insurance company to use the money
paid by the healthy people to pay for the treatment costs of the sick person.
However, when the pool is self-selecting rather than random, as is the case with
individuals seeking to purchase health insurance directly, adverse selection is a
greater concern. Insurance systems must then typically deal with two inherent
challenges: adverse selection and ex-post moral hazard.
13
Insurance companies like to compare buying health insurance after being
diagnosed with a serious medical condition like HCV to trying to buy fire
insurance on a burning house. That sounds really logical….except….most fire
insurance policies are never used as most houses don’t burn down. Everyone has
medical problems, however, at one time or another.
To prevent a person from buying health insurance only when they need it, the
insurance.Industry uses a procedure called “medical underwriting.” Loosely
translated into plain English, it means “discriminating against anyone we feel
may cost us money.” And this type of discrimination against people with health
problems is perfectly legal.
The French model of health insurance has been ranked by the World Health
Organization as the best in the world, because it permits a high quality of care
and nearly total patient freedom. . It was a compromise between Gaullist and
Communist representatives in the French parliament. The Conservative Gaullists
were opposed to a state-run healthcare system, while the Communists were
supportive of a complete nationalization of health care along a British Beverage
model. The resulting programme was profession-based. All people working were
required to pay a portion of their income to a health insurance fund, which
mutualised the risk of illness, and which reimbursed medical expenses at varying
rates. Children and spouses of insured people were eligible for benefits, as well.
Each fund was free to manage its own budget and reimburse medical expenses at
the rate it saw fit.
14
Market size and share of health insurance sector in India.
Star is the market leader for the stand-alone companies in the health insurance
sector. No company is even near it or even half of its revenue. It has the highest
hospital networks which are spread all over the country.
15
STAR HEALTH AND ALLIED INSURANCE COMPANY
INTRODUCTION: -
Health insurance which is considered to be a taboo among the insurance
companies, due to the perennial losses it produced, Star health insurance have
been setup exclusively for health insurance. They step in to the insurance field
as standalone health insurance company in the year 2006.It started its operations
on18th May 2006 foraying into the area of health, accident and travel insurance.
The company established full-scale in-house direct claims setting facility,
dispensing with the services of Third-party administrators.
Safecrop Holdings Pvt. Ltd., a consortium with WestBridge AIF, Rakesh
Jhunjhunwala and Madison Capital, has signed definitive agreements with the
shareholders of Star Health & Allied Insurance Company Ltd. (Star Health or
the Company) to purchase their shares in Star Health, India’s leading Private
Health Insurer. Existing shareholders of Star Health include Star Health
Investments Pvt. Ltd. and funds managed/ or advised by ICICI Venture, Tata
Capital and Apis Partners. The transaction is subject to regulatory and certain
other approvals. Kotak Investment Banking, Evercore and Mizuho Securities
(Singapore) acted as the financial advisors to Star Health and its shareholders.
Nishith Desai Associates and Trilegal acted for the purchasers and Platinum
16
Partners acted for the Company. Speaking on the investment, Mr. Jagannathan,
Chairman cum Managing Director, said, “We have started from a humble
beginning and have come to this level with an excellent team work. We feel
new investors, with their abundance experience and golden touch, will enable
the Company to scale further heights.” “We are really excited about Star Health,
a dominant market leader in the retail health insurance industry. We believe the
retail health insurance industry will continue to grow at a healthy pace in the
coming decade, driven by increasing penetration. This aligns well with
WestBridge’s investing philosophy and long-time horizon. We are highly
confident of Star’s business model and believe that Star will continue to lead the
retail health insurance space” said Sumir Chadha, Co-Founder & Managing
Director, WestBridge Capital. “The management of Star Health has built its
leadership position in private health insurance through innovation, perseverance
and excellence. I believe health insurance is a key tool for every citizen towards
financial stability. I am proud to be associated with Star Health and believe it is
best equipped to serve the country’s healthinsurance needs” said Rakesh
Jhunjhunwala.
Star Health is the largest health insurance company with a market share of
10.6% in health insurance across all the general insurance companies in India as
on 31st March, 2018. Star Health, based in Chennai, was founded in 2006 and
provides health insurance, overseas mediclaim and personal accident policies.
Company is based in Chennai and employs ~11,000 people providing insurance
coverage to ~1 crore lives as on 31st March, 2018. Star Health has a pan-India
distribution platform and an integrated ecosystem to tap the retail health
insurance opportunity with 434 branches/ offices, ~2.4 lakh agents and tie- up
with ~8,500 network hospitals. Led by its Chairman cum Managing Director,
Mr. V. Jagannathan, the Company has created an institutional framework of
systems and processes and maintained a professional management approach. It
has a strong and an experienced management team, which will continue to drive
the business and operations of the Company. The Company has a written a
direct premium of INR 4,161 crores (41% YoY growth) with profit after tax of
INR 171 crores and a networth of INR 960 crores as on/ for the year ended 31st
March, 2018
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VISION AND MISSION
Star health insurance is started in India with a vision of becoming the
largest and most preferred health insurance company in India and to provide
financial security for health care management.
The mission of Star health insurance company is:
· To provide prompt, courteous and quality service to customers.
· To offer wide range of innovative products and services.
· To leverage state of art technology for customer satisfaction.
· To adopt best management practices in business operations
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COMPREHENSIVE INSURANCE POLICY
Eligibility: -
* Entry age between 3 months and 65 years
* Lifelong renewals guaranteed.
* No exit age
* Dependent children (those who are economically dependent on their parents)
can be covered up to 25 years of age.
only if parents have policy in star.
This policy is for both individual and family
The policies are for 5 lacs 7.5 lacs 10 lacs 15 lacs 20 lacs 25 lacs
Benefits: -
A. Room, Boarding and Nursing charges :-
5 lacs 7.5 lacs 10 lacs 15 lacs 20 lacs 25 lacs -> Single Standard A/C
room
ICU/Operation Theatre Charges:-
5 lacs 7.5 lacs 10 lacs 15 lacs 20 lacs 25 lacs-> Actual
B. Ambulance Charges –
By Road (per policy period)
5 LAKHS Up to 2,000/-
7.5 LAKHS Up to 3,000/-
10 LAKHS Up to 3,500/-
15 LAKHS Up to 4,000/-
20 LAKHS Up to 4,500/-
25 LAKHS Up to 5,000/-
C. Air ambulance only available 7.5 lakh and more sum insured and the
benefit is of 10% of sum insured.
D. Pre Hospitalization:Medical expenses upto 30 days prior to the date of
admission.
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E. Post Hospitaliztion :Medical expenses up to a period of 60 days after the
discharge from the hospital.
F. Delivery charges
Normal delivery then benefits starting from 10,000 to 25,000
according to sum insured.
Caesarean delivery then benefits starting from 15,000 to 40,000
according to sum insured.
G. Waiting Period for Delivery 36 months for first delivery and 24 months
after a delivery claim under this policy
H. Coverage for the new born child (subject to a valid claim under point f)
Up to 50,000 to 1 lakh benefits.
Treatment of the New Born
Vaccination expenses up to Rs.1000/- of the new born baby. Claim
under this is
admissible only if claim under A of Section-2 above has been admitted
and while the
policy is in force.
Coverage for new born child from day 1, but conginental disease
(internal body problem) and external disease
I. Out Patient Dental/Ophthal Coverageonce in a block of every 3 years of
continuous renewal:-
Problem related to eye and teeth are reimbursed up to Rs. 10000
according to S.I.
J. Out Patient Medical Consultation coverage other than Out Patient Dental/
Ophthal Up to 1,200/- (per Consultation limit Rs.300/- to Up to 3,3 00/-
(per consultation limit Rs.300/-) according to S.I.
K. Hospital Cash upto 7 days per occurrence & upto 120 days per policy
period.(1 day time excess) cash is given at N-2 basis from 500 to 1500 as
per S.I .
L. Restoration benefit of 100%.
M. Bariatric Surgery:-
a) Expenses incurred on hospitalization for bariatric surgical procedure
and its complications thereof are payable subject to a maximum of
Rs.2,50,000/- during the policy period.
b) This maximum limit of Rs.2,50,000/- is inclusive of pre-
hospitalization and post hospitalization expenses.
c)The limit of cover for Bariatric Surgery forms part of sum insured
under Section 1
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d) Coverage under this section is subject to a waiting period of 36
months and payable only while the policy is in force.
N. Cover for Accidental Death and Permanent Total Disablement: -
1. Accidental Death
2. Permanent Total Disability following an accident
The sum insured for this cover is separately indicated in schedule of
benefits. Cover for one insured person opted by the proposer.
The cover is equal to sum insured.
this bonus is applicable only for coverage under Section 1. If the Insured opts to
reduce the basic Sum Insured at a subsequent renewal, the amount of bonus
shall not exceed such reduced sum insured.
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BENEFITS
1.Ambulance
*Ambulance Charges: Emergency ambulance charges up to a sum of Rs.750/-
per hospitalization and overall limit of Rs.1500/- per policy period.
* Air Ambulance Cover: Up to 10% of the Basic sum insured per policy period.
Available for Sum Insured of Rs. 5 Lakhs and above only.
* Emergency domestic medical evaluation: Subject to limits mentioned in the
table given below, the Company will reimburse reasonable and necessary
expenses incurred towards transportation of the insured person from the hospital
where the insured person is currently undergoing treatment to another hospital
for further treatment provided .
sum Insured
Rs. Up to 4,00,000 Rs.5000 /h
5,00,000 to 15,00,000 Rs.7500/h
20,00,000and 25,00,000 Rs.10000/h
2.Room
*Room, Boarding, Nursing Expenses as given below:
Sum Insured
Rs. 1,00,000 & 2,00,000 Limit Rs. Up to 2,000/- per day
3,00,000 & 4,00,000 Up to 5,000/- per day
5,00,000 - 25,00,000 Single Standard A/C Room
Surgeon, Anesthetist, Medical Practitioner, Consultants & Specialist Fees.
Anesthesia, Blood, Oxygen, Operation Theatre charges, cost of Pacemaker etc.
Cost of Medicine and drugs.
ONLY TREATMENT EXPENSES WILL BE GIVEN.
* ICU expenses are fully received
3. Pre & Post Hospitalization: -
* Pre-hospitalization medical expenses incurred up to 60 days are payable.
* Post-hospitalization medical expenses incurred up to 90 days are payable.
Every bill related to disease will be reimbursed in this period.
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4. No claim bonus: -
In respect of a claim free year of Insurance, for the Basic Sum Insured options
Rs.3,00,000/- and above, the insured would be entitled to benefit of bonus of
25% of the expiring Basic Sum Insured in the second year.
Additional 10% of the expiring Basic sum Insured for the Next years.
The maximum allowable bonus shall not exceed 100%.
5. Free health checkup: -
Payment of expenses towards cost of health checkup will not prejudice the
company's right to deal with a claim in case of non-disclosure of material fact
and / or Preexisting Diseases in terms of the policy
Sum Insured Limit Per Policy Period
Rs. 1,00,000/- & 2,00,000 Not available
3,00,000 Up to 750
4,00,000 Up to 1000
5,00,000 Up to 1500
10,00,000 Up to 2000
15,00,000 Up to 2500
20,00,000 Up to 3000
25,00,000 Up to 3500
Additional benefits: -
6. Automatic Restoration: -
*There shall be automatic restoration of the Basic Sum Insured immediately
upon exhaustion of the limit of coverage which has been defined during the
policy period.
* Such Automatic Restoration is available 3 times at 100% each time, during
the policy period.
* Each restoration will operate only after the exhaustion of the earlier one.
* It is made clear that such restored Sum Insured can be utilized only for illness
/ disease, unrelated to the illness / diseases for which claim was / were made.
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7. Recharge: - (given only by star)
the limit of coverage under the policy is exhausted / exceeded during the policy
period, additional indemnity up to the limits stated
3 lakhs to 4 lakh -> 25% of sum insured
5 lakh and above -> 1.5 lakh benefit
8. AYUSH Treatment: -
Expenses incurred on treatment under Ayurveda, Unani, Sidha and
Homeopathy systems of medicines in a Government Hospital or in any institute
recognized by the government and/or accredited by the Quality Council of
India/National Accreditation Board on Health is payable
9. Additional Sum Insured for Road Traffic Accident (RTA): -
If the insured person meets with a Road Traffic Accident resulting in in-patient
hospitalization, then the Basic sum insured shall be increased by 25% subject to
a maximum of Rs. 5,00,000/-.
This benefit is payable only if the insured person was wearing a helmet and
travelling in a two-wheeler either as a rider.
The additional sum insured shall be available only once during the policy period
and should be used for the particular hospitalization.
10. Newborn Baby cover: -
The coverage for New Born Baby starts from the 16th day after its birth till the
expiry date of the policy .(It is subject to a limit of 10% of the Sum Insured or
Rupees Fifty thousand, whichever is less, subject to the availability of the sum
insured, provided the mother is insured under the policy for a continuous period
of 12 months without break.)
11. Organ donor expenses are given up to 10% of sum insured or 1 lakh
whichever is less.
12. Shared Accommodation: -
If the Insured person occupies, a shared accommodation during in-patient
hospitalization, then amount as per table given below will be payable for each
continuous and completed period of 24 hours of stay in such shared
accommodation.
For 3 lakhs to 15 lakh -> 800 / per day
For 20-25 lakh ->1000/per day
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13. All day care: -
Star provides cover for the patients who visit hospital for less time like 3-4 hrs .
discharge sheets are observed.
Now a day’s problems are solved frequently at a fast speed due to technology
so it act as a benefit.
14. Assisted Reproduction Treatment: -
The Company will reimburse medical expenses incurred on Assisted
Reproduction Treatment, where indicated, for sub-fertility subject to:
*A waiting period of 3 years from the date of first inception of this policy with
the Company for the insured person.
*The maximum liability of the Company for such treatment shall be limited to
Rs.1,00,000/- for Sum Insured of Rs.5,00,000/-
*Rs.2,00,000/- for Sum Insured of Rs.10,00,000/-
* above benefit is for next 3 years.
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OBJECTIVE OF THE STUDY
Every study is done with certain objectives. The study without objectives preset
is a futile exercise, as it will end in no conclusion.
Objectives
26
RESEARCH METHODOLOGY
For the preparation of project report especially in case of Marketing every steps should
be anticipated closely. In this anticipation of formulation there may arise some
problems, since these are two types of information.
The data is being personally collected while working in the company. The products
were being taught by our mentor.
This secondary data were collected from the internal sources (Company’s
Documents) of as well as some external sources (Paper & Magazines). This
collection of these data is for easier and less time consuming.
27
LITERATURE REVIEW
28
Fukuyama (1997) investigated the productive efficiency and productive changes
of Japanese life insurance companies with primarily focus upon the ownership
structure and economic conditions. The results of the study revealed that mutual
and stock companies possess identical technologies, but the productive efficiency
and productive performance changes from time to time across the stock and
mutual under different economic conditions.
Rama and Baru (1994) examined the structure of health care provision existed in
public; private; and voluntary sectors and utilization patterns for both inpatient
and outpatients care across states. For this data obtain from the World Bank’s
Country Report on India, “India: health sector financing-coping with adjustment;
opportunities for reforms” and World Development Report 1993. The study
showed the presence of much variation in the availability of non-government
health services across states. In most of the states, public sector was the main
source of provider of curative services and private and voluntary sector marked
by uneven spread and regional variations. However, there were some states in
which private and voluntary sector was achieving the significant growth and
supplementing the public services. However, the suggested that the private and
voluntary sector should move only into those areas, where they can show better
results and get profit. Moreover, majority of socio economic groups depend on
public provisions. Therefore the cut back of public services will results in
disparities of access between rural-urban, advanced-backward areas and across
classes.
Ahuja (2004) examined the more suited arrangement for providing health
insurance to poor people in India and also explored how the reforms in insurance
sector alter health insurance prospects facing the poor in developing countries
and what changes have happened or likely to happen as a result of insurance
sector reforms. In developing countries, community based arrangement is more
suited for providing health insurance to low income people. Insurance sector
reforms lead to development of private health insurance, at the same time reforms
can affect the low income people through its effect on the provision and financing
of health care services. The study concluded in India, CBHI will play an
important role, but there is need to be encouraged by government’s interventions
in order to guide and direct health insurance market, so as to minimize the cost
escalation of health care provision.
29
enrollment is individual and membership is voluntary. The main barrier in
development of CBI schemes is to find an appropriate provider and financial
sustainability. So the government should come forward to subsidies this equitable
health financing mechanism. Therefore, CBHI in India offer valuable lesson for
the policy makers and practitioners in the field of health care
Ahuja and Narang (2005) provided an overview of existing forms and emerging
trends in health insurance for low income segment in India with focus on both the
demand and supply side factors promoting this development, and provided that
three conditions essential for extending health insurance to low income segment.
Further based on the efforts of the central government by way of its Universal
Health Insurance (UHI) schemes as well as on the three insurance pilots of United
Nation Development Programme (UNDP), some designs of health insurance for
low income groups were drawn. The study concluded that these schemes have
considerable scope of improvement for a country like India by providing
appropriate incentives and bringing these under the regulatory ambit. Currently
public health services are weak and inefficient, private and voluntary health care
is unregulated and scattered. The study suggested that in order to develop health
insurance for poor in a big way, health care provisions need to be engthened and
streamlined as well as coordination among multiple agencies is needed.
Gupta, Roy and Trivedi (2004) examined the role of TPAs and the issues that
required to be taken into consideration while evaluating their usefulness and
functioning in India. The study based on a series of meetings, discussions and
interviews with various TPAs, insurance companies and providers. No doubt, the
TPAs face different barriers in terms of capital, capacity and connections but still
they are providing cashless transaction at the time of service delivery to the
30
customers. The IRDA and Health Ministry should come together so as to ensure
TPAs which in turn will ensure active role of the TPAs in Community and
Universal Health Insurance Schemes. Moreover, the study concluded that TPAs
can play an important role in making insured health care availability smoother,
but neither can it be seen as a panacea for all the problems, nor it can be blamed
for these problems of health sector. The TPAs system should be regulated and
checked in order to take care off consumers’ interest.
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SWOT – Analysis
STRENGTHS WEAKNESSES
Stand alone health insurance Upcoming private health companies
company in the field. offering health insurance.
Experience, expertise and
support of Well established public sector
Big financial group. companies.
Latest Technology and
Infrastructure to support & Lack established infrastructure at
fasten the services. branch offices
All the range of health products
under one roof.
Cashless service without TPA
intervention i.e. in-house claim
settlement.
24 hours General Practitioner's
advice and medical counseling
24x7 in-house Call Center
Toll free telephone assistance
Complete knowledge backed
website to offer medical
information, including health
tips.
Large range of premiums
through different products for
every class of people.
Direct discount on premium for
no claim benefit
Welcome discount for the
proposers shifting from other
company with all the
continuation benefits.
Innovative products even for
chronic noncurable diseases
like diabetes, AIDS etc.
Availability of tailor made
policies.
32
OPPORTUNITIES THREATS
Ability of local people to pay for Established general insurance
good companies having brand name.
services.
From the malpractices being
Non-availability of any major health regularly done in this form of
insurance service provider. insurance
practices.
Willingness of Corporates to have a
tie-up with the company. Unwillingness of people to buy
health
Large sector of the population not insurance thinking of wastage of
covered under health insurance & money.
even
is unaware of the benefits. More no. Of proposals from senior
age group.who are in real need of
Increasing population going abroad health care expenses.
and hence availing Overseas policies.
Resistance among people as they
Inceasing number of road side have
accidents & increased cost of mindset of availing policies from
healthcare public
facilities sector companies.
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CANCELLATION, AUTOMATIC TERMINATION AND
PROCEDURE FOR CLAIM AND SETTLEMENT OF CLAIM
AUTOMATIC TERMINATION
The insurance under this policy with respect to each relevant insured person
policy shall be terminated immediately on the earlier of the following:
· Upon the death of the insured person
· Upon the exhaustion of the limit of coverage under the policy as a whole.
PROCEDURE FOR CLAIM
Claim by the policy holders shall be made up to the sum insured this may
include bonus granted to the particular policy.
The following are the conditions to obtain the claim:
I. Claim must be filed within 15 days from the date of discharge from hospital.
II. The insured person shall obtain and furnish the company with all original
bills, receipts and other documents upon which a claim based and shall give
the company such additional information and assistance as the company any
require in dealing with the claim.
The following are the documents to be submitted in support of claim:
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I. For reimbursement claim
1. Duly completed claim form.
2. Pre-admission investigations and treatment papers.
3. Discharge summary form the hospital, chemists
4. Cash receipts and reports for tests done.
5. Receipts from doctors, surgeons, anasthetists.
6. Certificate from the attending doctor regarding the diagnosis.
SETTLEMENT OF CLAIM
1. The company gives pre-authorization for cashless facility within four hours
from receipt of the request.
2. The company decides on reimbursement claims within thirty days of receipt
complete documents/ clarifications.
3. The company enables the customers to know claim status within three days
of receipt of documents.
Standards for redressal of grievances
1. The company ensures grievance redressal mechanism for customers to
approach easily.
2. They register all grievances and send acknowledgement within three days to
the customers.
3. They monitor grievances registered on integrated grievance management
system through SRMS portal.
4. They resolve grievances within 15 days if receipt from the customers.
5. The company inform customers availability of insurance ombudsman as a
redressal forum.
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SERVICES BOTH IN ONLINE AND OFFLINE
1. Customers are guided by the experienced agents to select the proper policy
according to their age and family background.
2. Cashless services for mediclaim i.e., whenever there is hospitalization the
customers need not pay the cash to the hospital including various medical
tests, scan and room rent etc.,
3. The agents will assist the customer during hospitalization for documentation
purposes and forwarding the papers to the head office.
4. In case of post hospitalisation, claims are settled without the interference of
TPA i.e., third party administrators. In other insurance companies TPA will
be appointed and they act as a mediator between the company and the
insured.
5. The company sends constant reminders through SMS and by post for the
payment of their renewal premium.
6. 24 hours toll free assistance is given to the customers. In case of emergency
and any enquiry the customer any contact the toll free numbers given in the
health card.
7. Free general physician consultation over phone is given by doctor’s team of
the company. By quoting the policy number any insured can contact their
doctor on the toll free number and get medical advice.
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· They can go through the particular claim if the customer and know the
status of the claim of the customer by entering the claim number given
to the customer.
· Claims helpdesk provides various information regarding claim process.
· Various helpline numbers are given to the customers for the easy contact
based on the zone, direct contact with the zonal officer over phone is
possible.
· Free health magazine is offered for the customers through on- line.
There by the customers can get medical advices.
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Performance of star health
Conclusion: - Star is a leader in the retail health insurance space with a market
share of 51.2% in the standalone health segment and 10.9% in the overall health
insurance space. The gross written premium increased at a CAGR of 39.7%
over FY14-FY18 as against the market CAGR growth of 18%. The company,
over the years, has moved away from the government business and has been
focussing on the retail health segment which forms 86.8% of the gross written
premium and would continue to do so.
The ratings remain supported by the company’s long and established track
record in health insurance, reasonable in-house claim processing efficiency,
large team of doctors and empanelled hospitals to drive a strong underwriting
process. The company has a strong distribution network and a diversified mix of
network of agents, bancassurance, brokers and alternate channels such as
online, direct marketing and tele-calling, which act as strong enablers to growth
of Star’s health business.
Star had adequate capital buffers in FY18, supported by its sizeable net worth and
solvency margin. In the past, Star received capital from its promoters as it is
backed by marquee investors including ICICI Venture, Sequoia Capital and Tata
Capital Growth Fund, and APIS Partners LLP. However, with the change in
promoters, Star’s shareholding would be distributed among three largest
shareholders, who would be infusing capital for future growth needs.
Moreover, its investment book portfolio quality was robust with more than 99.7%
of its debt securities rated ‘AAA’ as of FY18. Also, Star maintains comfortable
liquidity position with 45.5% of debt investments (based on book value) in
government securities. Thus, the company’s liquidity profile of the investment
book remains stable to cater to the needs of policyholders.
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Star is the largest premium collector and has the highest number of tie ups with
the hospitals.
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Key Findings in Star Health & Allied
Insurance Company Ltd
There is still much scope to explore the market as the city population is
above 30,00,000 & only 2 – 5% of population is covered under any kind
of health insurance coverage.
Underwriting procedures are done cautiously for overall risk assessment &
if found out of the box full efforts are taken to cover that person under some
different plan
Personal freedom is given to the Sales Managers to explore his / her talent
and generate business by his / her innovative ideas.
Underwriting guidelines are user friendly and fitted into the software called
PREMIA.
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As the work load goes up unedrwritting procedures should be more
cautiously done for not accepting doubtful cases so the repudiation rate of
the claims can also be reduced there by reducing disappointment for the
policy holders.
Medical underwriter can be appointed after the workload exceeds limit of
around 12/15 cases per day reduce the turn around time required for policy
issuing.
Non-network hospitals should be empanelled as soon as possible after
confirming their genuiness to reduce incidences of moral hazards.
The company totally depends on web services for their underwriting, there
should be some backup if the system fails to continue the work.
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RECOMMENDATIONS
Star should open its own hospitals being the market leader they van open
new or make some partners
The company totally depends on web services for their underwriting, there
should be some backup if the system fails to continue the work.
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BIBLIOGRAPHY
https://www.irdai.gov.in/ADMINCMS/cms/frmGeneral_Layout.aspx?page=Pag
eNo3729&flag=1
https://www.starhealth.in/media-center
file:///C:/Users/admin/Desktop/Financial%20Ratios%20-
%20Insurance%20Sector.pdf
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