Summer Internship Report

“Comparative study of health insurance policies of ICICI Lombard and other

companies”

Submitted in partial fulfilment for the award of the award of the Degree of
MBA (Insurance and Banking) from Amity University, Uttar Pradesh, Noida
Campus

Submitted by: Industry Mentor: Faculty Mentor:

Akshya choudhary Mr. savant keshriya Mr.B.R.Singh

Amity School of Insurance, Banking and Actuarial Science, Amity University, Noida Campus
 Certificate from Faculty

This is to certify that Ms. Akshya choudhary of MBA(I&FP) from Amity University, Uttar Pradesh, Noida
Campus has successfully completed the project work titled ‘Comparative study of health insurance
policies of ICICI Lombard and other companies’ in partial fulfilment of requirement for the
completion of MBA programme as prescribed by the Amity University, Uttar Pradesh, Noida Campus.

This project report is the record of authentic work carried out by him during the period from 13th May
2019 to 28th June 2019. He has worked under my guidance.

Signature

Name: Mr. B.R. Singh

Date:
 Declaration

Title of Summer internship: Comparative study of health insurance policies of

ICICI Lombard and other companies

I declare

(a)That the work presented for assessment in this summer internship Report is my own, that it
has not previously been presented for another assessment and that my debts (for words, data,
arguments and ideas) have been appropriately acknowledged.

(b)That the work conforms to the guidelines for presentation and style set out in the relevant
documentation.

AKSHYA CHOUDHARY

(A2865618004)

MBA-Insurance and Financial planning

 ACKNOWLEDGEMENT

The internship opportunity I had with ICICI LOMBARD GENERAL INSURANCE COMPANY
LIMITED was a immense chance for knowledge and professional development. Therefore, I
consider myself as a very auspicious individual as I was provided with an opportunity to be a
part of it. I am also thankful for having a chance to meet so many amazing people and
professionals who led me though this internship period.

I express my genuine thanks to SAVAN KESHARIYA, SALES MANAGER for taking part in
positive decision & giving compulsory advices and guidance and arranged all facilities to make
life easier. I opt this moment to acknowledge his involvement gratefully.

I pick out as this opportunity as a huge milestone in my career development. I will try tough to
use gained knowledge and skills in the best feasible way, and I will continue to work on their
enhancement, in order to attain desired career objectives.

AKSHYA CHOUDHARY

MBA-Insurance and Financial planning

 Table of Content

Chapter no Particulars Page no

1 Introduction
1.1 Motor insurance

1.2 Amendment in motor

insurance
1.3 (a)ICICI LOMBARD
GENERAL
INSURANCE
COMPANY LIMITED
(b) HDFC Ergo General
Insurance Company Ltd
(c)SBI General Insurance

(d)TATA AIG
GENERAL
INSURANCE
(e)United India insurance
Company
Chapter 2 Review of literature

Objective

Chapter3 Product of health

insurance and features
of plans
Chapter 4 Recommendation
Conclusion
References
Comparative study of health insurance policies
of ICICI Lombard and other companies
 Chapter 1
INTRODUCTION
1.1HEALTH INSURANCE

History

Health insurance in India is not of recent origin. Previously, it concerns for loss occur due to
illness and accident of a person. In India, health insurance schemes had developed due to
employee and employer relation. In 1948, the Employee State Insurance Scheme (ESIS) was
launched. It provides both the medical benefit and cash. Central government introduced a Central
Government Health Scheme (CGSH) in 1954 for government employee and employee’s family
to provide medical care. CGHS is contributory scheme .Health insurance in India came for
government employee and private employee in the form of Central Government Health
Insurance Scheme and Employee state Insurance Scheme. There were not any scheme exist for
individual and family. In 1986, ‘Mediclaim’ was first product of Health Insurance launched in
India by GIC. Mediclaim offered minimum and maximum coverage of Rs 15,000 and Rs 5lakh
respectively. In India, health insurance begins as cover for individual person and their
families that offered reimbursement for hospital medical care only. There have been
sub-limits and caps on every single item covered under the regulations. But, the sub-
limits were eliminated during 1990 with more and more private hospitals and
progressed lifestyle expectancy as an increasing number of human beings began to buy
medical health insurance products.

There are 29 Non life insurance companies and five stand alone health insurance
companies in India.

The five stand alone health insurance companies are as follows-

1. Max Bupa health insurance company ltd

2. Religare health insurance company ltd

3. Star Health and Allied Insurance company ltd

4. Apollo Munich health insurance company ltd
5. Cigna TTK health insurance company ltd

The Non life insurance companies are-

 Aditya Birla Health Insurance Co. Ltd.

 Bajaj Allianz General Insurance Co. Ltd.
 Bharti AXA General Insurance Co. Ltd.
 Cholamandalam General Insurance Co. Ltd.
 Future Generali India Insurance Co. Ltd.
 HDFC ERGO General Insurance Co. Ltd.
 ICICI Lombard General Insurance Co. Ltd.
 IFFCO-Tokio General Insurance Co. Ltd.
 Kotak General Insurance Co. Ltd.
 L&T General Insurance Co. Ltd.
 Liberty Videocon General Insurance Co. Ltd.
 Magma HDI General Insurance Co. Ltd.
 Raheja QBE General Insurance Co. Ltd.
 Reliance General Insurance Co. Ltd.
 Royal Sundaram Alliance Insurance Co. Ltd
 SBI General Insurance Co. Ltd.
 Shriram General Insurance Co. Ltd.
 TATA AIG General Insurance Co. Ltd.
 Universal Sompo General Insurance Co .Ltd.

In 2000, India allowed entry of private companies in insurance industry by

placing a restriction on FDI to 26%. In 2014, FDI limit is increased to 49%.
Firstly, in 1986 Health Insurance Products were introduced at a time when Indian
insurance sector were nationalized. The rule embedded to health insurance
policies were complex to understand and provides limited coverage under the
policy. There were no direct claim settlement between hospital and insurer and
also there was no TPA (Third Party Administrator) work in India . Therefore,
there were issues regarding claim services. At that time, this business was not
 able to earn profits for insurers and also not too much popular in the general
public.

Present Scenario

Health insurance is a growing sector of Indian economy and this industry grown due to public
awareness and liberalization of economy. The Indian health sector is one of the biggest health
sectors in world, with many numbers of people it deal with: approx 1.3 billion potential
beneficiaries. In terms of job creation and income, the Indian health industry has become one of
the most significant industries in the country. In 2018, 10 million Households of India do not
benefit from health coverage. On 25th September, the government of India discloses the launch
of health insurance policy for the poorest public of India. This new policy announced with the
hope to reach more than 500 million general public of India and named as “Modicare”.

In 2016, theNational Sample Survey Office (NSSO) posted the report “Key Indicators of Social
Consumption in India: Health” based on its 71st round of surveys. The survey found out in
2014, more than 80% of Indian people are not covered under health insurance policies, and only
18% of the urban population (government funded 12%) and 14% of the rural population
(government funded 13%) was covered under health insurance.

In 2011, 3.9% of India's Gross Domestic Product (GDP) becomes spent inside the
health sector. Policies are preparing that offer individual and family cover. .In the
opinion of World Bank, by 2010, over 25% of Indian population approached some
type of medical coverage to improve the knowledge and decrease the delay for
purchasing medical coverage. The GIC (General Insurance Corporation) of India and
the IRDA (Insurance Regulatory and Development Authority) had launched a program
that creates awareness about health insurance for citizen of India. In 2007, the National
Health Insurance Program (RSBY- Rashtriya Swasthya Bima Yojana) is driven by the
Ministry of Health and was received by 29 states in 2014. It is fi nanced 75% by the
central govermnment and 25% by the state government. The employee and 4 of his
wards profit by medical coverage on the off chance that they are not insured under any
framework and live beneath the neediness line. In 2001, TPA (Third party administer)
was introduced by IRDA (Insurance Regulatory and Development Authority), which
worked as a link between the insurance company and the hospitals and thus permitted
insurer to offer cashless services on their polices.

In India, health insurance provided by both private and public companies. General health offices
– basic care offered by local clinics, provincial emergency clinics, national medical clinics - are
financed by the state government and the administrative state and overseen by the state experts.

Health insurance sector has announced a growth of more than Twenty percent in collection of
premium for the third year consecutively.

In 2017-18, Health and general insurance companies collected 37029 crore as premium of
health insurance, record a growth of 21.8 % over 2016-17, as per the annual report of
IRDAI(Insurance Regulatory and Development Authority of India).

In 2017-18, health and general insurance company issued 1.47 crore policies of health insurance
(excluding travel and personal accident policies), covering 48.20 crore people, a growth of 10 %
in the number of people covered over preceding year.

Three-fourth of people covered under government-financed health insurance plans, and the one-
fourth people by individual and group policies issued by health and general insurers.

There is also boost in net ICR (incurred claims ratio) in financial year 2017-18. The public sector
general insurers held market share at 58 % in year 2017-18. The private general insurers shares
increased to 21% in year 2017-18 from 19 % in year 2016-17, and the standalone health
insurers shares in health premium increased to 21% from 18 % in year 2016-17.

Standalone health insurance companies reported an underwriting losses in year 2017-18, around
436 crore, in contrast of an underwriting losses of 261 crore in year 2016-17.
 300

250

200

150

100

50

0
2011 2012 2014 2017P 2020P

PREMIUM INCREASES YEAR PER YEAR

FUTURE OF HEALTH INSURANCE IN INDIA

In the Indian general insurance industry, health insurance is the second biggest sector. It has set
to achieve new heights in the next few years as private and public insurers are approaching up
with a variety of schemes to cover the available insurance market. As per recent findings, the
health insurance industry of India is one of the majority prolific ones in world. Health sector is
predicted to increase at 17% in future (most probably it will achieve $280 billion by 2020).

As a mass of residents in India is alive with HIV/AIDS, the private health insurers are cashing in
on the huge possibility by scheming unique policies for such people. India possibly will soon
spot a national health insurance plan for people alive with HIV. The NACO (National Aids
Control Organization) is scheduling to create insurance ' universal and inclusive for PLHIV', we
observed though analyzing and studying trends in health insurance industry of India.

There are approx 28 active (TPAs) third party administrators in India, and infrastructure of TPA
in the nation has witnessed a growth with the increasing penetration of health sector. The TPAs
are known as important service providers in the health industry .As per study, portability in
Health insurance is also popular in India as it permits health insured to change companies while
retaining their NCB (no-claims bonus) benefit.

1.2 Amendment in Health Insurance

To capture details about health Insurance company, we must first understand what are the
amendments produced in this sector from time to time. With increase in life expectancy,
disposable income of people and increase in importance of heath awareness, there are certain
amendments coming along which are needed to be mentioned as given below:

 All Health Insurance products can now be renewable for lifetime, without any renewal
restriction age. Hence for example, if some person takes health insurance at later age of
life, it can be renewed without any new formality or any kind of restriction.

 Grace period to renew Health Insurance now is 30 days, before insurance company has
right to inform customer for reminding customer to renew the policy before it gets
expired

 One of the recent amendments is health Insurance policies from Life insurance
Companies will have 5 years of minimum term, whereas for a Non-Life company it could
have a maximum term of 3 years.

 Through one of the amendments, a clear procedure has been charted out where parents
are empowered for smooth migration of children from Floater plans to their own
independent plans.

 All the insurers will be mandatorily now having to put their policy wordings of all their
products on their website. Few of the insurers were there in past who were not keeping
this information public. Hence forth keeping this information on their website is
mandatory for all Insurers.
 In case of Denial of Coverage, the communication and Loading on fresh Health Insurance
proposals should be given in writing.

 The claim and Grievance cells for senior citizens should be separate.

 Also, it was made clear through this amendment that loading on Claims will be done only
when an individual claim for 3 consecutive years exceed 500% of the renewal premium.

 Now it is up to Health Insurance Customers with multiple insurance policies, can have a
choice where he can choose any product out of it which suits him better. Contribution
would be effected between Insurance companies, without involving the customer.

 It is expected by IRDA to release soon the Standard Definitions, Exclusions, and Forms
(like Claim Forms) in near future.

 In policy wording it is mandatory to mention in detail with clarity about Renewal

Procedure (regarding maximum age, changes in coverage at later ages, upgrading cover,
loading charges) .

 In case of any change in Terms of the policy at the time of renewal, it should be
communicated with the policy holder 3 months before the renewal date.

 Insurers are required to mandatorily settle claims within 30 days of submission of

complete documents.

 Insurance Companies cannot reject claims on technical grounds of delayed submission, if

the customer can provide valid reasons for the delay caused.

 Cashless Cards should be issued within 15 days of issue of the Health Insurance
Policy. There is no requirement to issue Fresh cards every year on renewal. The same
cashless card can be continued every year.
  One of the important amendments is Hospital Network would be the responsibility
of the Insurance Company, and not the TPA (which is the case currently) Insurance
Companies would be required to make direct agreements with Hospitals. These
agreements could be tripartite with the TPA. In short, Insurance Companies would
administer the network and would be held responsible for issues that arise in the network.
(Since TPAs were originally brought in to primarily administer the network of hospitals,
their role after these regulations take effect, would be diluted significantly.)
 Also Group Health Policies may be offered by any insurer for a term of one year except
credit linked products where the term can be extended up to the loan period not
exceeding five years.
 In case of Any Change of TPA in a policy should be informed to customer with 30days
of such change. All data should be seamlessly transferred to the new TPA, ensuring there
is no hassle caused to the customers.

1.3 ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED

This is to mention that ICICI LOMBARD GIC LTD is one of the main private general insurance
company in India with a GPW (gross written premium) ofRs147.89 billion for the year finished
March 31,2019.The below are given no of policies issued V/s no of claims settled led as on
march 31,2019 :

No of Policies issued: 26.5 Million policies

No of claims settled: 1.6 Million claims

ICICI Lombard was begun in 2001 as a joint scheme between Fairfax Financial Holdings and
ICICI bank. Throughout the years, it has developed quickly along with insurance industry of
India. In 2019, it turned into the fourth largest general insurance corporation in the nation. Its
GDPI (Gross Direct Premium Income) has developed as a CAGR of 13.9% among 2008-2018 to
achieveRs123.57billion(US$1.92billion).
a. MILESTONE OF ICICI LOMBARD GIC LTD

ICICI Lombard – Nibhaye Vaade

2017 - become a listed company, GDPI crossed Rs 100 billion (US$ 1.54 billion)
2016-First non-life insurance company in India to issue subordinated debt
2015-Investment book amount crossed Rs 100 billion (US$ 1.56 billion)
2014-Number of policies issued surpassed 10 million
2010-Settled more than 5 million claims
2006-Crossed Gross Direct Premium Income (GDPI) of Rs 10 billion (US$ 220.61
million)
2004-Became India’s largest private sector general insurer
2001-Commenced non-life insurance operations

b. Awards and Recognitions

A customer centric approach always makes ICICI Lombard General Insurance to receive various
awards and accolades in its business area. These awards are a evidence to the confidence reposed
in the organization by its clients.

In 2017,wins the Asia Quality Excellence & Leadership Awards

ICICI Lombard received the Golden Peacock Award for Business Excellence and the
Claim Service Leader Award in 2016.
Golden Peacock Innovation Management Award in the year 2015.
In 2019, Effie ‘Silver’ Award for the health insurance campaign “Tension nahin,
Insurance lijiye”.
ICICI Lombard have been adjudged “India’s Leading General Insurance Company –
Private” at the Dun & Bradstreet BFSI Award 2018.
Finnoviti Awards – The Company won the coveted Finnoviti Award 2018 for its app
‘Risk Inspect’ for real time property risk assessment.
 IBAI Wards – ICICI Lombard was adjudged “Most Policyholder and Broker Friendly
Insurer, 2017” - Top Quartile. The award was presented by Insurance Brokers
Association of India.

(B)HDFC Ergo General Insurance Company Ltd

HDFC ERGO General Insurance Company Limited is a shared project between ERGO
International AG and HDFC Ltd. , Ergo is a Germany-based corporation that is branch of
the Munich Re Group. HDFC holds 51 per cent, and ERGO the other 49 per cent. The company
operates in 101 cities of India with more than 127 branches and 2,000 plus staff members.

This company offers a variety of non-Life insurance products from Health, Motor,
Travel, Personal Accident and Home customized policies like Marine, Property and
Liability Insurance.
It is the fourth leading private sector Non-life insurance company in India. HDFC ERGO
General
It is 3rd largest General Insurance Company in private sector, with Gross Written
Premium of ` 8,722 crore for FY19 and market share of 5.1% as at March 31, 2019.
Issued more than 8.5 million policies and serviced 2.1 million claims in FY19.
Comprehensive product portfolio along with a balanced channel mix.
Solvency ratio of 175 % vis-à-vis IRDAI required solvency ratio of 150%.
iAAA rated by ICRA (A Moody's Investors Service Company) indicating highest claims
paying ability.
Credit rating of ICRA/AAA and CRISIL/AAA with a stable outlook for the Non-
Convertible Debentures (Subordinated Debt) programme.
Pan-India presence across 122 branches in 106 cities and a close knit family of 3,300+
professionals.
ISO certified processes for Claims Services, Operations and Customer Services and
The firm is a private company and is categorized as non-government Company. The
company's authorized share capital is 6,000,000,000 and its paid up capital is
5,386,202,600.
It received an ISO Certification in 2010.
 In June 2016, the firm announced the takeover of the L&T General Insurance for
approximately 551 crores; this was approximately 1.1 times the gross premium of the
last. The merger completed on 23 August 2017.
On 19th June 2019 HDFC announced that it has acquired majority stake in Apollo
Munich Health Insurance for Rs 1,346.84 crore.
Apollo Munich will be amalgamated with HDFC ERGO General Insurance Company
Limited

Products and services

Retail Products - Motor Insurance, Health Insurance, Travel Insurance, Home Insurance,
Personal Accident
Rural Products - Parivar Suraksha Bima Gramin Suraksha Bima, , Cattle Insurance,
Weather Insurance, Crop Insurance
Commercial Products -,Property Insurance, Engineering Insurance, Liability Insurance

Achievements
Rated iAAA which indicates the firm's highest paying ability by IRCA.
Awarded the Best Insurance Company in Private Sector - General by the World HRD
Congress at ABP NEWS - Banking, Financial Services & Insurance Awards 2014.
Awarded by International Alternative Investment Review (IAIR) as the Best General
Insurance Company in India, 2013 and 2014.

(c) SBI General Insurance

SBI General Insurance Company Limited is a joint project between the Insurance Australia
Group (IAG) and State Bank of India. State Bank of India owns 74% and Insurance Australia
Group owns 26%. SBI General in association with State Bank of India covered over 1.5 Crore
Saving Bank Account holders of SBI with a Personal Accident Insurance cover. SBI General has
also established its presence in nearly 14,000 Branches of State Bank of India.
In Financial year 2016-17, SBI General Insurance Company Limited (SBIG) had a gross
written premium of Rs.2.604.5 crore leading to a growth of 28%.
Since 2017, the insurer's occurrence extends to 110 cities pan India with more than 2600
employees.

SBI General Insurance, a subsidiary of State Bank of India, on Friday reported 11.3 per
cent year on year growth in profit before tax at Rs 470 crore for the financial year ended
March 2019. The company had posted profit before tax of Rs 422 crore in the last fiscal,
SBI General Insurance said in a statement.
The company's underwriting profit, a difference between premiums collected on insurance
policies by the insurer and expenses incurred and claims paid out, jumped 146 per cent to
Rs 79 crore in FY19 as compared to Rs 32 crore in FY18.
The GWP (Gross Written Premium ) of the corporation increase by 33 % to Rs 3,553 crore
as on March 31, 2019, vs. Rs 4,717 crore in 2017-18. However, the solvency ratio declined
marginally to 2.34 in FY19 against 2.54 last year. GWP are the total revenue from a
agreement expected to be received by an insurer before deductions for reinsurance or
ceding commissions.
Commenting on the earnings numbers, SBI General Insurance MD Pushan Mahapatra said
that the company has recorded a robust top line and bottom line growth. "Our focus is on
becoming digital ready in the near future in order to cater to product segments in travel,
health and personal accident space," he said.
SBI General Insurance Company Limited is a joint endeavor between the State Bank of
India and Insurance Australia Group (IAG). SBI owns 70 per cent of the total capital, while
IAG holds 26 per cent stake in the company. Last year, SBI offloaded 4 per cent stake in its
subsidiary to Axis New Opportunities AIF and Premji Invest for Rs 482 crore.
SBI General Insurance reported net profit growth of about 150 per cent in 2017-18 to Rs
3.96 billion. Underwriting profit was Rs 320 million, against a loss in this segment of
almost Rs 2 billion in FY17.
Pushan Mahapatra, managing director, added: “We have also recorded a lower loss ratio
and minimised our operating expenses further.”
 The ratio of operating expenses ratio to GWP improved from 21 per cent in FY17 to 18 per
cent. The claims ratio declined from 75 per cent to 71 per cent.
The company expects a growth rate for the coming quarters of 36 per cent, double that of
the sector.
“Health (insurance) grew 19 per cent last year, with good growth expected to continue this
year,” Mahapatra told Business Standard, with the majority of covers being sold to semi-
urban and rural customers. The combined ratio improved to 98 per cent, without accounting
for extraordinary income, from 113 per cent in FY17.
The solvency ratio improved from 2.19 in FY17 to 2.54 in FY18. Motor insurance
premiums grew 44 per cent and fire insurance by 10 per cent. Crop insurance grew 125 per
cent.
Motor insurance is 28 per cent of SBI General’s premium revenue, followed by fire at 23
per cent, and crop insurance at 20 per cent. Health insurance covers, including those for
personal accidents, were 14 per cent.

(d) TATA AIG GENERAL INSURANCE

Tata Aig General Insurance Company Limited is a shared endeavor between American
International Group, Inc. (AIG) and Tata Group. The Tata Group owns 74 per cent stake in the
insurance venture with AIG holding the rest 26 percent. Tata Aig General Insurance Company,
which started in India on January 22, 2001, provides insurance solutions to individuals and
corporate.

A wide range of product offered by Tata Aig general insurance including insurance for personal
accident, automobile, home, energy, travel, marine, property and casualty. The company's
products are accessible through distribution channels like banks, agents, broker (through bank
assurance tie ups), and direct channels like digital marketing, telemarketing worksite etc.

It has an asset base of estimated INR 10,050 crores. (as of 31st March 2019).
With more than 200 offices spread across India, the Company has a robust
multi-channel distribution network of 22,000+ licensed agents and 390+
licensed brokers. The Company has a workforce of over 5,000 employees,
including 550+ claim experts and a dedicated Customer Service & Operations
team (as of March 2019), consistentl y del ivering superior service experiences
powered by the latest innovations in technology.
The gross written premium for the company increases at a pace of 30%in
FY2017-2018 as the gross written premiums are increases from Rs 4297 crore
in FY2016-2017 to Rs 556 7 crore in FY2017 -2018.
Awards Won by TATA AIG Insurance Company

 TATA AIG was honored as the "General Insurer Claims Team of the Year" by Claims
Awards Asia 2013
 Tata AIG was awarded as the "Best Travel Insurance Company of the Year" by CNBC
Awaaz Travel Awards 2013
 TATA AIG's Health Insurance Cover MediPrime was renowned as the Best product
Innovation award in the health sector

Achievements of TATA AIG Insurance Company Limited

 TATA AIG General Insurance Company was renowned as the Best Employer of the year
by Asia Insurance Review, Singapore
 TATA AIG's CEO Mr. K.K.Mishra was renowned with the "Corporate Excellence
Award for CEOs with Excellence in Finance" honor by the Institute of Public Enterprise
 TATA AIG's VP – E-Business & Marketing Mr. Gunjan Ghai was honored as 50 Most
Talented CMO’s of India. This gratitude was given at the 22nd Edition of World Brand
Congress

(e) United India insurance Company

United India Insurance Company Limited is a government owned General Insurance Company
of India. Its headquarter is in Chennai. The Gross Domestic Premium for the FY 2018-19 is
Rs.16385 Cr. It was started on 18th Feb 1938,but nationalized in 1972. United India has recorded
a massive growth in terms of both expansion and revenue. Currently it has more than one crore
policy holders, and 18,300 employees. The GDP(Gross Domestic Premium) for the Financial
Year 2018-19 is Rs.16385 Cr. United India has been large clients like ONGC Ltd, Mumbai
international airport etc. United India Insurance Company (UIIC) was previously a subsidiary of
the General Insurance Corporation of India (GIC). As per IRDA Act 1999 while GIC turned into
a reinsurance company, its 4 subsidiaries namely New India Assurance, Oriental Insurance,
National insurance and United India Insurance got self-government. The formation of United
India Insurance Company Limited was the result of amalgamation jointly 5 foreign insurance
companies, 12 Indian Insurance Companies, 4 cooperative insurance societies and southern
region general insurance operations of LIC India.

. The company has made its existence in 200+ Tier II & III villages and towns through its
inventive Micro Offices. United India Insurance Company Limited also played a revolutionary
role in terms of taking out Insurance to rural people with large executions of policies like Vijaya
Raji Janani Kalyan Yojana covering 45 Lakh women in Madhya Pradesh & Universal Health
Insurance Programme of Government of India, Tsunami Jan Bima Yojana, National Livestock
Insurance and other similar schemes. It has been rated ‘AAA/Stable’ by CRISIL.
Chapter 2

Review of literature
Objective of study

 Comparative analysis of health insurance products

 Comparative analysis between

1. ICICI LOMBARD COMPLETE HEALTH INSURANCE

2. HDFC ERGO HEALTH SURAKSHA SILVER PLAN
3. SBI GENERAL AROGYA PLUS
4. TATA AIG MEDI PRIME HEALTHINSURANCE
5. UNITED INDIA FAMILY MEDICARE POLICY

Study of benefits and features of these plans

Health insurance

Health assurance offers a large variety of health assurance plans for buyer. Flexible policy term,
premium payments, treatment coverage, riders and hospital networks are surrounded by the
many perks that come with buying a health plan.

Structure and organization

The Indian societal shield scheme provide coverage for insured persons against risks associated
to old age, death, but also sickness and unemployment and finally industrial accident at work
and occupational diseases

This social shield scheme is not worldwide and provides only partial coverage, targeting
primarily organized sector's workers constituting less than 10% of the populace in India. societal
security and health insurance is defined by 5 main texts in India:

The Employees (Workmen's) Compensation Act, 1923;

The Employees' State Insurance Act, 1948;

Employees' Provident Funds & Miscellaneous Provisions Act, 1952;

The Maternity Benefit Act, 1961;

The Payment of Gratuity Act, 1972;

Societal security remuneration are mainly managed by: EPFO(Employee Provident Fund
Organization and ESIC (Employee State Insurance Corporation) .

Types of policies

Health insurance in India usually pays for simply inpatient hospitalization and for treatment at
hospitals in India. Outpatient services were not owed under health policies in India. The original
health policy in India was Mediclaim Policies. In Year 2000, Indian government liberalized
assurance and permitted private players into the assurance sector. The introduction of private
insurers in India saw the preamble of many innovative products like, top-up plans, family floater
plans, critical illness plans, top up policies and hospital cash.

The health insurance industry hovers approximately 10% in density calculations. The main
reason for the low penetration and coverage of medical insurance are the be short of competition
in the insurance sector. IRDA which is accountable for assurance policies in India can create
health circles, similar to telecom circles to promote competition.

Government health services are accessible to all people under the tax-financed public system. In
practice, bottlenecks in accessing such services require households to seek private care, resulting
in high out-of-pocket payments.

Health insurance policy in India today can be largely classified into these categories:

Hospitalization

Hospitalization policies are indemnity policy that compensates expenditure of

hospitalization and medical expenses of the insured subject to the sum insured. The sum
insured can be applied on a for each member basis in case of individual health plans or
on a floater basis for family floater policies. In floater policies the sum insured can be
utilized by any of the members insured under the plan. These plans do not generally pay
any cash benefit. In accumulation to hospitalization benefits, particular policies may offer
a number of extra benefits like newborn coverage and maternity , domiciliary benefits,
day care procedures for specific procedures, pre- and post-hospitalization care where
patients cannot be moved to a hospital, daily cash, and convalescence.
There is an additional type of hospitalization policy called a top-up policy. Top up
policies have a high deductible usually set a level of existing cover. This policy is
besieged at people who have some amount of assurance from their employer. If the
employer provided cover is not sufficient people can add-on their cover with the top-up
policy. However, this is subject matter to deduction on each claim reported for each
member on the final amount payable.
Family Floater Health Insurance:

Family health assurance plan covers whole family in single health insurance policy. It
works under hypothesis that not the entire family member will suffer from illness in one
point in time. It covers hospital expenditure which can be pre and post. Most of health
assurance companies in India offering family insurance have good quality network of
hospitals to assistance the insurer in time of urgent situation.

Pre-Existing Disease Cover Plans:

It covers against disease that insured had before purchasing health policy. Pre-Existing
Disease Plans offers conceal against pre-existing disease e.g. kidney failure, diabetes and
many more. After Waiting period of 2 to 4 years it gives all covers to insured

Senior Citizen Health Insurance:

According to name these kind of health insurance policy are for older people in the
family. It offers protection from health issues throughout old age. As per guidelines of
IRDA, every insurer should provide cover up to the age of 65 years.
Maternity Health Insurance:
Maternity health insurance ensures up to the extent of maternity and other added
expenses. It provides cover for both pre and post natal care, baby delivery (either
caesarean or normal). The maternity insurance provider have huge range of network
hospitals and cover provided for ambulance expense. These services are observed by the
Maternity Benefit Act. The Maternity Benefit Act cover those women who do not
covered by the ESI but who are worked in mines, circuses, factories plantations, shops or
other orgnaization employing at least 10 persons. Also covered are women employed in
an organization covered by the ESI, but whose salary more than the ceiling of subjection.
The Indira Gandhi Matritva Sahyog Yojana (IGMSY) program, launched in 2010 by the
Ministry of Women and Child Development, has been set up in some districts (52 in
2017). This program is advised for pregnant women aged 19 or more than 19, during
their first 2 pregnancies (viable child). The benefit contains of a amount of RS 6000 paid
in 3 installments, subject to having performed the obligatory health examinations for the
child and the mother
  to 6 months of the child
 at the end of the 2nd trimester of pregnancy
 at birth
Hospital daily cash benefit plans:
Hospital Daily cash benefits are a defined benefit policy that gives a defined sum of
money for each day of hospitalization. The payments are given for defined number of
days in the policy year.
Critical illness plans:
Critical illness plans are benefit based plans which pay a lump sum (fixed) amount on
diagnosis of critical illness mentioned in the policy and medical procedures. These illness
are normally specific and high severity and low frequency in nature that high cost when
compared to day to day treatment need. e.g. Cancer, stroke, heart attack etc. Now some
insurance company has come up with choice of staggered payment of claims in
combination to upfront lump sum payment.
Disease specific special plans:
Some insurance companies offer specially designed disease specific policy like Dengue
Care. These are drafted keeping in mind the increasing oce of viral diseases like Dengue
in India which has become a cause of uneasy and thus provide facility based on
behavioral, medical need and lifestyle factors related with such conditions. These plans
primarily aim to help customers handle their unexpected health expenses at a minimal
cost.

The main publicly funded health insurance schemes

Plans funded by central government

 Employee State Insurance scheme: This scheme covers organized private sector workers,
which is about 55 million people.

 Central Government Insurance Scheme: This scheme covers central government agents
and retirees, i.e. about 3 million people.
  RSBY: this scheme covers families below the poverty line of about 40 million families.

Federally funded schemes

 Andhra Pradesh: This plan covers families under the poverty line or with yearly income
less INR 75,000. It represents 70 million beneficiaries.
 Karnataka: this plan covers members of rural cooperatives, more than 3 million people
 Tamil Nadu: This plan funds families below the poverty line or with yearly income less
INR 72,000, which represents about 40 million beneficiaries..

Key aspects of health insurance

Payment options

 Direct Payment or Cashless Facility: Under cashless facility, the individual does
not require to pay the hospital as the insurer pays directly to the hospital. Under this
scheme, the insured and all those who are mentioned in the policy can undertake
treatment from those hospitals approved by the insurer.
 Reimbursement at the end of the hospital stay: After staying for the period of
the treatment, the patient can take a reimbursement from the insurer for the treatment that
is covered under the policy undertaken.

Cost and duration

 Policy price range: Insurance companies propose health insurance from a sum
insured of 5000/ for micro-insurance policies to a higher sum insured of 50 lakh and
beyond. The general insurance policies for health insurance are commonly available from
1 lakh to 5 lakh.
 Duration: Health insurance policies offered by non-life insurance companies generally
for a period of one year. Life assurance companies offer plans for a period of several
years.
Tax benefits

Under Section 80Dof Income Tax Act the insured who takes out the policy can claim for tax
deductions.

ICICI Lombard General Insurance Highlights

Features Specifications

Network Hospitals 3600+

Waiting Period for Pre-existing Disease 4 years

Incurred Claims Ratio 76.89%

Number of Policies Issued 1014478
Grievances Solved 98.91%
Renewability Lifetime

HDFC Ergo General Insurance Company Ltd Highlights

Features Specification
Network hospital 8600+
Incurred claim ratio 74.36
Waiting period for pre existing disease 4 years
Number of policies issued 654375
Grievances solved 100.00%
Renewability Lifetime

SBI General Insurance Highlights

Features Specification
Network Hospitals 3000+
Incurred claim ratio 71.47%
Waiting period for pre existing disease 4 years
 Number of policies issued 417400
Grievances solved 96.01%
Renewability Lifetime

TATA AIG GENERAL INSURANCE HIGHLIGHTS

Features Specification
Network Hospitals 3000+
Incurred claim ratio 71.12%
Waiting period for pre existing disease 4 years
Number of policies issued 210310
Grievances solved 99.90%
Renewability Lifetime

United India Insurance Highlights

Features Specification
Network Hospitals 7000+
Incurred claim ratio 56.3%
Waiting period for pre existing disease 4 years
Number of policies issued 1230765
Grievances solved 96.59%
Renewability Lifetime
 Health Insurance Offered by ICICI LOMBARD:
 ICICI Lombard Health Booster
 ICICI Lombard Complete Health Insurance
 ICICI Lombard Health Care Plus Policy
 ICICI Lombard Group Personal Accident Policy
 ICICI Lombard Group Health Insurance
 ICICI Lombard Personal Protect Insurance Policy

Comparison chart of companies individual and family floater policies

ICICI LOMBARD COMPLETE HEALTH INSURANCE

HDFC ERGO HEALTH SURAKSHA SILVER PLAN
SBI GENERAL AROGYA PLUS POLICY
TATA AIG MEDI PRIME HEALTH INSURANCE
UNITED INDIA INSURANCE FAMILY MEDICARE POLICY

Name of ICICI LOMBARD HDFC SBI General TATA AIG United India
policy → Complete Health ERGO Arogya plus MEDI Prime insurance
insurance Health policy Health family
Parameter↓ suraksha Insurance Medicare
silver policy
Policy 1 or 2 year ,as per 1 or 2 year 1,2 or 3 years 1 or 2 years 1 year
period plans offered
For group only
one year
Entry age Individual policy- No limit for Minimum age 3 Minimum 18 Minimum age
Proposer must be of age at entry months and years Maximum – 18
18 years. maximum age 65 65years(For years Maximu
Children minimum Children years children 91 days) m age – 80
six years below 5 year years Children
No limit on the would be between the
upper limit entry age. covered only ages of 3
In floater plan, if both parents months and 18
children are covered are covered years will be
between the ages of 3 under HDFC covered if the
months and 5 years at ERGO parents are
least one adult covered.
 covered under this policies.
policy.

Basis Individual and Individual and Individual and Individual and Floater
Family floater Family floater floater Family floater
Medical test compulsory age of 45 compulsory compulsory after Compulsory after
compulsory
years (age as on last after the age the age of 45 age of 45 and
after the age of
birthday) and sum of 45 sum
45(50% insured
of
insured up to Rs.10 greater than Rs5
costs
lakh lakh
reimbursed on
qualification)
Sum insured Rs 3 lakh to Rs 50 Rs.3 lakh to Sum insured RS 2 lakh to Rs Rs.1 to 5 lakhs
lakh Rs.7.5 lakh options are Rs 1 10 lakh in increments
lakh,Rs 2 lakh,Rs of Rs.50,000,
3 lakh Rs.5 to 10
lakhs in
increments of
Rs.1 lakh
Renewability Lifelong Lifelong Lifelong Lifetime Lifelong
Coverage Hospitalisation cover Day care Room rent, Post and pre Day care
Post and pre procedures boarding hospitalisation treatment
hospitalisation costs expenses for expenses costs Ayush
Day care treatments 144 days Medical AYUSH treatment
cover practitioners fees treatments up to Cashless
AYUSH treatments at Ambulance Intensive care 25,000 facilities
approved hospitals expenses unit Ambulance Inpatient
Reset benefit Domiciliary Nursing expenses expenses hospitalisation
Additional sum expense Day Care Day Care expenses
insured In-patient expenses for 142 expenses for 140 Pre/Post-
Emergency treatment Day Care Days hospitalisation
ambulance cover Pre- and post- Procedures. Domiciliary expenses
Free health check-up hospitalisation Ambulance expense Organ donor
Wellness programme expenses expenses up to Waiting period hospitalisation
Preexisting diseases Organ donors INR 1500. of 2 years expense
covered after two treatment Domiciliary
year of waiting expenses hospitalization
period. AYUSH Maternity
Value added service treatments expenses
Optional coverage
Hospital daily cash
 Maternity benefit
Critical illness cover
Doner exxpenses

exclusion Expenses arising Expenses Per-existing Per-existing Per-existing

from HIV arising from disease will not disease will not disease will
Per-existing disease HIV covered for first covered for first not covered for
will not covered for Pregnancy, 48 month 48 month first 48 month
first 48 month dental and First nine month Expenses arising Dental
external aids exclusion for from HIV treatment
Per-existing maternity Naturopathy
disease will treatment
not covered
for first 48
month

ICICI Lombard Complete Health Insurance:

The ICICI Lombard Complete Health Insurance policy is a total health insurance solution that
aims to offer coverage to not just the proposer but also his family. Coverage options are also
flexible. Customers can opt to make their cover more comprehensive by opting to cover critical
illnesses in addition to the basic plan.

Features of ICICI Lombard Complete Health Insurance

Some of the prominent features of ICICI Lombard Complete Health Insurance can be listed as
follows:

 This policy is available in both individual and family floater variants.

 Any illnesses contracted within the first 30 days of the commencement of policy will not be
covered. However, this does not apply for accidents.
 All pre-existing diseases can be covered after 2 years of waiting period.
 This policy is available in five different sum insured options - Rs.3 lakh, Rs.4 lakh, Rs.5 lakh,
Rs.7 lakh, and Rs.10 lakh.
 Pre-hospitalisation medical expenses are covered for a period of 30 days before admission in
a hospital.
 Post hospitalisation medical expenses are covered for a period of 60 days after discharge from
a hospital.
 There is 2-year waiting period for certain illnesses like cataract, benign prostatic hypertrophy,
hernia, stone in the urinary system, etc.
 Voluntary deductible option is available under this policy to receive premium discounts.
 There is a free look period of 15 days during which policyholders can review the terms and
cancel the policy if not satisfied.
 The premium amount paid for this policy is eligible for income tax benefits as per Section
80D of the Income Tax Act.
 There is a 3-year waiting period for policyholders to avail benefits under the maternity cover.
 Pre-policy medical examination is required for people entering this cover after 46 years of
age.
 This policy is offered in 1 or 2 year policy terms.
 Free health checkup is available under this policy annually for up to 2 members in a floater
cover.
HDFC ERGO Health suraksha silver key feature
 Offers 1 or 2 years policy coverage period
 reward 10% family discount
 Avail cashless services across 5000+ hospitals
 Complete health plan with no sub-limits
 No limit for age at entry
 medical check-up mandatory after 45 years
 AYUSH cover available
 5% extra on Sum Insured for each claim-free year
 No limit for age at entry
 Lifelong renewability
 Enjoy hassle-free claims procedure
 SBI General Arogya Plus Policy key feature
 Both coverage options - Individual & Family Floater options.
 Medical test mandatory after age of 55 years for people with no medical history.
 142 Day Care expenses covered.
 Sum Insured choice of INR 1, 00,000, INR 2, 00,000 & INR 3, 00,000.
 OPD expenses as precise in the policy schedule.
 Coverage of Pre and Post Hospitalisation Expenses - 60 days before and 90 days after the
hospitalisation.
 Maternity Expenses covered up to the OPD limit.
 Save tax under Sec 80 D (Tax benefits are subject to change in tax laws).

 Key Features of Tata AIG MediPrime Plan

 Assured renewal of policy for life

 . The company has a direct claim service team so no use of third party administrators
(TPA) to process claims

 Wide range of coverage amount ranging from Rs.2 lacs to Rs.10 lacs

 No sub limits for hospitalization benefits

 Provides coverage for most day care procedures

 No need of pre-policy medical check-up up to 45 years and up to Sum Insured of Rs 5

lacs.

 Coverage for AYUSH in-patient treatments like Ayurvedic, Unani or Homeopathy

Key features of United India Family Medicare

 large cover for treatment adjacent to illnesses and accident
 No pre-policy medical tests required for Sum Insured up to Rs.10 lacs and age up
to 45 yrs
 Get coverage for pre hospitalisation, during hospitalisation, post hospitalization
Value-Added Benefits Under ICICI Lombard Health Insurance Plans:

Free value-added services offered by ICICI Lombard Health Insurance are:

 Free health check-up which includes medical examination, fasting blood sugar, urine
routine, blood grouping and CBC, ECG, PPBS – Post Prandial, and Total Cholesterol.
 Online chat with ICICI Lombard-appointed doctor.
 To help customers stay fit and healthy, benefit from the insurer’s value-added service -
dietician and nutritionist consultation.
 Specialist consultation with one follow-up session.
 The in-house wellness and claim processing platform, ICICI Lombard Health Care,
delivers multiple wellness initiatives and easy claim processing services.
 The Health Advisor facility is an online platform that enables customers to share their
experiences about medical facilities and record reviews.

ICICI Lombard Partners with Practo to Launch Health Insurance App for OPD
Expenses
ICICI Lombard and Practo amalgamated to launch IL Take Care healthcare app. With the help of
the app, the users can book health appointments, analyze reports and manage individual health
data. The app leverages Practo’s network of doctors, profiles of its thousands of users and an
infrastructure created by Practo to manage the exchange of information like prescriptions and
bills. Using that to its power, ICICI Lombard plans to offer outpatient health insurance products
to its users. This health insurance app takes care of outpatient (OPD) expenses of all of its
customers.

OPD insurance is relatively popular in developed countries but has limited scope in the Indian
insurance industry, mainly due to lack of authentic digital records of patients, their health history
and a digitized infrastructure for prescriptions and medical bills. The patients insured under
relevant policies from ICICI Lombard taking the service from a doctor or a medical
establishment empanelled with the platform will be able to make use of this solution. It will also
help the doctor community to provide a better, more seamless experience to their patients.
Recommendations:

An early entry to any policy is always beneficial

Lesser premium is to be paid
There are proper checks and advises on fitness
No medical required in the initial years
Conclusion

By review the policy of different 5 companies it has been noticed that whichever
policy insured take he needs to take care of-

Inclusion and exclusion

Entry and Exit age
Renewable process
Any checkup required
Waiting period
Hassle free claim settlement process
AYUSH coverage
Portability of policy
Other value added services
 After the study of all 5 plans I think the ICICI LOMBARD complete health
insurance is better because it provides add-on cover of critical illness up to
sum insured, for coverage of child in family floater policy only one person
are needed to covered under this plan.

References
BIBOLOGRAPHY

https://www.irdai.gov.in
www.icicilombard.com
www.hdfcergo.com
www.sbigeneral.in
www.tataaig.com
https://uiic.co.in/