Post Graduate Diploma in

Health Insurance Management

Learner Handbook
 Sections Page No.

1. Program Guide 01

2. Assignment Instructions 05

3. Project Instructions 07

4. Term End Examination 14

5. Contact Session 16

6. Questions for Assignments 17

 Section 1

Program Guide

Program Mission
To empower diverse aspirants to gain the technical competencies, professional
training, insurance knowledge and management skills to manage and lead in
the dynamic health insurance industry.

Program Objectives
• To equip the graduates to deal with the growing medical insurance
awareness and the demand for quality healthcare facilities.
• To cultivates in the learners, in depth knowledge of planning and designing
of underwriting.
• To train aspirant with relevant knowledge and skills regarding the work
culture, efficient handling and execution of assigned job profiles in the
insurance sector.

Medium of Instruction
The PGDHIM program is available in English Medium.

Duration
The program should be completed within one academic year.

Credit System
Symbiosis School for Open and Distance Learning follows credits System. For
obtaining the diploma of Post Graduate Diploma in Health Insurance

Learner Handbook 1
Management (PGDHIM), you have to successfully complete course work of 32
credits.
1 credit = 30 study hours
4 credit = 50 marks
6 credit = 75 marks
8 credit = 100 marks
Sr. Continuous Term End Total
Course Name of Course Credits
No. Assessment Assessment Marks
Health Insurance,
101 4
Its Models & 15 35 50
Financials
102 Public Health 20 55 75
6
Insurance
Theory Health Insurance
103 20 55 75
Courses Products & 6
Underwriting
Health Insurance
104 Claims 4 15 35 50
Management

105 Legal Aspects in 30 70 100

8
Health Insurance

106 Project Report 4 15 35 50

Mandatory
Letter
non credit Contact Session - - -
Grade
course
Total
32 115 285 400

Assessments:
Learner has to undertake below listed assessments for successful completion
of the program i.e PGDHIM.
I. Assignments
ii. Project report
iii. Attendance to contact session (at Pune)
iv. Term End Examination (TEE)
Learner Handbook 2
Program assessments will serve as key component of learning and help to
assess your progress.

Important Dates
1st set: 1st October

Assignment Submission 2nd set: 1st November

3rd set: 1st February

4th set: 1st March

Project Synopsis Submission 15th January

Project Report Submission 1st April

Admit Card Generation* (Dates will be notified)

Personal Contact Session* April/May (Dates will be notified)

Term End Examination* Month of May/June

(Dates will be notified)
*Subject to change
Note : For regular updates, please log on www.ssodl.edu.in
You are required to score at least 50% marks in both continuous assessment
(assignments, project synopsis) as well as term end assessments
(examination, project report) of each courses separately.
Attendance to contact session is also one of the mandatory criteria (except
for international learners).
On completing all the academic assessments successfully i.e. assignments,
synopsis, project report, term end examination and attendance to contact
session, you would become eligible for award of Diploma i.e. PGDHIM.
Learner who do not quality in any of the mandatory criteria in one academic
year can take extensions in the next academic year. Backlog examination
fees will be applicable for re-appearing.

Learner Handbook 3
Each assessment criteria is explained further in detail. Kindly read this
handbook carefully.
For academic queries you can write to hhm@ssodl.edu.in
For any other assistance you can write to coordinator@ssodl.edu.in

Legal Jurisdiction
All disputes pertaining to the program, including admission shall fall exclusively
within the jurisdiction of Pune, Maharashtra only.

Learner Handbook 4
 Section 2

Assignment Instructions

As a part of continuous assessment, you have to submit the given set of

assignments for each course. The submission of assignments is compulsory.
The marks that you get in assignments will be counted in your result. Therefore,
you are advised to take assignments seriously.
Refer below instructions for assignments:
• You have to submit 4 sets of assignments, which includes course wise
questions. Below are the details of timelines of their submissions.
Set of Assignment Submission Date
1st 1st October
2nd 1st November
3rd 1st February
4th 1st March

• Questions for assignments are given in this handbook in the subsequent

section.
• It is mandatory to write below details in your answer sheet. The first
page of your answer sheet should have all the below duly filled
headings:
PRN No. Name of Learner:
Program Name :
Set of Assignment: 1st / 2nd /3rd /4th

• Please keep moderate margin on both the side of word file, so this may
facilitate the evaluator to write their comments/marks in the margin.

Learner Handbook 5
• Refer following guidelines while writing your answers sheets:

Particulars Title/headings Main content / Sub heading

Font size 14 Bold 12 with 1.5 line spacing
Font type Arial/ Calibri Arial/ Calibri

• Write the question and then start your answer below. Each page of the
assignment should be serially numbered.
• Write answer in your own words; do not copy from the course material. Do
not copy from other learners otherwise, it will not be considered for
evaluation. It will affect your result negatively.
• You should submit computerized soft copy of assignments through “Log-in
page on learning management system”, in word/pdf format. Assignments
are to be submitted online through learning management system.
• Before submission of assignments, you should ensure that you have
answered all the questions in all assignments. Incomplete assignments
will make you score fewer marks.
• You should secure at least 50 % marks in each set of assignments course
wise.
• For your own record, retain copy of all assignments, which you upload.
Once you pass in assignment, you cannot resubmit it for improvement of
grade.
• Complete the assignments within the specified timelines mentioned in this
handbook.
• If you fail to submit assignments or you scored less than passing marks in
assignments, you are not eligible to appear for term end examination.

Learner Handbook 6
 Section 3

Project Instructions

Learning Objectives
• Relate activities carried out in department with reference the selected
topic
• Apply principles of hospital management for identifying the gaps
• Design a survey / study for the identified gap.
• Develop writing, presentation, communication and analytical skills
• Compute the findings and illustrate the results.
• Summarize & give recommendations.
You are required to undertake project in the field of hospital /healthcare industry
on any topic of his/her interest.

Project Synopsis 15 Marks

Synopsis is part of continuous assessment for the course of project report.

Course Name Credits Synopsis Project Report Total

Project Report 4 15 Marks 35 Marks 50 Marks

Project synopsis is brief summary of the major points of your planned project. To
carry out project, you will have to first choose a subject area based on your
interest. You can then finalize a topic after consultation with your guide.
The topic should be limited so that it can be completed within the time limit with a
well-drafted report.

Learner Handbook 7
The topic should be limited and focused so that it can be completed within the
time limit with a well-drafted report.
• Choosing topic
The indicative list of topics is available at your learning management system.
You are at liberty to choose the topic and place of project work. Your experience,
interest and feasibility will help you in finalizing it. If you desire, guidance in
selection of topic is also available from our faculty through email or telephone.
• Font Type: New Times Roman Size: 12
• Line Spacing Body of the text, List of tables/graphs/charts/ bibliography :
1.5 lines
You have to submit synopsis of your project work in soft copy through learning
management system before 15th January. The synopsis should consist of 8-10
pages.
Final project report will be rejected if synopsis is not submitted within prescribed
timeline.
Please follow below format for preparing the project synopsis:
• Title of the project
• Introduction
• Aim and objectives
• Review of literature
• Methodology
• References
• Official requirements if any
These headings are explained further under Guidelines for Project Report.
Guide Details:
You will require a guide for carrying out the project.
Please mention below details of guide.
• Name

Learner Handbook 8
• Qualification
• Designation
• Contact details

Who can be the Guide?

The eligibility criteria to be a guide is as follows:
• M.Phil / Ph.D. or
• Master Degree in Health Sciences with minimum two years experience
You have to establish contact on his/her own with a local hospital/nursing home/
community/Third Party Administrator (TPA) / health insurance company
offices for guide and project work. Establishing such contact will be your sole
responsibility.
Note: You should follow the format of synopsis in a systematic way. You will start
to work on the project only after the approval of the synopsis.

Guidelines for Project Report

Final project report is to be submitted as typewritten & black hard bound with
golden embossing in person or via courier or post. Last date of submission is
1st April.
Project report should closely follow the standards and general format outlined
below.
a. Guiding principle
The purpose of the project is to give learners the opportunity to carry out an in-
depth study of an applied nature, synthesizing various elements, yet pursuing
one area of interest in depth. Your project report should make clear what you
have attempted and why you have attempted it. It should also elaborate
methods of data collection and analysis of the obtained data. Any
recommendation made should be supported by the evidence presented and by
logical argument using deductive and inductive reasoning.

Learner Handbook 9
b. Starting project work
Once your synopsis is approved, start the project work as planned and complete
as per the timeline. Start working in the department and with your data
collection. Prepare questionnaire or checklist for collection of data if applicable.
After the data is collected and analyzed, you can start working on your project
report. Remember to be in regular contact with you guide for guidance and help
in carrying out project and writing the report.
c. Organizing project report
Once you have completed project work, it is time to write your project report.
Please ensure that you have at least two weeks for report writing. Please note
that simply writing what you have observed in a department or organization is
not a project.
Bind the typewritten project report in black hard bound with golden embossing.
Obtain the certificate with stamp & signature from head of the institution/
organization where you carried out the work and attach it to your report without
which the project will not be evaluated.
Make two copies of your project report. Send one copy to SSODL and retain the
other for your record.
Word limit
The final project report should be between 8000 and 10000 words (30 - 45
pages of typed text). Photographs, drawings, graphs, tables, survey forms and
appendices can be added over and above the page limit and should be labeled
properly. Project report will not be considered for evaluation if:
• Submitted without an approved project proposal
• Either less than 8000 words(30 pages of text) ormorethan11000 words
(50 or more pages of text)
• Simply a study or observation or review of activities or literature without
any valid conclusion and recommendations
• Hand written
• Not related to the initial project proposal that was sent for approval

Learner Handbook 10
d. Guidelines and format for writing synopsis/ project report
It is recommended you to follow these guidelines. The final report should be
written and presented in the following sequence:
• Title page: Write your name, PRN, program name, title of the project and
academic year on this page.
a. No Plagiarism Declaration (Format attached in this handbook)
b. Certificate from project guide
c. Acknowledgements
d. Table of contents with page numbers
• Introduction: This section includes brief introduction of the
organization, background of your project topic / problem statement, and need
for study/significance of the project. You have to justify why your project wok
is an essential component of quality management in healthcare. Unresolved
issues, challenges, social concerns, or educational or national/international
issues should be pointed out. Outline the underlying concepts that are further
discussed in the project report. Describe the standard/standards that you have
referred for your project in short.
With reference to the background of the topic, explain statement of the problems
that are occurring and a specific statement of the exact gap in the knowledge
you will study. The gap in knowledge is the nerve center for your study.
• Aims are usually written in broad terms. They set out what you hope to
achieve at the end of the project.
• Objectives: Project objectives should be closely related to the statement
of the problem and summarize what you hope will be achieved by the
study.
• Literature Review: This should include previous work done on the field
of study and anything that you consider to be relevant to the project topic
or problem statement and to its investigation. It will include a large
number of references to the literature in your chosen area.
• Methodology: In this section describe briefly and precisely about
following:
Learner Handbook 11
a. Study area (The unit/ area/ group chosen for collection & analysis of data
in the project)
b. Sample size (The number of individual samples measured or
observations used in a survey or project or research)
c. Process of study, methods / questionnaires used
d. Duration of the study
• Results: Provide statistical inference and interpretation on your final
results. Write all the tests and analysis you did. You should include the
statistical techniques if used during analysis. Results should contain a
systematic presentation of your findings in relation to the survey
purpose. It should be presented as tables and/or diagrams, e.g. graphs,
flow charts, etc. each with a unique number (e.g. Table 5, Figure 3) and a
caption / heading describing the table or figure clearly. The results
should also be described in words, referring to any tables and figures
you choose to include.
• Discussion: The findings presented in the results section should be
discussed in this section. The discussion may include findings from other
related surveys / studies that support or contradict your own results
/findings.
• Summary and conclusions: This should provide an overview of the
project, conclusions, implications and recommendations. Also specify
the limitations of your study. You may indicate the scope for further study.
• Bibliography: List the books, articles, websites that are referred and
useful for research on the topic of your specific project. References have
to be written in APA format. These should be alphabetically listed
• Appendices: Appendices should be labeled (APPENDIX A or I) and
properly titled. You may include consent form, questionnaire in it.
e. Plagiarism
Plagiarism includes:
• Copying (using another person's language and/or ideas as if they are

Learner Handbook 12
 your own)
• Quoting directly
• Paraphrasing
• Using ideas
• Cutting and pasting
If any plagiarized content is found in your report, it will be rejected.

No-Plagiarism Declaration

Title of the article:

Name(s) of the learner:
PRN:
Name of Project Guide:
I hereby state and declare that, this project report is submitted as part of
partial fulfilment of the requirements of <Program Name> by me as per my
own intellect. This report is the result of my independent scholarly work
and I have not copied any contents of the said report from anyplace.
Proper references have been cited for all the material used to give credit to
original author if I have borrowed any sentences / ideas of such author.
Further, I declare that, the said report has not been published by me earlier
in any form.
I am aware that, plagiarism is an offence and if committed same will lead to
non-evaluation and rejection of my project report and appropriate action
against me.
Date:
Place:
Signature:
(Please bind this declaration along with your final project report.)

Learner Handbook 13
 Section 4

Term End Examination

You have to appear for a term end examination towards the end of the academic
session. It is conducted to assess the knowledge of learner in a particular
course. It forms a major component of evaluation system and carries not less
than 70% weightage in your result.
As you have read earlier, the syllabus is distributed over two semesters. You
have to appear for a semester examination towards the end of each
semester.
Eligibility for Examination
• Learner has to submit the assignments and secure passing
marks in respective course in respective semester. If you fail
to submit any one of the course assignment in time, you will
not be considered eligible for that respective course
examination.
• Project report submission
• Attended contact session
Term End Examination will be conducted in the month of May/June.
The eligible learner has to fill examination form, which will be
available on website 2 months prior to the date of examination.
Follow the instructions meticulously while the filling the form.
The examination will be arranged at the examination centre(s) at
major cities in India. List of examination centres is available on
website. The schedule is communicated 2 months prior to term
end examination.
The term end exam will cover the entire scope of a course.
Therefore, every topic of the course is important from exam point
of view. The exam paper will comprise of different types of
questions like long / short answer questions covering scenario
Learner Handbook 14
 based /analytical questions, fill in the blanks and true/ false. You
must secure minimum 50% marks in term end examination for
passing.
Back log examination fee will be applicable for re-appearing.

Result
On completion of each semester exam, result will be declared by SIU within 45
days. On successful completion of required assessment criteria of the
program, consolidated grade sheet & passing certificate will be issued to each
learner.
Convocation
Convocation of Symbiosis International (Deemed University) is held in the
month of October of the year. Detailed information of the Convocation is
displayed on the university and institute website (www.siu.edu.in and
www.ssodl.org) in the month of September. All learners who become eligible for
obtaining the Diploma Certificate need to submit their application by due date
and follow the respective guidelines.

Learner Handbook 15
 Section 5

Contact Session

Contact session is a Mandatory Non Credit course.

A Contact session will be conducted in the month of April / May. It is mandatory
for all the registered students to attend the contact session (except
international students). The interactive session will consist of lectures by
faculty / subject experts, group discussions and clarifications on concepts
and courses by the faculty & guest speakers.
Please note that attendance to contact session is one of the mandatory criterion
towards eligibility for award of Post Graduate Diploma for all (except
International students).
You have to register for the contact session. Registration details and schedule
will be available on website three months prior to the session.

Learner Handbook 16
 Section 6

Questions for Assignments

1ST Set of Assignments

Answer the following questions:

Course 1: Health Insurance, Its Models & Financials
• Describe the current scenario of Health Insurance Industry in India?
(5 Marks)
• What are the Rating Methods in health insurance? (5 Marks)

Course 2: Public Health Insurance

i. Short note on:
• Universal Health Coverage in India (3 Marks)
• Ayushman Bharat (2 Marks)
ii. What is RSBY scheme?What are the key features of the RSBY Scheme?
(5 Marks)
Course 3:Health Insurance Products & Underwriting
• What are the different types of benefits that are associated with the long
term care health insurance plans? (3 Marks)
• Coinsurance (2 Marks)
• Discuss about the similarities and differences between individual
insurance and group medical insurance benefits. (5 Marks)

Learner Handbook 17
 ND
2 Set of Assignments

Answer the following questions:

Course 1: Health Insurance, Its Models & Financials
• What is community health insurance? What are the advantages and
disadvantages of community health insurance? (5 Marks)

Course 2: Public Health Insurance

• What is ECHS? (5 Marks)
• Describe the Claim Reimbursement process under CGHS scheme?
(5 Marks)

Course 3: Health Insurance Products & Underwriting

• How do you evaluate the market performance of a new insurance

product? (5 Marks)
• Short note on Top-Up Products (5 Marks)

Learner Handbook 18
 3rd Set of Assignments

Course 4: Health Insurance Claims Management

• What is Third Party Administrator(TPA)? Enlist the role of TPA. (5 Marks)

• What is claims? Why is health claims repudiated? (5 Marks)

Course 5: Legal Aspects in Health Insurance

• What are the general guidelines to TPA in respect of services in relation
to Health Insurance Policies as per Regulations, 2016. (10 Marks)

• Write down the important provisions relating to health insurance

products as per IRDAI (Health Insurance) regulations 2016 (5 Marks)

Course 6:

Project Synopsis- As a part of continuous assessment 15 Marks

Learner Handbook 19
 4th Set of Assignments

Course 4: Health Insurance Claims Management

• What is Reinsurance? Enlist the functions. (2 Marks)
• What is an Ombudsman? (3 Marks)

Course 5: Legal Aspects in Health Insurance

• Protection of policy holders interest as per regulations 2017 (5 Marks)
• What is fraud? What are the industry interventions to manage fraud?
(10 Marks)

Learner Handbook 20