“A study on awareness

of health insurance among the lower income group people.”

A Project Submitted to

University of Mumbai for partial completion of the degree of

Bachelor in commerce (Banking & Insurance)

Under the Faculty of Commerce

By

PRIYANKA K. GHOSH

Under the Guidance of

PROF. URVI JAIN

RSET’s

Ghanshyamdas Saraf College of Arts & Commerce

Affiliated to University of Mumbai

Reaccredited by NAAC with ‘A’ Grade

S.V. Road, Malad (West)

Mumbai- 400064

(April-2020)

1
“A study on awareness of health insurance among the lower income
group people.”

A Project Submitted to

University of Mumbai for partial completion of the degree of

Bachelor in commerce (Banking & Insurance)

Under the Faculty of Commerce

By

PRIYANKA K. GHOSH

Under the Guidance of

PROF. URVI JAIN

RSET’s

Ghanshyamdas Saraf College of Arts & Commerce

Affiliated to University of Mumbai

Reaccredited by NAAC with ‘A’ Grade

S.V. Road, Malad (West)

Mumbai- 400064

(April-2020)

2
 RSET’s

Ghanshyamdas Saraf College

of Arts and Commerce

Affiliated to University of Mumbai

Reaccredited by NAAC with ‘A’ Grade

S.V. Road, Malad (W)

Mumbai – 400064

CERTIFICATE

This is to certify that Ms. Priyanka K. Ghosh has worked and duly completed her
Project Work for the degree of Bachelor in Commerce (Banking and Insurance)

under the Faculty of Commerce in the subject of and his project is entitled, “A
STUDY ON AWARENESS OF HEALTH INSURANCE AMONG
THE LOWER INCOME GROUP PEOPLE.” under my supervision.

I further certify that the entire work has been done by the learner under my guidance
and that no part of it has been submitted previously for any Degree or Diploma of any
University.

It is her own work and facts reported by her personal findings and investigations.

___________________________ _____________________
Project Guide Principal

Date:
___________________________
External Examiner

Date :

3
 DECLARATION BY LEARNER

I the undersigned Ms. PRIYANKA K. GHOSH here by, declare that the work

embodied in this project work titled “A study on awareness of Health Insurance

among lower income group people.”, forms my own contribution to the research work

carried out under the guidance of Prof. Urvi Jain is a result of my own Research Work

and has not been previously submitted to any other University for any other Degree /

Diploma to his or any other University.

Wherever reference has been made to previous works of others, it has been clearly

indicated as such and included in the bibliography.

I, here by further declare that all information of this document has been obtained and

presented in accordance with academic rules and ethical conduct.

____________________

PRIYANKA GHOSH

Name and Signature of the Learner.

Certified by: - _________________

PROF. URVI JAIN

Name and Signature of the Guiding Teacher

4
 ACKNOWLEDGEMENT

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

is so enormous.

I would like to acknowledge the following as being idealistic channels and fresh

dimensions in the completion of the project.

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

this project.

I would like to thank my Principal, DR. JAYANT APTE for providing the necessary

facilities required for completion of this project.

I take this opportunity to thank our Chief Coordinator, DR. LIPI MUKHERJEE for

her moral support and guidance.

I take this opportunity to thank our Coordinator, PROF. URVI JAIN for her moral

support and guidance.

I would also like to express my sincere gratitude towards my project guide Prof. Urvi

Jain whose guidance and care made the project successful.

I would like to thank my College Library, for having provided various reference books

and magazines related to my project.

Lastly, I would like to thank each and every person who directly or indirectly helped

me in the completion of the project especially my Parents and peers who supported

me throughout my project.

5
 Index

CHAPTER TITLE OF THE CHAPTER PAGE

NO. NO.

1 INTRODUCTION: 1-47

1.1 WHAT IS INSURANCE

1.2 TYPES OF INSURANCE

1.3 INSURANCE POLICY COMPONENTS

1.4 CHARACTERISTICS OF INSURANCE

1.5 FUNCTIONS OF INSURANCE

1.6 PRINCIPLES OF INSURANCE

1.7 WHAT IS HEALTH INSURANCE

1.8 EVOLUTION OF HEALTH INSURANCE

1.9 IMPORTANCE OF HEALTH

INSURANCE

1.10 TYPES OF HEALTH INSURANCE

1.11 ADVANTAGES OF HEALTH

INSURANCE

1.12 DISADVANTAGES OF HEALTH

INSURANCE

1.13 HOW TO SELECT THE RIGHT

HEALTH INSURANCE POLICY

6
 1.14 COVERAGE OF HEALTH INSURANCE

1.15 ELIGIBILITY CRITERIA FOR HEALTH

INSURANCE
1.16 DOCUMENTS REQUIRED WHEN
BUYING A HEALTH INSURANCE POLICY

1.17 FACTORS AFFECTING HEALTH

INSURANCE CONSUMPTION

1.18 HEALTHCARE SCHEMES BY

GOVERNMENT OF INDIA

1.19 HEALTH INSURANCE COMPANIES

1.20 HEALTH INSURANCE CLAIM

PROCESS

1.21 GROWTH AND DEVELOPMENT OF

HEALTH INSURANCE IN INDIA

1.22 TREND IN HEALTH INSURANCE IN

INDIA

1.23 ISSUES AND CHALLENGES FACED

BY THE INDAIN HEALTH INSURANCE
CONSUMERS

1.24 KEY PARTICIPANTS IN THE HEALTH

INSURANCE INDUSTRY

1.25 BENEFITS OF BUYING HEALTH

INSURANCE ONLINE
1.26 BENEFITS OF BUYING HEALTH
INSURANCE AT EARLY AGE

1.27 AWARENRESS OF HEALTH

INSURANCE IS IMPORTANT

2 RESEARCH METHODOLOGY: 48-51

7
 2.1 TITLE OF THE RESEARCH STUDY

2.2 DURATION OF THE RESEARCH STUDY

2.3 RATIONAL OF TH RESEARCH STUDY

2.4 SCOPE & COVERAGE OF RESEARCH

STUDY

2.5 OBJECTIVES OF RESEARCH STUDY

2.6 RESEARCH DESIGN

2.7 SOURCES OF INFORMATION

2.8 SAMPLING DECISIONS

2.9 DATA COLLECTION ANALYSIS &

INTERPRETATION

2.10 SIGNIFICANCE OF RESEARCH

STUDY

2.11 LIMITATION OF RESEARCH STUDY

3 REVIEW OF LITERATURE 52-63

4 DATA ANALYSIS & INTERPRETATION 64-93

5 FINDING, SUGGESTION & CONCLUSION 94-97

ANNEXURE 98-100

BIBLOGRAPHY & REFERENCE 101-

104

8
 CHAPTER-1

INTRODUCTION

1.1 WHAT IS INSURANCE?

The word “insurance” is thought to derive from ensuren or insuren, meaning to give (a
formal) assurance. “Insurance” means an arrangement with a company in which a
person pay them regular amounts of money and they agree to pay the costs if, for
example, the policyholders die or get ill, or if he lose or damage something. Insurance
is a contract, represented by a policy, in which an individual or entity receives financial
protection or reimbursement against losses from an insurance company. The company
pools clients' risks to make payments more affordable for the insured. Insurance policies
are used to hedge against the risk of financial losses, both big and small, that may result
from damage to the insured or her property, or from liability for damage or injury caused
to a third party. Insurance is a contract (policy) in which an insurer indemnifies another
against losses from specific contingencies and/or perils. There many types of insurance
policies. Life, health, homeowners, and auto are the most common forms of insurance.

1.2 TYPES OF INSURANCE

1. Life Insurance

Life Insurance is different from other insurance , the subject matter of insurance is the
life of a human being. The insurer will pay the fixed amount of insurance at the time of
death or at the expiry of the certain period. At present, life insurance enjoys maximum
scope because the life is the most important property of an individual. Each and every
person requires the insurance. This insurance provides protection to the family at the
premature death or gives an adequate amount at the old age when earning capacities are
reduced.

2.General Insurance

9
The general insurance includes Property Insurance, Liability Insurance, and Other
Forms of Insurance .Fire and Marine Insurances are strictly called Property Insurance.
Motor, Theft, Fidelity and Machine Insurances include the extent of liability insurance
to a certain extent. The strictest form of liability insurance is fidelity insurance, whereby
the insurer compensates the loss to the insured when he is under the liability of payment
to the third party.

1.3 INSURANCE POLICY COMPONENTS:

• Premium: A policy's premium is its price, typically expressed as a monthly cost.

The premium is determined by the insurer based on individual or individual's
business's risk profile, which may include creditworthiness. For example, if a
person own several expensive automobiles and have a history of reckless
driving, you will likely pay more for an auto policy than someone with a single
mid-range sedan and a perfect driving record. However, different insurers may
charge different premiums for similar policies. So finding the price that is right
for the person requires some legwork.

• Policy Limit: The policy limit is the maximum amount an insurer will pay under
a policy for a covered loss. Maximums may be set per period (e.g., annual or
policy term), per loss or injury, or over the life of the policy, also known as the
lifetime maximum. Typically, higher limits carry higher premiums. For a
general life insurance policy, the maximum amount the insurer will pay is
referred to as the face value, which is the amount paid to a beneficiary upon the
death of the insured.

• Deductible: The deductible is a specific amount the policy-holder must pay

outof-pocket before the insurer pays a claim. Deductibles serve as deterrents to
large volumes of small and insignificant claims. Deductibles can apply
perpolicy or per-claim depending on the insurer and the type of policy. Policies
with very high deductibles are typically less expensive because the high out-
ofpocket expense generally results in fewer small claim.

10
1.4 CHARACTERISTICS OF INSURANCE

 Sharing of Risks - Insurance is a device to share the financial losses which may
occur to individual or his family on the happening of certain events

 Co operative Device -Insurance is a co-operative device to spread the loss caused

by a particular risk over a large caused by a particular risk over a large number of
persons who are exposed to it and who agree to insure themselves against the risk.

 Value of Risk - Risk is evaluated at the time of insurance. There are several methods
of valuing the risk. Higher the risks, higher will be premium

 Payment on Contingency -If the contingency occurs, payment is made; payment is

made only for insured contingency. If there is no contingency, no payment is made.
In life insurance contract, payment is certain because the death or the expiry of term
will certainly occur. In other insurance contract like fire, marine, the contingency
may or may not occur

 Amount of Payment of Claim - The amount of payment depends upon the value of
loss occurred due to the particular insured risk. The insurance is there upto that
amount. In life insurance insurer pay a fixed sum on the happening of an event or
within a specified time period. Example – In fire insurance, if fire occurs and half
the property is destroyed, but the whole property is insured, then payment of claim
will be made only for that half building that is destroyed not the whole amount of
insured.

 Insurance is different from Charity - In charity, there is no consideration but

insurance is not given without premium

 Large number of Insured Person - Insurance is spreading of loss over a large number
of persons. Larger the number of persons, lower the cost of insurance and amount
of premium and incase lower the number of persons, higher the cost of insurance
and amount of premium.

 Insurance is different from Gambling - In gambling, there is no guarantee of gain,

by bidding the person expose himself to risk of losing. Whereas in insurance, by
getting insured his life and property, he protect himself against the risk of loss.

11
1.5 FUNCTIONS OF INSURANCE

Functions of insurance can be divided into parts;

I . Primary Functions

o Certainty of compensation of loss: Insurance provides certainty of payment at

the uncertainty of loss. The elements of uncertainty are reduced by better
planning and administration. The insurer charges premium for providing
certainty.

o Insurance provides protection : The main function of insurance is to provide

protection against risk of loss. The insurance policy covers the risk of loss. The
insured person is indemnified for the actual loss suffered by him. Insurance thus
provide financial protection to the insured. Life insurance policies may also be
used as collateral security for raising loans.

o Risk sharing : All business concerns face the problem of risk. Risk and insurance
are interlinked with each other. Insurance, as a device is the outcome of the
existence of various risks in our day to day life. It does not eliminate risks but it
reduces the financial loss caused by risks. Insurance spreads the whole loss over
the large number of persons who are exposed by a particular risk.

II .Secondary Functions

o Prevention of losses : The insurance companies help in prevention of losses as

they join hands with those institutions which are engaged in loss prevention
measures. The reduction in losses means that the insurance companies would
be required to pay lesser compensations to the assured and manage to
accumulate more savings, which in turn, will assist in reducing the premiums

o Providing funds for investment : Insurance provide capital for society.

Accumulated funds through savings in the form of insurance premium are
invested in economic development plans or productivity projects.

o Insurance increases efficiency : The insurance eliminates the worries and

miseries of losses. A person can devote his time to other important matters for
better achievement of goals. Businessman feel more motivated and encouraged

12
 to take risks to enhance their profit earning. This also helps in improving their
efficiencies.

o Solution to social problems : Insurance take care of many social problems. We

have insurance against industrial injuries, road accident, old age, disability or
death etc.

o Encouragement of savings : Insurance not only provides protection against risks

but also a number of other incentives which encourages people to insure. Since
regularity and punctuality of payment of premium is a perquisite for keeping the
policy in force, the insured feels compelled to save.

1.6 PRINCIPLES OF INSURANCE

1. Principle of utmost good faith : A contract of insurance is a contract of -

Uberrimae Fidei - i.e., of utmost good faith. Both insurer and insured should display
the utmost good faith towards each other in relation to the contract. In other words, each
party must reveal all material information to the other party whether such information
is asked or not. There should not be any fraud, non disclosure or misrepresentation of
material facts.

2. Principle of Insurable Interest: This principle requires that the insured must
have a insurable interest in the subject matter of insurance. Insurance interest means
some financial interest in the subject matter of contract of insurance. Insurance interest
is that interest, when the policy holders get benefited by the existence of the subject
matter and loss if there is death or damage to the subject matter.

3. Principle of Indemnity : This principle is applicable in case of fire and marine

insurance only. It is not applicable in case of life, personal accident and sickness
insurance. A contract of indemnity means that the insured in case of loss against which
the policy has been insured, shall be paid the actual cost of loss not exceeding the
amount of the insurance policy. The purpose of contract of insurance is to place the
insured in the same financial position, as he was before the loss

13
4. Principle of Contribution: The principle of contribution is a corollary to the
doctrine of indemnity. It applies to any insurance which is a contract of indemnity. So
it does not apply to life insurance. A particular property may be insured with two or
more insurers against the same risks. In such cases, the insurers must share the burden
of payment in proportion to the amount insured by each. If one of the insurer pays the
whole loss, he is entitled to contribution from other insurers. Example – B gets his
house insured against fire for Rs. 10000 with insurer P and for Rs. 20000 with insurer
Q. A loss of Rs. 15000 occurs, P is liable to pay for Rs. 5000 and Q is liable to pay Rs
10000. If the whole amount of loss is paid by Q, then Q can recover Rs. 5000 from P
and vice versa.

5. Principle of Subrogation : The doctrine of subrogation is a collorary to the

principle of indemnity and applies only to fire and marine insurance. According to
doctrine of subrogation, after the insured is compensated for the loss caused by the
damage to the property insured by him, the right of ownership to such property passes
to the insurer after settling the claims of the insured in respect of the covered loss.

6. Principle of Causa Proxima : Causa proxima, means proximate cause or cause

which, in a natural and unbroken series of events, is responsible for a loss or damage.
The insurer is liable for loss only when such a loss is proximately caused by the peril
insured against. The cause should be the proximate cause and can not the remote cause.
If the risk insured is the remote cause of the loss, then the insurer is not bound to pay
compensation. The nearest cause should be considered while determining the liability
of the insured. The insurer is liable to pay if the proximate cause is insured.

7.Principle of Mitigation of Loss: An insured must take all reasonable care to reduce
the loss. We must act as if the property was not insured.

1.7 WHAT IS HEALTH INSURANCE ?

Health insurance is an agreement whereby insurance company agrees to undertake a

guarantee of compensation for medical expenses in case the insured falls ill or meets
with an accident which leads to hospitalization of the insured. Generally, insurance
companies have tie-ups with the leading hospitals so as to provide cashless treatment to

14
the insured. In case the insurance company has no tie-ups with the hospital, they
reimburse the cost of expenses incurred by the insured. The government also promotes
health insurance by providing a deduction from income tax.

Health insurance is a method to finance healthcare. The ILO defines health insurance
as the reduction or elimination of the uncertain risk of loss for the individuals or
household by combining a larger number of similarly exposed individuals or
households who are included in a common fund that makes good the loss caused to any
one member. Health financing is an important part of broader efforts to ensure social
protection in health. Since independence, the health care system in India has been
expanded and modernized considerably. There is growing evidence that the level of
health care spending in India is 6 per cent of its total GDP which is considerably higher
than that in many other developing countries. Even though the economic input is
increasing, the poor people of rural area are not reaping the benefits of it due to failure
at various levels. The rural population faces the same risks as the urban population such
as illness, injury, accident and death. The rural population is more vulnerable to such
risks because of their social and economic situation. There is a felt need to provide
financial protection to rural families for the treatment of major ailments, requiring
hospitalization and surgery.

Indian insurance sector is a substantial one and currently there are many health
insurance providers in India. The insurance regulatory body (IRDA) opened this sector
in 2000 and investment up to 26% is currently allowed to invest by foreign companies
in India. This sector consists of private as well as public sector companies to solicit
insurance within the regulations of IRDA. There are lots of options as far as insurance
companies are concerned, public as well as health insurance private operators as well.
Health insurance in India is popularly known as Mediclaim. PSU health insurance
companies have named basic health insurance plans as Mediclaim. Most of the general
insurance companies also provide health insurance products. The health insurance
companies in India whom IRDA has issued license for providing health insurance
products.

15
1.8 EVOLUTION AND ORIGIN OF HEALTH INSURANCE
The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen
from the Peter Chamberlen family. In the late 19th century, the early health insurance
was actually disability insurance, in the sense that it covered only the cost of emergency
care for injuries that could lead to a disability. This payment model continued until the
start of the 20th century in some jurisdictions, where all laws regulating health
insurance actually referred to disability insurance. Patients were expected to pay all
other health care costs out of their own pockets, under what is known as the fee-
forservice business model. During the middle to late 20th century, traditional disability
insurance evolved into modem health insurance programs. Today, most comprehensive
private health insurance programs cover the cost of routine, preventive, and emergency
healthcare procedures, and also most prescription dmgs, but this was not always the
case.

A Health insurance policy is an annually renewable contract between an insurance

company and an individual. Some health care providers will agree to bill the insurance
company if patients are willing to sign an agreement that they will be responsible for
the amount that the insurance company doesn't pay, as the insurance company pays
according to "reasonable" or "customary" charges, which may be less than the
provider's usual fee. The "reasonable" and "customary" charges can vary.

1.9 IMPORTANCE OF HEALTH INSURANCE

In today's date health insurance is of true importance in everyone s life. The spiraling
medical costs are not easy to afford. Buying a health insurance policy for yourself and
your family is important because medical care is expensive, especially in the private
sector. Hospitalisation can burn a hole in your pocket and derail your finances. It will
become even tough, if the person who brings in the money, is now in a hospital bed.
All this can be avoided by just paying a small annual premium which would lessen your
stress in case of medical emergencies.

16
A good health insurance policy would usually cover expenses made towards doctor
consultation fees, costs towards medical tests, ambulance charges, hospitalization costs
and even post-hospitalization recovery costs to a certain extent.

There are people who save funds in order to meet the healthcare needs in life. But the
health uncertainties can be major. In such cases to deal with the huge list of medical
expenses, people have to extract funds from their personal savings. This affects the
personal or family budge on which various other things might depend. So in order to
avoid any such situation it is important to prepare oneself for it. Buying an insurance
policy for health is the only provision that can be of great help in such cases. It protects
the person from having to bear the treatment expenses on his own. The policy covers
the person with a comprehensive canopy that ensures the total healthcare of the insured.
To take care of all the medical care needs of the policy holder, the plan weaves along
several beneficial features. The features like in-patient treatment, pre- hospitalization,
post- hospitalization, day- care procedures and health check- ups, and also takes care of
additional expenses that are incurred during the healthcare procedure. Besides this there
are optional features like critical illness cover. This is a feature that facilitates the best
health treatment during any major health ailment. The health insurance providers have
considered all sorts of problems faced by people in this regard. So they have formulated
several innovative policies that can cater to them the best healthcare services at the time
of requirement. It has added variety to the kind of insurance plans available for people.
It helps the person to choose the plan that can fulfill maximum healthcare needs of the
insured.

1.10 TYPES OF HEALTH INSURANCE

 Individual Health Insurance: This policy covers the health expenses and
hospitalization expenses of individual who has taken the policy. Premium under
this policy is determined as per the age of insured. An individual health
insurance is a type of health insurance policy customized for a single person;
typically, for people below the age of 40 years to safeguard and cover oneself
from various illnesses, hospitalization, and other medical emergencies that may
arise during your lifetime. While an individual health insurance is essentially

17
 designed for young people without families, you can still opt to cover for
dependents such as your senior parents, spouse and two children. Additionally,
if you’re planning to get married and have kids soon, you may also opt for the
maternity benefit in advance, to make sure you complete the waiting period just
in time.

Features of Individual Health Insurance :

 This kind of health insurance for individuals offers cover only for the insured
individual.
 The insurance provider covers certain medical costs of the insured based on the
premium paid.
 Hospitalization- The policy covers hospitalization charges.
 Lifetime renewal.
 Tax deductions under section 80D of the Income Tax act.
 Covers surgery costs, room rent, physician’s fee and laboratory tests.
 The insured has to pay a predetermined amount for certain health care services.
This is called co-payment.
 Pre and post hospitalization expenses are covered under this plan.
 Provides coverage for critical illness.

 Family Health Insurance Plan: Under this policy, an individual can include all
the family members against multiple diseases under a single cover. Family
health plan offers a fixed sum assured for the family members, which can be
availed by all members of the family or by any one individual in the family.
Benefits of Family Health Insurance Plan
 Hassle free
 Avail discount on family health plan
 Easy to add to family members
 Include parents insurance and in laws too
 Continuous policy coverage
 Attractive features
 Tax benefits

18
 Senior Citizen Health insurance Plan: Health insurance for Senior Citizens is
offered by various insurance companies, specifically for people who are aged
65 years and above. These health insurance schemes readily cover any kind of
medical expenses incurred by customers. The older we get, the more our
physical and mental stress over finances and the ability to afford good
healthcare. A senior citizen health insurance plan is designed to offer financial
aid for medical treatments to individuals over 60 years of age in their hour of
need. Senior citizen health insurance plans offer critical illness cover, cashless
hospitalisation, pre-existing disease cover, and a higher sum assured. With
increasing age comes the additional risk of contracting diseases and falling sick.
Since, the later years of an individual’s life are physically more challenging and
financially less sound, having a medical insurance scheme to take care of any
urgent medical expenditure is a clever move. Health insurance schemes for
senior citizens/parents offer, various special features like cashless
hospitalization, critical illness coverage, specific coverage for diseases like
Cancer, Stroke and so on.

Features of Senior Citizen Health Insurance:

 Hospitalization cover including medical bills and room charges

 Cashless Hospitalisation
 Day Care expenses which arise out of technological advancements
 Ambulance Charges are covered
 Pre-existing diseases are covered based on the insurance provider
 No medical test required before availing medical insurance. This is based on
insurance provider
 Higher sum insured coverage
 Pre-existing disease coverage
 Faster and hassle-free settlement

 Surgery and Critical Illness Insurance Plan: This plan is suitable for the insured
that requires treatment against critical illness, such as kidney failure, paralysis,
cancer, heart attack etc. As the medical expenses of these treatments are very
high, the premium applicable to these types of policies is also high. Critical

19
 illness insurance plans are meant to provide health cover against pre-specified
debilitating illnesses that can be very expensive to treat and usually take a long
time for recovery. Such illnesses can be very destructive for individuals and
their families as they result in extended and expensive diagnosis, apart from the
inability to work and offset the expenses in some way.

Features of Critical Illness Insurance Plan:

 Usually a 30 day grace period will be applicable after diagnosis (depending on

insurer), with compensation being paid out on survival during this period.
 Sum assured will be paid out as lumpsum post-hospitalization.
 Pre-medical check-ups required for people over a certain age limit (generally 45
years).
 Day care procedures can also be covered, wherein treatment such as dialysis
that can be done within a few hours will be covered.
 Pre-existing diseases are not covered under this health insurance plan, though
most insurers allow cover for pre-existing diseases on completion of a certain
period of uninterrupted premium payment (usually 4 years or more).
 Most insurers will have a list of cashless network hospitals where treatment can
be availed without payment of cash (settled by the insurer itself).

 Maternity Health Insurance Plan: This policy covers costs, including pre and
postnatal care, child delivery expenses of newborn babies. This policy is also
covered for the newborn up to a certain period of time as mentioned in the plan.
Ambulance costs are also covered. A maternity health insurance policy will
cover the hospitalisation and delivery costs of the new-born (be it a normal
delivery or a Caesarean), pre- and post-hospitalisation expenses, and pre- and
post-natal care of the new-born. In addition, the newborn is also provided a
health cover for a certain period of time after his/her birth. Maternity insurance
plans also cover ambulance charges, in most cases, in case the to-be mother
needs to be taken to the hospital by an ambulance.

 Features of Maternity Health Insurance Plan:

20
  Hospitalisation expenses (including cost of drugs, room rent charges, specialist
fees, etc.)
 Pre- and post-hospitalisation expenses
 Delivery expenses and New-Born Cover

 Ambulance charges
 Pre- and post-natal expenses

 Personal Accident Plan: This policy covers hospitalization expenses in the event
of an accident. Premium amount is depending upon the amount of cover taken.
An accident insurance plan is basically something that provides for accidental
death benefit, disabilities (total or partial) and the expenses that come across in
term of hospitalisation, transportation of patient and family and repair of vehicle
or residence. Other miscellaneous expenses might also be covered under such
plans.

The base criteria through which different plans from different insurers are compared.

 Plan Basis
 Age Limits
 Sum Assured
 Accidental Death Benefit
 Disability Factors
 Medical Expenses and Ambulance Charges
 Bonuses

1.11 ADVANTAGES OF HEALTH INSURANCE

 Cashless Treatment: If you are insured, you can get cashless treatments as your
insurance company would work in collaboration with various hospital networks.

 Pre and post hospitalization cost coverage: Insurance policy also covers pre and
post hospitalization charges up to the period of 60 days, depending on the
insurance plans purchased.

21
  Transportation Charges: Insurance policy also covers the amount paid to
ambulance towards the transportation of insured.
 No Claim Bonus (NCB): This is the bonus element which is paid to the insured
if the insured does not file a claim for any treatment in the previous year.

 Medical Checkup: Insurance policy also provide options for health checkups.
Free health checkup is also provided by some insurers based on your previous
NCBs.
 Room Rent: Insurance policy also covers room expenses depending on the
premium being paid by the insured.
 Tax Benefit: Premium paid on Health insurance is tax deductible under section
80D of the Income Tax Act.

1.12 DISADVANTAGES OF HEALTH INSURANCE

 Cost: Health insurance can be very costly even for those that have a health
insurance plan through their employers. This cost can sometimes be so
expensive that the person may struggle to make payments. This is problematic
for those that have a low income or are self-employed.

 Medical Coverage: Actual medical coverage can also be a disadvantage to some

people with health insurance. The medical coverage may not be enough to
sufficiently cover the cost of tests, surgeries and procedures that need to be done.

1.13 HOW TO SELECT THE RIGHT HEALTH INSURANCE POLICY

It’s difficult to select the best insurance policies as all insurance company provides a
similar type of insurance plan. We are aware of how important health insurance is in
protecting a family’s finances in the event of a medical emergency. But how does one
buy a health insurance plan? Here are some tips to buy medical insurance with the help
of a health insurance plan. Hence some of the important points that any Person should
look before purchasing any plans are:

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  Get adequate coverage

There is little logic on scrimping on premiums while buying mediclaim policies. The
focus has to be on getting the maximum coverage required by your family at affordable
premiums. Remember, you pay from your pocket whatever a mediclaim policy or health
insurance plan doesn’t.

 Company’s geographical presence

Insurance companies providing mediclaim policies or health insurance plans typically

have tie ups with hospitals having large networks. You need to check whether hospitals
or healthcare facilities empanelled with a prospective insurance company, are situated
close to your residence. Also, check if the insurance company has a presence across the
country so that in the case of the need for physical interaction, you are not
inconvenienced.

 Width of coverage

Mediclaim policies and health insurance plans provide financial protection to you in
case of medical emergencies but the coverage of the emergencies are specified in the
policies. It is important to be aware of these conditions, the ailments and diseases that
are covered. Consider opting for a health insurance plan that has a wide coverage and
few exclusions.

 Coverage of pre-existing diseases

If you suffer from a particular ailment, you will need to disclose this at the time of
buying a health insurance plan. At the same time, it is important to know from when
the disease will get covered. Typically, insurance companies start covering pre-existing
ailments after 3-4 years of continuous coverage.

 Save on premiums by buying online

Almost all companies offering health insurance companies offer online policies. The
premiums for such mediclaim policies and health insurance plans are lower since the
companies pass on savings from distribution and other cost savings. However,
remember that advice and support you get from an advisor will be absent and you will
need to deal with the company directly. This makes it important for you to choose an

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insurance company well known for its customer service both online and in its branch
offices across the country. To sum up, online health insurance provides you with
financial protection your family needs in case of medical emergencies. Yet, one needs
to keep these five things in mind to make the most of this protection too

1.14 COVERAGE OF HEALTH INSURANCE

The insurance coverage depends on various factors like the type of the policy, the age
of the insured, type of treatment availed, and the insurer. Generally, the below benefits
are covered:

Cashless Treatment -All health insurance providers partner with a number of hospitals
across the country to make the process of insurance settlements smoother. If a
policyholder chooses to avail treatment at any of these hospitals that fall under the
insurance company’s network, then they can avail cashless treatment. With this facility,
the insurance company will pay for the expenses through a direct channel between the
insurer and the hospital. The customer will not be required to pay for anything except
for any expenses not covered by the insurance plan. If expenses exceed the limits
mentioned in the policy, the insurer will pay up to the amount that is covered. The
remainder will have to be borne by the policyholder. This facility lightens the out of
pocket expenses that the life insured needs to bear.

Pre - Hospitalization and Post - Hospitalization When a person first sees signs or
symptoms of an illness, it is imperative to get tested and checked up. But undergoing
these medical tests can cost quite a bit. If the tests reveal a diagnosis that requires
hospitalisation, they can claim for a reimbursement for these expenses. After
hospitalisation, there are further check-ups that might be required, along with
medication and follow-up treatments. These expenses will also be taken care of by the
health insurance policy. The period for this facility ranges between 30 days and 180
days before and after hospitalisation.

Ambulance-When emergencies arise, an ambulance is usually the given method of

transportation. In many cases, ambulances are have the equipment to keep the person
stable. Ambulances are also needed while shifting the person from one hospital to
another whenever necessary. The insurance plan will cover these costs in most cases.

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No-claim Bonus-An attractive feature of health insurance policies is the no-claim
bonus. If a policyholder does not make a claim for the entire year, then the insurance
company rewards them with a no-claim bonus (NCB). The NCB is given in the form of
a discount on the renewal premium. For every no-claim year, the NCB increases.

NCB in the first year is usually 10 percent and goes up to a maximum of 50 percent
over the years.

Preventive Check-ups-Many of us do not feel the need for health check-ups when do
not show symptoms or have any pain. A visit to the doctor usually arises when there is
a problem. But regular check-ups can help detect illnesses early on and this can help
doctor’s nip it in the bud and prevent it from become worse. Preventive health checkups
help minimize costs associated with health issues and also reduce chances of diseases
progressing to later stages. Insurance plans cover the cost of such check-ups because it
contributes to minimizing larger claims.

Tax Benefits-Under the Income Tax Act, 1961, premiums paid towards health insurance
are eligible for tax deductions under Section 80D. Therefore health insurance is a good
investment to make for those who want to save tax as well.

Co-payment-Co-payment reduces the premium of the plan but will not affect the sum
assured. The co-pay clause is applied in different ways by insurers. Some may apply it
when a policyholder gets treatment in a Non-Preferred Provider Network (PPN)
hospital. In some cases, co-pay maybe applied only to certain ailments specified in the
policy or medical expenses related to pre-existing conditions. Others may insist on
copay if the policyholder undergoes treatment in certain metropolitan cities. The main
advantage of co-pay to the policyholder is a low premium. Higher co-pay may lower
the premium. Unfortunately, the co-pay clause is rife in senior citizens’ mediclaim
where premiums are not low. It means that the age at which insured need medical
facilities the most is when the insurer will also have to bear the burden of hospital bills
partially.

Restoration-Benefits Many health insurance providers offer this benefit under which if
the total sum assured amount is exhausted, it will be replenished. Usually, the restored
amount can be used on a completely different ailment from the one that the insurance
was used for before. Some companies offer restoration options of up to three times in
25
one policy period. This means the life insured can claim the sum assured thrice for three
different ailments without having to pay extra premiums.

Healthy Lifestyle Benefits- Insurance companies reward those who opt to live healthier
lifestyles. For non-smokers and teetotalers, the insurance premium may be discounted.

Furthermore, for those who quit smoking during the policy, there are rewards in the
form of discounts on premiums awarded for making the healthier choice.

1.15 ELIGIBILITY CRITERIA FOR HEALTH INSURANCE

In India, people under 45 years of age are not required to undergo a mandatory health
checkup when obtaining a health insurance policy. They are, however, required to
disclose any pre-existing conditions such as diabetes or hypertension. It is, therefore
usually advised that one should get a health insurance when young so that the premium
would be less.

1.16 DOCUMENTS REQUIRED WHEN BUYING A HEALTH

INSURANCE POLICY

There are few documents that you need to provide such as:

 Age proof ,Any one of Birth Certificate, 10th or 12th mark sheet, Driving
License, Passport, Voter ID, etc.

 Identity proof ,Driving License, Passport, Voter ID, PAN Card, Aadhar Card,
which proves one’s citizenship.

 Address proof , Electricity Bill, Telephone Bill, Ration Card, Driving License,
Passport, should clearly mention the permanent address.

 Some plans require a medical check-up (usually for elder people above the age
of 45 years)

 Passport Size Photo

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1.17 FACTORS AFFECTING HEALTH INSURANCE CONSUMPTION

Health insurance is one of the fastest growing segments in India but the insurance
amount is not sufficient as there is lack of awareness about the amount of sum insured,
over dependence on corporate health insurance coverage, willingness to pay a premium
that is only up to the highest limit of rebate under Section 80D of the Income Tax Act
etc. Price and innumerable economic, demographic, socio-cultural, political and other
factors determine economy’s consumption of health insurance.

1)Price- It is a critically important determinant of insurance demand and supply. The

price is that insurers charge is influenced by their cost structure, by the competitiveness
of the particular line of insarance and by government tax and other policy.

2) Economic Environment- Many economic factors influence health insurance

consumption. Among those found to be the most consistently important is a level of a
country’s economic development. Level of country’s income has been found to be the
most important factor in explaining the level of national life and health insurance
consumption. The higher a country’s income, other things being equal, the more it’s
spends on all type of insurance.

3)Demographic Environment-Aging populations, education level of the population, the

structure of household, industrialization and urbanization, etc., are the demographic
factors influence life and health insurance consumption.

4)Social Environment-Country’s political and economic stability influences the

insurance demand. An unstable political environment depresses insurance demand
because citizens cannot fully rely on insurance marketing their premium, as loss maybe
unenforceable.

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1.18 HEALTHCARE SCHEMES BY GOVERNMENT OF INDIA

The Indian government (central & state) have launched numerous medical insurance
schemes to improve healthcare and make it accessible for the weaker sections of society
Here is a list of health insurance schemes provided by the government:

o Rashtriya Swasthya Bima Yojana (RSBY): This scheme was launched by

the Ministry of Labour and Employment to provide health insurance
coverage for families below the poverty line. The Beneficiaries under this
scheme can avail a health benefits cover of up to Rs.30,000. A registration
fee of Rs 30 is chargeable.

o Pradhan Mantri Suraksha Bima Yojana: Is an initiative by the government

to bring access to insurance especially for the economically weaker sections
of society. This scheme features affordable premiums and provides
compensation to the family of the deceased.

o Central Government Health Scheme (CGHS): This scheme was launched in

1954. It provides comprehensive healthcare facilities to the central
government employees, pensioners and dependents of these employees.

o Aam Aadmi Bima Yojana (AABY): This is a social security scheme

launched in 2017 to provide healthcare facilities for rural landless
individuals. The head of the household or earning member of a family will
be covered under the scheme (AABY). The beneficiary should be between
18 to 59 years of age. The dependent of the beneficiary will receive
Rs.30,000 upon natural death, Rs.75,000 upon accidental death or
permanent disability, and Rs.37,500 on partial disability.

o Janashree Bima Yojana (JBY): This scheme was launched in August 2000.
This scheme targets people falling below the poverty line (BPL) in 45
occupational groups covered under the scheme.

o Employment State Insurance Scheme (ESIS): This is a social security

initiative aimed at providing socio-economic protection to the working class
and their dependents. The scheme ensures that all member and their family
will receive full medical care from day one.
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 o Universal Health Insurance Scheme (UHIS): The Indian public sector
insurance companies have implemented this scheme to improve the access
to healthcare for poor underprivileged families. Beneficiaries will receive
reimbursement for medical expenses up to Rs.30,000 and accidental death
cover up to Rs.25,000. The insurance premium for this scheme is Rs.200 per
person, Rs.300 for a family of five, and Rs.400 for a family of seven.

Other Government Initiatives in Health insurance

Apart from the government-run schemes, social security benefits for the
disadvantaged groups can be availed of under the provisions. The other
initiatives taken by the Government of India to address issues relating to
access to public health systems are.

o The National Health Policy 2002: Aims to evolve a policy structure, which
reduces inequities and allows the disadvantaged sections of the population
a fairer access to public health services. The main objective of the policy is
to ensure more equitable access to health services across the social and
geographical expanse of the country. It also seeks to increase the aggregate
public health investment through increased contribution from the Central as
well as state governments and encourages the setting up of private insurance
for increasing the scope of coverage of the secondary and tertiary sector
under private health insurance packages.

o Voluntary Health Insurance Schemes: Private Insurance is an insurance

were the buyers are willing to pay premium to an insurance company that
pools people with similar risks and insures them for health expenses. The
key distinction is that the premia are set at a level, which provides a profit
to third party and provider institutions. Premia is based on an assessment of
the risk’s status of the consumer or group of employees and benefits entitled
under this, rather than as a proportion of the consumer’s income.

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1.19 HEALTH INSURANCE COMPANIES

 Star Health and Allied Insurance Company

Star Health and Allied Insurance Company Limited commenced its operations in 2006.
Health insurance is an effort to provide solutions at affordable rates. It covers all
individual business interests in health insurance plans, overseas mediclaim policy and
personal accident policies. Star health insurance, offers a wide range of health insurance
products at affordable prices to make health insurance every human being’s right. It has
emerged as India’s first Stand-Alone Health Insurance Company. It deals in personal
accident, mediclaim and overseas travel insurance.

This insurance company is present across the country. They provide services a wide
range of individuals through their 8200+ network hospitals. During the year 2018-2019
the company issued 3734365 policies. The number of person covered under various
plans is 11,617,000 during the year 2018-19. The company has over 62 percent of
claims settlement ratio during the year 2018-2019.

Some Policies provided by Star Health and Allied Insurance Company

o Family Health Optima Insurance Plan o Senior

Citizens Red Carpet Health Insurance Policy o Star
Comprehensive Insurance Policy o Medi-Classic
Insurance Policy (Individual) o Star Health Gain
Insurance Policy o Super Surplus Insurance Policy o
Star Unique Health Insurance Policy o Diabetes Safe
Insurance Policy o Star Cardiac Care Insurance Policy
o Star Student Travel Protect Insurance Policy

 Bajaj Allianz General Insurance Company Limited

Bajaj Allianz General Insurance Company Limited is one of India’s most trusted and
preferred insurance providers. The company began its operations in 2001 and today has
a pan-India presence in over 800 towns and cities. The company has been constantly
expanding its operations to reach out to its customers. The company is a joint venture
between Bajaj Finserv Limited and Allianz SE, two companies that have garnered a

30
solid reputation for domain expertise, professional business practices, stability, and
foresight. In the very short duration that Bajaj Allianz Life Insurance has been a part of
the health insurance scene in India, it has earned a wide consumer base alongside being
a market leader and a much-preferred private sector health insurance provider. The
insurer provides 531046 customized health insurance policies to meet the various needs
of customers. The number of person covered under various plans is 24,685,000 during
the year 2018-19 and access to the cashless facility at over 5700+ empanelled hospitals
across India. The company has over 78 percent of claims settlement ratio during the
year 2018-2019.

Some Policies provided by Bajaj Allianz General Insurance Company Limited

o Health Guard o Global Personal Guard Policy (Individual) o Critical
Illness o Extra Care Plus Policy

 Apollo Munich Health Insurance Company Limited

Apollo Munich Health Insurance Company Limited was previously known as Apollo
DKV Insurance Company Limited. The company started as a joint venture between
Apollo Group of Hospitals and Deutsche Krankenversicherung AG (DKV AG),
Europe's largest private health insurer on the 8th of August, 2007. Apollo DKV started
on a journey to re-define the health insurance sector in India. The stakeholding of the
two companies was in the ratio of 74:26 (Apollo Group of Hospitals—DKV AG). In
December 2009, Apollo DKV was renamed as Apollo Munich Health Insurance. The
company continues to bring out innovative products. Apollo Munich offers a large
number of customer care services to help people stay healthy and fit always. The
journey of uncomplicating health insurance in the country has just begun and has a long
way to go.
Apollo Munich is one of the most trusted and preferred health insurance brands in India.
There are 5,116,000 persons were covered and 1063052 policies were issued under this
company. The company has over 62 percent of claims settlement ratio during the year
2016-2017. Cashless hospitalization can be availed in 4500+ network hospitals across
India.

31
Some Policies provided by Apollo Munich Health Insurance Company Limited
o Health Wallet Individual o Optima Restore Plan o Easy Health Plan o
Day2day Care Policy o Optima Cash

o Optima Vital o
Optima Senior

 ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited brings to the Indian market the
combined expertise of two individual enterprises, making it a formidable force in the
general insurance industry. It offers insurance solutions to individuals as well as
companies in the form of personal and business financial protection solutions
respectively. Some of their retail insurance solutions include auto insurance, travel
insurance, personal accident cover and health insurance.
ICICI offers some insurance solutions to all kind of policyholders. Life-long
renewability, coverage of pre-existing diseases after renewing the policy for four
continuous years and tax benefit under section 80 D, etc. The company issued 4234760
policies, offers insurance solutions to 15,179,000 persons during the year 2018-19.
Incurred claim ratio is 68 percent during the year. It also offers four years waiting period
for pre-existing diseases.

Some policies provided by ICICI Lombard General Insurance Company Limited

o ICICI Lombard Complete Health Insurance o Health Booster Policy o
Personal Protect Policy o ICICI Lombard Healthcare Plus Policy

 Oriental Insurance Company Limited

Oriental Insurance was incorporated on 12 September 1947 as a government owned

non-life insurance company. It was established as a completely owned subsidiary of
Oriental Government Security Life Assurance Company Ltd. to execute its parent
body's general insurance operations. In 1956, when insurance business was
nationalized, Oriental insurance became part of LIC till 1973. After 1973, Oriental
Insurance became a subsidiary of General Insurance Corporation of India until 2003
when the company was de-linked from the parent company and set up as an independent
32
insurance company. In 2003, the Union Government acquired all the shares of Oriental
Insurance Company Limited from General Insurance Corporation of India. On the 2nd
of February 2018, the Government of India announced the merger of Oriental Insurance
with National Insurance Company Limited and United India Insurance Company. The
company caters to almost every aspect of general insurance that includes health, motor,
travel and so on.

The Oriental insurance company limited highlights a number of members covered under
the health insurance policies are 30,325,000 and 1250812 policies were issued in the
year 2018 -19. The company has over 113.86 percent of claims settlement ratio during
the year 2018-2019.

Some Policies provided by Oriental Insurance Company Limited

o Oriental Group Mediclaim o Oriental

Happy Family Floater Policy o Oriental
Insurance Individual Mediclaim o Oriental
Overseas Mediclaim Insurance

 New India Assurance Company Limited

The New India Assurance Company is basically a multinational insurance company of

the general insurance industry. It is a state-owned insurance company which is entirely
owned by the Indian Government. The company is based out of Mumbai and running
its business in 28 different countries all over the world. The New India Assurance is a
leading firm of the general insurance industry. The company was founded on 23rd July,
1919 by Sir Dorabji Tata. After 5 years of successful operations, it got nationalized.
New India Assurance is popular for its extensive operations in the insurance industry in
India. It owns around 2097 offices out of which 1041 are micro branches. Currently,
there are around 50000 insurance agents out of which 19000 are employed by the
insurance company. The company is providing a great level of service to its consumers.
The New India assurance caters to almost every aspect of the general insurance industry
and it provides around 170 insurance products. It provides effective plans so that it can
meet the consumers’ need easily.

33
The incurred claim ratio of New India Insurance Company is 103.19 percent. The
number of members insured under this company is 87,561,000 and 1683506 policies
were insured as per the year 2018-19.

Some Policies provided by New India Assurance Company Limited

o New India Floater Mediclaim Policy o New

India Asha Kiran Policy o New India Janatha
Mediclaim Policy o New India Senior Citizen
Mediclaim Policy

 SBI Health Insurance Company

SBI General Insurance Company or SBI GIC is a combined collaboration company

between Indian public sector banking giant State Bank of India and Australia’s leading
insurance group, Insurance Australia Group (IAG). SBI holds 76 percent in the joint
venture general insurance company and IAG holds 24 percent stake in the same. This
is a timely partnership between two strong partners. SBI is India’s largest public sector
bank with established country wide networks and IAG is a global risk management
player having operations in Australia, New Zealand, United Kingdom and Asia. The
overseas partner group has made several insurance products available under different
brands and its premium collection is over $10.99 billion per year. Tie up with a global
insurance leader enables the SBI GIC group to provide worldwide insurance coverage
to its policyholders. And broad and deep market coverage of SBI group in India enables
bringing world-class insurance products to the doorsteps of consumers.

SBI health insurance company issued 756443 health insurance policies with wide
coverage, and persons insured in this company is 2,748,000 in the year 2018-19. The
company has over 53 percent of claims settlement ratio during the year 2018-2019.

Some Policies provided by SBI Health Insurance Company

34
 o SBI Group Health Insurance o
Critical Illness Insurance Policy o
Hospital Daily Cash Policy

 National Insurance Company

National Insurance Company Limited possesses a wide network all over India. There
are 1998 offices all over the country run by 14902 insurance professionals. The process
of National Insurance is not limited to India as they are working in Nepal also. National
Insurance Company is the second largest non life insurance company in India on the
basis of Gross Direct Written Premiums or GDWP. National Insurance holds the biggest
market share in the motor insurance market in the midst of all insurance companies in
India in terms of GDWP accumulated in the current fiscal year of 2015. Apart from a
large share in motor insurance, national insurance mediclaim policy and national health
insurance schemes also have a reasonable share of the market. Being the lead in the
North and East zones, the amount of premium registered with the National Insurance
Company is Rs.11282.64 crores in the year 2015.

National Insurance Company issued 1725290 health insurance policies with wide
coverage, and persons insured in this company is 1,47,728,000 in the year 2018-19. The
company has over 115.55 percent of claims settlement ratio during the year 2018-2019.

Some Policies provided by National Insurance Company

o National Parivar Mediclaim Policy o

National Overseas Mediclaim Policy o
National Mediclaim Policy

 United India Insurance Company

United India Insurance Company Limited was incorporated as a Company on 18th

February 1938. General Insurance Business in India was nationalized in 1972. Twelve
Indian Insurance Companies, four Co-operative Insurance Societies and Indian
operations of five Foreign Insurers, besides General Insurance operations of southern
region of Life Insurance Corporation of India, were merged with United India Insurance

35
Company Limited. After Nationalization United India has grown by leaps and bounds
and has 18,300 workforces spread across 1,340 offices providing insurance cover to
more than 1 crore policy holders. The company has a variety of insurance products to
provide insurance cover from bullock carts to satellites. United India has been in the
forefront of designing and implementing complex covers to large customers, as in cases
of ONGC Ltd., GMR- Hyderabad International Airport Ltd., Mumbai International
Airport Ltd. and Tirumala-Tirupati Devasthanam. They have been also the pioneer in
taking Insurance to rural masses with large level implementation of Universal Health
Insurance Programme of Government of India and Vijaya Raji Janani Kalyan Yojana (
covering 45 lakhs women in the state of Madhya Pradesh) , Tsunami Jan Bima Yojana
(in 4 states covering 4.59 lakhs of families), National Livestock Insurance and many
such schemes.

United India Insurance company issued 1182067 health Insurance policies, and persons
insured in this company is 54,468,000 in the year 2018-19 and their incurred claim ratio
is 110.95 percent in the year.

Some policies provided by United India Insurance Company

o Family Medicare o Individual

Mediclaim Plan o Health Insurance
Policy-Platinum o Senior Citizen Health
Insurance Policy o Super Top Up
Medicare Policy o UNI Criticare Health
Plan o Workmen Medicare Policy

 Max Bupa Health Insurance Company Limited

Max Bupa Health Insurance Company is an Indian Insurance provider extending core
services mainly in health insurance sector. It is a joint venture between Max India
Limited and Bupa Finance Plc, a UK based healthcare group. This combined business
enterprise was mainly targeted on permitting the health insurance business in the Indian
market. The company has about 11 branch offices all over the country. The services are
extended to individuals as well as organizations. Bupa Group is the subsidiary of The
British United Provident Association Limited (BUPA). It is the largest medical insurer
36
in the UK in private sector. It has cemented its foundation in over 190 countries and
caters to about 10 million customers. Max India Limited is a diversified insurance
player in the private sector. It has united with Mitsui Sumitomo Insurance Group, a
Japanese healthcare giant and has been operating Max Healthcare jointly. It also owns
a life insurance subsidiary named as Max Life Insurance. Max Neeman is a clinical
research business which is also a fully owned subsidiary.

Over 5,433,000 people have been insured and had issued 696107 health Insurance
policies with Max Bupa Health Insurance Company and incurred claim ratio is 50
percent in the year 2018-19.

Some policies provided by Max Bupa Health Insurance Company Limited

o Personal Accident Health Assurance Policy o Hospital Cash

Health Assurance Policy o Critical illness Health Assurance
Policy
o Heartbeat Insurance Policy - Individual and Family Floater

1.20 HEALTH INSURANCE CLAIM PROCESS

Health insurance acts as a safety net for an individual's finances in case he/she meets
with an unforeseen accident. The insurance policy ensures that the insured gets the best
treatment available without worrying about clearing the costs at the time of discharge.
Knowing about the claim process is an important piece of information that the insured
should be armed with at all times. There are certain procedures that the insured will
have to follow at the time of making a claim.

There are two main types of claim process which an individual can choose when making
a claim on their health insurance. These are:

 Cashless Claim Process

 Reimbursement Claim Process

37
Cashless Claim Process

When the insured provides their health insurance details along with their ecard or any
other type of physical proof of the purchased health insurance policy, the insured can
receive treatment at a hospital. This holds good if the injury or illness is covered under
the health insurance policy. Once the insured is discharged from the hospital, the
hospital will forward the medical bills to the health insurance company. The company
will then analyze and evaluate the expenses and settle the payment. This process is
known as cashless hospitalization. Over here, the hospital settles the bills with the
insurance company. This provides a stress free recovery period for the insured. The
process of making a claim on a health insurance at a cashless hospital depends on the
type of treatment that the insured has to undergo.

 Claim Process for Planned Treatment: To avail this plan, the insured will have
to inform the health insurance company prior to being admitted into the hospital.
The insurer should be informed at least 4 days before the policyholder is
admitted or before the treatment date. This time frame varies with each
insurance company. The insured should inform the insurance company by
submitting a cashless claim form to the insurer via email, post or fax. Once the
insurance agency receives the form, they will contact the hospital as well as
notify the insured regarding about the claim request. The policyholder will have
to provide their health insurance card at the time of admission into the hospital.
Any medical expenses incurred thereafter are paid for by the insurance
company.
 Claim Process for Emergency Treatment: At the time of an unforeseen event
that lands the insured in a hospital, either the insured or the next of kin should
contact the customer care team of the health insurance company to locate the
nearest cashless hospital. Once admitted, the hospital will have to duly fill up a
cashless claim request form. Once done, they will have to submit the same to
the health insurance company by either email, post or fax. The insurance
company will then send an authorization letter to the hospital indicating the
converge of the policy. The medical bills incurred by the policyholder will be
covered by the health insurance company. If the claim gets rejected, the

38
 insurance company will notify the insured and the hospital stating their reasons
for rejection.

Reimbursement Claim Process

In the event that the policyholder or insured has been admitted into a hospital or clinic
and pays for their treatment, the policyholder will have to reclaim the money spent from
the insurer. The hospital that the insured has been admitted into does not have to be
empaneled with the insurance company. In such cases, the cashless claim facility that
provided by the insurance policy cannot be claimed. Once the insurer has paid for their
treatment and hospitalization costs, they will have to make a reimbursement claim. The
insurer will have to provide the original bills to the health insurance company to make
a reimbursement claim. The insurance company will evaluate the claim that will then
decide to either approve or reject it. Once the insurance company approves the claim,
they will make the payment to the policyholder. The insurance company will notify the
insured in case they reject the reimbursement claim.

1.21 GROWTH AND DEVELOPMENT OF HEALTH INSURANCE IN

INDIA
Health insurance has experienced dramatic growth over the past two decades. The
number of persons covered has increased annually by over 25 percent from 1991-92 to
2005-06. The premiums have increased by 35% during the same period. During 200506
the non-life health insurance companies collected premiums of Rs 22.6 billion and
covered an estimated 17 million. persons. During the same period, life insurance
companies covered around 66,000 lives under health clause and generated Rs 94 million
as health insurance premium. This was a substantial change (at least in premium) since
the premium collected by life companies from health clause increased from Rs 76
million in 2004 - 2005 to Rs 94 million in 2005 - 2006, an increase of nearly 35 per
cent. In 2006-2007, the insurance industry in India registered real growth (measured by
first-year premiums) of 94.96 percent, exceeding the growth of 47.94 percent achieved
in 2005-20064. The impressive growth has also resulted in greater insurance penetration
or premium volume, as a ratio of GDP for 2006 was at 4.1 percent for life insurance
and 0.6 percent for non-life insurance. The total premium for life and nonlife insurance

39
market in India was $41.74 billion5 The Indian healthcare industry was worth Rs.5,125
crores6 with a compounded annual growth approximately 37 percent between 2002 and
2008. The market penetration is only around 2 percent of population in India. The
Health Insurance Industry is one of the fastest growing segments among other insurance
segments. The Indian healthcare industry is worth around Rs.60,497 crores with a
compounded annual growth approximately 42.3 percent between 2008 and 2015. The
chart given below shows the total revenue forecast for Indian Healthcare
Insurance Market - 2008 to 2015

The health insurance industry in India is the fastest growing segment in the non-life
insurance sector. The market witnessed a robust double-digit growth of 24% in FY 17,
with a market share of 24%, in the entire non-life insurance sector. It has been the fastest
growing market segment, registering a CAGR of 23%, for the past 10 years. This
phenomenal growth may be attributed to the liberalization of the economy and growing
general awareness among the public on healthcare.

The health insurance industry is at an embryonic stage, with roughly 25% of the
population under its coverage. There exists a huge potential for growth and penetration
of health insurance to a larger population. Additionally, there are both opportunities and
restraints in the marketing and distribution of health insurance products in India. This
report is an attempt to uncover the prospects of successful marketing of such products
from the standpoint of insurance marketers, and look at issues impeding the growth of
the health insurance market in India.

The launch of National Health Protection Scheme under Ayushman Bharat, in

September 2018, in order to provide coverage of up to INR 500,000 (USD 7,723) to
more than 100 million vulnerable families, holds heavy expectations, which increases
penetration of health insurance in India, from nearly 34% to 50%. Also, about 47.9
million farmers benefitted under Pradhan Mantri Fasal Bima Yojana (PMFBY) in 2017-
2018.

40
1.22 TREND IN HEALTH INSURANCE IN INDIA

Health insurance can be defined in a very narrow sense where individual or a group
purchases health coverage in advance by paying a premium. But it can be also defined
broadly by including all financing arrangements where consumers can avoid or reduce
their expenditures at time of use of services. The health insurance existing in India
covers a very wide spectrum of arrangements and hence the latter interpretation of
health Insurance is more appropriate. Health insurance is different from other segments
of insurance business and it is more complex because of serious conflicts arising out of
adverse selection, moral hazard, and information gap problems. India spends about 6
per cent of GDP on health care. Private health care expenditure is 75 per cent or 4.25
per cent of GDP and the rest (1.75 per cent) is government funding. At present, the
insurance coverage in India is negligible. Most of the public funding is for preventive
and primary care programmes while private expenditure is largely for curative and
tertiary care. Health insurance is very well established in many countries. But in India,
it is a new concept except for the organized sector employees. In India, only about 2
per cent of total health expenditure is funded by public/social health insurance, while
18 per cent is funded through government budget. In many other low- and
middleincome countries, contribution of social health insurance is much higher. There
are various types of health coverage in India.

1.23 ISSUES AND CHALLENGES FACED BY THE INDIAN HEALTH

INSURANCE CONSUMERS

The endeavor of health insurance the consumers with the options or the products that
can address issues of prevention and treatment of illness, lead to wellness and thereby
help them to healthier life. Thus, there are significant challenges being faced by the
health insurance policyholders.

 Problems with Claims Processing

Problems with claims processing, experienced either firsthand or by peer groups, deters
consumers across segments from buying health insurance

41
i.) Consumers believe that reimbursement of claims from insurance companies for
cash paid in hospitals require numerous follow-ups.

ii.) In case of cashless transactions, the perception is that there is a need to submit
several documents

iii.) Another predominant perception is that insurance companies reject claims on

dubious grounds, rendering the insurance policy futile.

Such instances discourage consumers from investing in health insurance policies.

Negative experiences with claims processing could also lead to negative publicity,
making insurance policies less popular

 Limited Product Coverage

Health insurance plans do not cover outpatient care and certain ailments such as
diabetes, blood sugar, eye and dental surgeries. The view is that the policy covers health
problems that have a low probability of occurring, rendering the premium paid futile if
hospitalization does not occur in a particular year.

 Less Importance is given to Health Insurance

For most consumers, the need to save and invest for a home, education, vehicle,
children’s marriage and other lifecycle needs to take precedence over the need for a
health insurance policy. A misconception prevalent among many consumers is that the
return on investment in health insurance is low, with little reward if they make no
claims. In addition, several consumers, particularly younger age group, tend to believe
that people over 45 years of age who are more prone to ailments need a health insurance
policy. There is therefore a tendency to invest in a health insurance policy only when
extra funds are available, or if consumers have faced hardships in the past during a
medical emergency. One of the reasons for this could be the confusion created by
multiple participants about insurance being an investment or risk transfer mechanism
in the consumer’s mind.

 Limited Options of Doctors and Hospitals

Insurance companies have their own network of hospitals and seldom reimburse
procedures performed in hospitals outside of the network

42
i.) In the event that a consumer uses a non-network hospital during an emergency,
the policy becomes ineffectual.
ii.) ii. Further, Indian consumers tend to establish a comfort level with doctors.
They are reluctant to switch to other providers if their doctors are not part of the
network.

 Agent and Payment Related Issues

Insurance advisors do not suggest suitable options to consumers hide information, are
unaware of the products they sell or coerce them into buying policies that are not suited
to their needs. This has created discontent among consumers that agents do not act in
their interest and instead of treating advisors as trusted partners, several consumers are
wary of them. Another common grievance of consumers is that there are few outlets to
deposit premiums. Moreover, while companies have been encouraging the use of the
internet to pay insurance premiums, consumers in non-metros make limited use of the
internet. There are other challenges which are cited below:

i) Complicated policy document: Consumers find it difficult to understand the

various jargons and paperwork involved in the health insurance policy.
ii) Limited awareness: Limited awareness about health insurance has led to not
consideration this option to a significant number of people.
iii) Expensive: Consumers perceive that health insurance policies are expensive
and are meant for the rich and the educated only. It has been found that
consumers with a health insurance cover share similar views as those
without, in terms of their skepticism towards claims processing, limited
coverage in terms of products, and doctors and network hospitals. While this
skepticism has been based on experience, many of the other negative
perceptions stem from the fundamental lack of awareness about health
insurance.

1.24 KEY PARTICIPANTS IN THE HEALTH INSURANCE

INDUSTRY

The health insurance industry comprises several key players across its value chain.
43
  Insurance Companies

The robust growth of health insurance premium income in recent years has helped
ensure that health insurance is considered a focus segment by most Insurance
companies. Health insurance is currently being offered by non-life Insurance
companies, specialized health insurance companies and life insurance companies in
India. Star Health and Allied Insurance and Apollo DKV Insurance are the only two
specialized health insurance companies in India. Bupa Group, A leading international
health and care company and Max India Ltd formed a new Partnership to enter the
health insurance market in India. Major health insurers from overseas, such as Aetna
Insurance Company, CIGNA Insurance Company as well as other multi-national life
and nonlife companies, have also evinced interest in entering the Indian health
insurance Market.

 Third Party Administrators (TPAs)

TPAs were established as a result of regulations introduced in the financial year 2001.
Their key responsibilities include providing administrative support for insurers, such as
admission and settlement of claims, and establishing provider networks of hospitals that
policyholders can utilize. Many TPAs provide a wider variety of value added services
such as ambulance service, medicines and supplies, information about health facilities,
hospitals, bed availability, and have moved beyond the boundaries that they were
originally intended to fulfill.

 Reinsurers

Reinsurers play a critical role in the health insurance value chain. They take on part of
the risk that insurers assume from their customers so that the insurer can assume greater
individual risks. In the past, most of the top 50 global reinsurers operated indirectly
from their overseas offices by sharing the reinsurance risks assumed by the General
Insurance Corporation of India. One reason for this was that global reinsurers felt that
rates for reinsurance products were inadequate and not at all reflective of global market
conditions. However, with the entry of large players into the Indian market, this seems
to be changing. Apart from providing reinsurance support, reinsurers can also support

44
insurance companies in defining their product and customer segments based on their
global experience.

 Healthcare Providers

Increased favorable regulatory drivers, changes in demographics and changes in

disease profile have led to the rapid demand for quality healthcare provision. Private
players have invested significantly in this market, leading to ‘corporatization’ or
emergence of hospital chains. However, the focus of these players has been

largely urban as this is where the infrastructure and the patient pool is available for these
players. The selective concentration of health care providers is a major concern to be
addressed, especially since studies have shown that those living in rural areas spend
about as much on healthcare as those in towns. Currently healthcare providers are not
being regulated in India with regard to standardization and accreditation norms.

This has resulted in each healthcare provider being significantly different from the other
in terms of the healthcare costs, processes and quality amongst others.

 Distribution Channel Partners

Agents and brokers are the key distribution channels for selling retail and group health
insurance respectively. Bank assurance is also evolving as an important distribution
channel for retail health insurance. The usage of direct distribution channels like the
internet, telemarketing etc is limited in India currently, but will gain importance as the
industry matures. This form of distribution is popular in the developed countries and is
catching on in India as well.

 Regulators

The Insurance Regulatory and Development Authority (IRDA) regulates, promotes,

ensures orderly growth of the insurance and the reinsurance business in India and
protects the interests of the policyholders. Currently, health insurance forms a part of
the non-life insurance business and is being governed by the non-life insurance
regulations in India. The IRDA is considering announcing separate guidelines for health

45
insurance to promote sustainable growth of the health insurance in India. Despite a well
established industry structure in the health insurance industry in India, the industry has
not been able to achieve its true potential.

1.25 BENEFITS OF BUYING HEALTH INSURANCE ONLINE

Unlike earlier days, today life is extremely fast paced; so much so that one often fails
to look after his/her eating habits. In short, in today's fast life, we tend to ignore our
health big time.

Life is full of ups and downs, and with various changes in one's routine life, keeping
up with personal health might turn out to be a big task. Unexpected mishaps or
unforeseen incidents can come up in anyone's life, thus, it's always recommended to
buy medical or healthcare insurance.

A single good health insurance policy can always be one solution to many of your
problems. Therefore, it is always said that Health insurance has become a necessity.

But, many of us don't bother to buy these insurance products due to the hassles and
tedious paper work involved within the whole process of buying medical insurance
policy. Thus, it is advisable to buy online health insurance policy and take the benefits
of a health insurance policy coverage.

When one of your family member is being treated for a critical illness or an accident,
there are different aspects like the medical bills during the course of treatment,
hospitalisation charges, doctor's fees, medicines, etc. may cause mental pressure to
you. As a result of this several patients decide to take early discharge from the
hospital.

Undoubtedly, it is very important to complete the entire treatment to cure an illness or

overcome a damage from accident. Thus, a simple health insurance policy helps a lot
in such instances.

There are various general insurance companies in the market, who provide some of
the best deals in health insurance policies. These health insurance plans helps you to
manage for the expenses incurred for the treatment, thus, supports in arranging funds
46
without sacrificing a holiday trip or selling a valuable household item which creates a
lifelong hardship for all the family members.

Yet, people hesitate before buying a health insurance policy! Health Insurance have
always been useful to people as it monetarily helps in seeking quality treatment from
well known medical centers across the country. The common problem among today's
youth is that they think they are very less prone to fall sick and so does not require any
health insurance policy. Such people should understand the importance of health
policy which could be beneficial to them in their near future.

Health Insurance online provides complete freedom to customers from standing in

long queues, having long discussion with insurance agents/brokers in finding a
suitable policy. Buying health insurance policy online is very time saving and
convenient method to buy a health policy as people can get adequate time to read
through all the terms and conditions of the policies and then select a favourable
insurance plan as per their requirement. Also with the advancement of technologies
making payments for buying a policy is made simpler. You can make payments just
by using Net banking or credit cards without any extra effort of moving from your
seat.

1.26 BENEFITS OF BUYING HEALTH INSURANCE AT EARLY AGE

Health Insurance is necessary for every individual, keeping in mind the rising medical
costs and spurt of lifestyle diseases amongst Indians. A medical emergency can attack
anyone, anytime and impact an individual emotionally and financially. Financial
advisors therefore suggest that it is prudent if you to buy a health plan early in life. Here
are the top reasons to convince you to make the purchase before turning 30.

1. Buy early for the best price: At 25, a plan with Rs 5 lakh coverage would cost
you around Rs 5000, at 35 you'll have to shell out around Rs 6000 and at 45 the cost
rises to Rs 8000. So buy it as early as possible to book the policy at the lowest possible
premium.

2. Because your employer cover is just not sufficient: With exponential increase
in healthcare costs, the need for health insurance cannot be overstated. Check the cost
47
of a week's hospitalized for a regular illness and then compare it with your company's
coverage. Most likely you'll be persuaded to buy a cover immediately. Still not sure?
Think about when you grow older and might need more frequent medical attention.

3. Because incidence of lifestyle illnesses has increased: Fact is, you don't have to
be 60 to need a health insurance. Sedentary lifestyle has led to increased occurrence of
lifestyle disorders involving heart, cancer, lung conditions and stroke, claiming younger
lives. It is therefore imperative to insure oneself timely. Moreover, health insurance
policies offer annual health checks ups to encourage health awareness. Preventive
services include counseling, screenings, and vaccines that help you to better manage
your health.

4. Because you are a busy executive: Most of us have to travel extensive for work.
A health insurance policy that covers emergency medical evacuation along with making
available the best healthcare facilities around the world for some common yet critical
diseases therefore makes total sense.

5. Buying it early means better financial planning: Buying it early to not only
means cheap but makes better financial sense as well. Accidents occur without any
warning and an adequate medical cover will ensure that you are covered for
emergencies and allow you to invest your hard earned money in long-term investments.
Of course you also save tax for paying the premium. Under section 80D, the current
ceiling for that is Rs.15,000 annually.

6. Young buyers get a more comprehensive deal: Buying health insurance at a

young age ensures there is no scope for preexisting diseases as you will be covered
early, and any diseases diagnosed later will be covered automatically.

7. Buying early means you'll enjoy full benefits when you need: When you buy a
health plan, you have to serve several waiting periods-for certain surgeries, special
treatments, pre-existing illness coverage, etc. If you buy it now, when do not need it
immediately, it would mean you would have served the requisite waiting periods and
be able to claim all full benefits later.

Also, you can earn loyalty bonus. Most health insurance policies offer a loyalty or- no
claim bonus if the customer continues with the same policy year on year.

48
8. Because it covers much more than just hospitalization: New health plan cover
you for day care procedures and OPD, not just serious hospitalization. Even vector
borne diseases are covered. Most plans also have maternity benefits, which may be
relevant at this stage of life. Also, your new born will be covered from birth without
any additional premium.

Depending on your level of cover, a health policy helps you pay for services such as
ambulance, day-care procedures in addition to a number of non-hospital related services
such as chiropractic, dental, physiotherapy, optical, dietary advice and some alternative
therapies like Ayurveda and Homeopathy as well. In case you are looking for a bigger
cover for the extended family, there are insurers who will customized the plan for that
too.

1.27 AWARENESS OF HEALTH INSURANCE IS IMPORTANT

India may have ranked in a higher position in 2019 when it comes to rocket science,
technology and health care research. But, getting a health insurance policy for Indians
is still not mandatory. Despite the fact that health insurance should be the first step of
all financial plans, a large section of the population is still not aware of health care
insurance. Kicking off such a crucial aspect of health care is apparently what contributes
to high death rates and critical medical debt that the nation is grappling with.

In fact, the lack of health insurance awareness among people is one of the hurdles in the
penetration of the country’s health sector industry. Although the healthcare industry
ranks among the fastest-growing industries in the country, health insurance keeps pace
at a slow speed.

The sad part is that insurance companies are unable to tap a major chunk of the
population. This is what putting the lives of millions at risk.

The factors that promote public awareness program related to health insurance in India.
Only 27% of the People are Covered. If we go by the joint report of KPMG and FICCI,

49
we find that only 27% of the people have health insurance in India. The number is
undoubtedly very low in comparison to our mammoth population.

The gap is alarming and astonishing. Astonishing because on the one hand, we are
claiming to pace up with other countries when it comes to the private and public
healthcare sector. On the other hand, medical costs are escalating rapidly and are on a
continuous rise.

With the IRDAI annual report, where we stand as a country in terms of Insurance
Penetration and Insurance Density. In general, Insurance Penetration and Insurance
Density are the two benchmarks that signify consumption and awareness of insurance
in a particular geographical area.

• Insurance Penetration: It is calculated as a first-year new business premium to GDP,

i.e. the percentage of the insurance premium to GDP. Currently, Insurance
Penetration is one of the lowest at 3.69% in India.
• Insurance Density: It is the ratio of premium in a given year to the total population.
The insurance density in India was $59.7 in 2016 (life 46.5 and general 13.2), as
per the government and industry data.

There is a huge difference in insurance penetration and density in India compared to

countries like the US and the UK.A very closer study has found that insurance
penetration and insurance density are somewhat proportional to the literacy rate.

a. India ranks among countries with the lowest general insurance penetration and
density. And we have a comparatively lower literacy rate - just 73%.
b. US and UK have a 99.0% literacy rate, so they have higher insurance penetration
rates.

So, the need for health insurance awareness programs and proper education should be

the priority in villages and remote areas where literacy rate is low. Several initiatives

should be taken with objectives to tell people the importance of health insurance and

50
build the trust and credibility of insurance companies among them, Listed below are

highlights of such public awareness programs:

 Cashless treatment: Let people know about cashless treatment. Make them
understand that they will be treated without spending even a single rupee in
world-class hospitals.
 Financial cushion: People should be taught that health insurance policies act as
much needed financial support in case of medical emergencies. It saves them
from getting stuck in financial stress.
 Helpful during medical inflation: The medical costs are increasing, and it will
keep increasing. Let customers know that it is only health insurance plans that
enable them to get better treatment without spending from their own pocket.
 Increased life risks: In today’s world, we’re at a higher risk of breaking our
health and being hospitalized. Getting a health cover can solve this problem.

 Lump sum payment: Make people aware that a lump sum amount is paid to the
insured or nominee in case the insured person is diagnosed with a critical illness,
like cancer, heart attack, stroke, etc.
 Worldwide cover: It’s also necessary to explain people about the worldwide
coverage benefits under some policies.
 Types of Health Policies: Spreading knowledge about the coverage provided in
different types of health insurance plans is another area of concern to lure people
to buy health insurance. Enlighten them about the monetary and maternity
benefits offered in a health insurance cover.
 Clarifying doubts: Health insurance is a subject matter of discretion. Let people
know that they should not buy any plan blindly. Instead, they ask questions and
clarify all their doubts from the insurance agent before choosing a plan.
 Terminologies & parameters: It is essential to equip potential policy buyers with
terminologies and parameters such as claim settlement ratio (CSR), incurred
claims ratio (ICR), Solvency Ratio and so forth. These factors will help them
distinguish between various players.

51
 Optional benefits: In the awareness program, focusing on optional benefits such
as add-on cover, riders along with general inclusions is necessary. Also,
exclusions should not be ignored.
 Healthy lifestyle: Letting buyers know that if they live a healthy lifestyle or buy
a policy at a young age, it can lead them to lower premium rates.
 Use of technology: We should increase customer awareness and engagement
through mailers, videos, radio YouTube, etc.

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Figure 1.1: BELOW POVERTY LINE FAMILIES ENROLLED IN RSBY IN
DIFFERENT STATES

The government program that is most important for the poor, Rashtriya Swasthya Bima
Yojana (RSBY) gives medical insurance of up to Rs 30,000 (for a family of five). As
the graph shows, In Manipur state very less BPL Families have enrolled in RSBY
70925 families have enrolled. In Bihar 7028409 BPL families has enrolled for RSBY.
Top 5 States where the BPL Families enrolled in RSBY are Bihar, West Bengal,
Karnataka, Orissa & Chattisgarh.

53
Figure 1.2 CONTIBUTION OF VARIOUS CHANNELS IN HEALTH
INSURANCE PREMIUM OF 2018 – 2019

Among various channels for distribution of health insurance policies, “Direct Sales-
Other than Online” contributed a major share in total health insurance premium at 34%.
The share of this channel was high at 38 % in Group Health Insurance premium, after
100 % share in Gross premium from Government Business. “Individual Agents” is the
second major channel for distribution of Health Insurance Business. This channel
contributed 31% in total Health Insurance premium. Their share in Individual Health
Insurance premium was high at 73 %. Third important channel for distribution of Health
Insurance Business is Brokers, who contributed 22 % of total Health Insurance
premium. The share of Brokers was high at 43 % in Group Health Insurance
premium.“Bancassurance” channel contributed 6 per cent of total health insurance
premium and “Online Sale” channel contributed 1 per cent of total health insurance
premium.

54
Figure 1.3 TREND IN HEALTH INSURANCE PREMIUM OF 2018 – 2019

During the FY 2018-19, General & Health Insurance Companies collected 44873 crore
as Health Insurance Premium registering a growth of 21.2% over the previous FY
201718. Health insurance premium continues to grow over 20% year on year during the
past four financial years. The four public sector general insurers continue to hold a
larger market share at 52% during the FY 2018-19. However, there is a marginal dip in
the market share of public sector insurers from 58% in FY 2017-18. On the other hand,
the share of private sector general insurers has increased marginally from 21% in FY
201718 to 24% in FY 2018-19 and the share of stand-alone health insurers in health
insurance premium has gone up from 21% in FY 2017-18 to 24% in FY 2018-19.

55
Figure 1.4 SHARE OF TOP 5 STATES IN TOTAL INSURANCE PREMIUM
OF 2018 - 2019

While five states namely Maharashtra, Tamil Nadu, Karnataka, Delhi UT and Gujarat
contributed 66 per cent of total health insurance premium, the rest 31 States/UTs have
contributed 34 per cent of the total Health insurance premium. The state of Maharashtra
alone contributed 13708.44 crore (31 per cent) of total health insurance premium.

Conclusion:

This chapter provides a brief information about the Health Insurance market in India.
It includes evolution and origin of health insurance, importance of health insurance,
types of health insurance, advantages of health insurance, disadvantages of health
insurance, Information about how to select the right health insurance policy, which
documents are required while buying a health insurance policy, eligibility criteria for
buying health insurance, factors affecting health insurance consumption, health
insurance companies and their services, healthcare schemes by government of India,
health insurance claim process, growth and development of health insurance in India,
trend in health insurance in India, issues and challenges faced by the Indian health
insurance consumers, key participants in the health insurance industry & Awareness of
health insurance is important.

56
 CHAPTER-2

RESEARCH METHODOLOGY

2.1 TITLE OF THE RESEARCH STUDY:

“A study on awareness of Health Insurance among lower income group people”

2.2 DURATION OF THE RESEARCH STUDY:

This study was carried out for duration of 6 month.

2.3 RATIONAL OF THE RESEARCH STUDY:

Health Insurance is very important in today’s life. Millions of Indians lose their lives to
heart diseases and diabetes. As we know the medical costs have dramatically risen
lately. Hospitalisation can burn a hole in the pocket .So, in case of a medical emergency,
consumers end up spending their savings, which takes a toll on their future plans. Health
insurance provides people with a much needed financial backup at times of medical
emergencies, but India still continues to have the lowest health insurance penetration in
the world. So this study will help us to know the awareness among the people.

2.4 SCOPE & COVERAGE OF RESEARCH STUDY:

This study was given an overview of the awareness of health insurance among lower
income group people. The intention is to analyze the level of awareness of Health
Insurance companies and their policies among the lower income group people. Since
Health Insurance is very important in our today life because Hospitalisation can burn a
hole in the pocket . All this can be avoided by just paying a small annual premium which
would lessen the stress in case of medical emergencies. The important aspect of the

57
analysis is to examine the perception of policyholders, benefited through private sector
or public sector health insurance policies in Malad & Kandivali (West) area.

2.5 OBJECTIVE OF THE RESEARCH STUDY:

 To find out the awareness of Health insurance among lower income group
people.
 To find out the ratio of people have awareness and people who buy health
insurance .
 To analysis the customer level satisfaction about health insurance.
 To find out the reason behind not buying health insurance policy by lower
income people.
 To find out the factors which influences the respondents in selecting particular
health insurance policies.

2.6 RESEARCH DESIGN:

The research design of this study considering its objectives, scope & coverage was
exploratory as well as descriptive in nature.

2.7 SOURCES OF INFORMATION:

• PRIMARY DATA:
The primary data has been obtained from the selected group of population with the
help of questionnaire.

• SECONDARY DATA:
The secondary data has been obtained from published as well as unpublished literature
on the topic and from Journals, Research Articles, Thesis, Websites.

58
2.8 SAMPLING DECISIONS:

 SAMPLE SIZE:

Appropriate number of sample size (i.e. 100) was put to used for the purpose of
collecting primary DATA from the selected lower income population.

 SAMPLING METHOD:

Non-probability sampling design based on convenient sampling method has been used
for this research study.

 SAMPLING FRAME:

The representative sampling units in appropriate & justified size has been conveniently
drawn from amongst different people heterogeneous socio-economic age groups, but
homogeneous occupations, gender who are lower income people.

 RESERCH INSTRUMENT:

A structured non-disguised questionnaire has been prepared to get the relevant

information from the respondents. The questionnaire consists of variety of questions
presented to the respondents for their responses. The researcher has been used
questionnaire with support & cooperation of the selected population who have low
income.

 SAMPLING MEDIA:

Sampling media has been in the form of Filling up of questionnaire.

2.9 DATA COLLECTION, ANALYSIS & INTERPRETATION:

The collected information and primary DATA has been subjected to DATA analysis
and interpretation. The collected primary DATA has been precoded considering the
designing of the structured and non-disguised questionnaire. The primary DATA has

59
been scrutinized, edited and validated and thereafter it has been presented in the forms
of DATAs, charts, graphs and diagrams as the case may be.

2.10 SIGINIFICANCE OF THE PROPOSED RESEARCH STUDY:

This study is important because we know the condition of health insurance in India is
pitiful, as a huge part of our population does not use health insurance to finance their
medical expenditures. A large majority of people in India believe that health insurance
is not a worthy investment and therefore, avoid buying such insurance products. he
main reason for the indebtedness among the poor and the middle class people is the
escalating medical costs. A large proportion of people either avail loans or sell their
assets in order to settle the colossal medical expenditures incurred. The principal reason
behind this is that people in India lack the knowledge of the simple steps to take to
secure our healthcare costs. We are all aware of the healthcare scenario and the rising
costs, but we often dismiss the need for insurance with the thought that it may be
unnecessary.

2.11 LIMITATION OF THE PROPOSED RESEARCH STUDY:

 The sample size selected by the researcher is limited.

 The study is applicable only to Malad & Kandivali (West) Mumbai Therefore
the results cannot be generalized for the whole industry.
 The time factor in collecting the responses as in conducting the research would
be limiting factor.

Conclusion:

This chapter present information about a scope of study, need of the study, duration of
the study, rational of the study, the significance of the study, statement of the problem,
research design, sources of information, sampling decisions objectives of the study, data
collection method the methodology adopted, a pre-test for the study, limitation of the
study.

60
 CHAPTER-3

REVIEW OF LITERATURE

1)Anil Gumber & Veena Kulkarni (2000) in their study “Health Insurance for
Informal Sector”. they had explores the availability of Health Insurance coverage for
the poor and especially women. There is strongly expressed need for health insurance
among low income households in both rural as well as urban areas. This need as a risen
primarily because of heavy burden of out of pocket expenditure on them while seeking
healthcare.

2)Randall P Ellis, Moneer Alam, Indrani Gupta (2000) in their article “Health
Insurance in India” they had concluded that Central to the preceding discussion have
been two important limitations of the present health care system and its financing in
India. The first limitation is exceptionally high health care expenditure over three
fourths of which is private out-of-pocket expenditure. The paper comes up with a series
of recommendations including improvements in delivery of health care and its
financing, efficient functioning of the ESIS and the CGHS, ammending the Mediclaim
system to tap the huge market potential, modification of the benefits and claims system
of Mediclaim policies, alterations in the exclusion clause, enhanced competition and
the possible privatization of health insurance within a strict regulatory regime

3)Michael Kent Ranson (2002) in his research study “Reduction of catastrophic health
care expenditures by a community-based health insurance scheme in Gujarat, India:
current experiences and challenges” he had conclude In India, as in many other
developing countries, spending related to hospitalization is often catastrophic for
household finances. The study shows that community-based health insurance schemes
can effectively protect poor households from the uncertain risk of medical expenses,
and they can be implemented in areas where institutional capacity is too weak to
organize mandatory, nationwide risk-pooling.

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4)Ajay Mahal (2002) in his study “Health Policy Challenges for India: Private Health
Insurance and Lessons from the International Experience” The experiences of these
countries hold three key lessons for India, which is plagued by poor quality of health
care, potentially high costs of care and increased burden of health spending on the poor.
The messages has to do with patient satisfaction and quality of care. It is quite clear that
patient choice among providers and insurers is emerging as one of the single most
valuable elements of health policy internationally.

5)Sonal Kala & Dr.Premila Jain (2005) in their research " Awareness of Health
Insurance among people with special reference to Rajasthan(India)".They had find out
that people are aware about health insurance but refused to take health insurance and
medical insurance. People have trust more on public general insurance companies rather
than private general companies. People were not must aware regarding the policies and
term and conditions of health insurance and According to them Health Insurance
Companies are not transparent.

6)Ahuja & Rajeev (2005) done a study on “Health Insurance for the poor in India: An
analytical Study.” According to them Micro insurance that deals with insurance for the
poor is emerging in India. all micro insurance arrangements taking roots in the country
can be categorized in to three distinct types: intermediate type, manager type and
provider type. Each type has its own strengths and weaknesses. All these types may be
appropriate for a large and diverse country like India.

7)Mark V. Pauly, Peter Zweifel, Richard M. Scheffler, Alexander S. Preker, and

Mark Bassett (2006) in their study “Private Health Insurance In Developing
Countries” they had this approach suggests a somewhat different focus for insurance
system design in developing countries. The typical analysis focuses on the adequacy of
insurance coverage in achieving access and the fairness of premiums. This approach
does not deny that those are desirable goals but views as a first step the ability to offer

62
insurance that people will find attractively enough priced (relative to the benefits
provided and their own income constraints) that they are willing to buy it.

8)B. Reshmi,N. Sreekumaran Nair, K.M. Sabu, and B. Unnikrishnan (2007) in their
study “Awareness of Health Insurance in South Indian population- a community based
study” They stated that the health insurance companies should come out with clear cut
policy details, as many of the respondents had no ideas about the various benefits and
risks involved in a policy. To develop a suitable health insurance scheme, it is important
to understand people’s perceptions and develop a package that is accessible, available,
affordable and acceptable to all sections of the society.

9)Sarosh Kuruvilla & Mingwei Liu (2007) a study on “Health Security for the
RuralPoor? A Case Study of a Health Insurance Scheme for Rural Farmers and Peasants
in India” The study conclude that the implications are that there are three necessary
preconditions for the creation of successful self-financed health insurance schemes for
large, poor, rural and informal sector populations. The first is a system for the
mobilization of the widely dispersed poor populations, which is the key problem. The
second is the design of an administrative vehicle or system to register subscribers,
collect premiums and issue identity cards. And the third is the existence of an adequate
healthcare delivery infrastructure.

10)M. Kent Ransona,, Tara Sinhab, Mirai Chatterjeeb, Akash Acharyac,Ami

Bhavsarb, Saul S. Morrisd, Anne J. Millsa (2007) in their research study “Making
health insurance work for the poor: Learning from the Self-Employed Women’s
Association’s (SEWA) community-based health insurance scheme in India.” The study
found that the Self-employed Women’s Association (SEWA) scheme is inclusive of
the poorest, with 32% of rural members, and 40% of urban members. The financially
better off in rural areas are significantly more likely to submit claims than are the
poorest, and men are significantly more likely to submit claims than women.

63
11)B Reshmi, Ragil Raghunath, B Unnikrishnan (2009)research on “Awareness of
Health Insurance among Inpatients at a Tertiary Care Hospital in Coastal Karnataka”
the study stated awareness was found to be low probably because of the fact that about
53% of the population were from the lower socio-economic status. Media seemed to
have played an important role in dissemination of information. The calls for effective
information, education and communication activities which will improve understanding
of insurance by the public and hence awareness of health insurance will also improve.

12)Dr. Sumninder Kaur Bawa & Ms. Ruchita (2011) in their research “Awareness
and Willingness to pay for Health Insurance- An Empirical Study with reference to
Punjab ,India.” stated that Health Insurance is not a new concept and the people are also
getting aware about it. But only 19.4% are being covered by Health Insurance and large
population are still spend their money on medical expenses.11.9% of people are ready
to buy health insurance policy without any condition but 19.8% are ready to buy only
when certain conditions are fulfill.

13)Jatinder S.Bedi (2011)in his study “Pre-launch Survey Report of Insurance

Awareness Campaign.” A high proportion of insured household have salaried, regular
wage earner or self employed .The higher amount of laborers are uninsured and among
both the insured and the uninsured, urban household are better off than rural household.
Rural household many member taking Life Insurance not Health Insurance because
there is lack of awareness among people.

14)Kiplagat Jebiwott Isabella (2011) in his study “determinants of heath insurance

choice in KENYA” he had noticed that over 90 percent of the respondents do not have
health insurance. This is a / category of respondents at a youthful age bearing the lowest
education attainment, are smokers with relatively low employment status but, worst of
all, have the lowest wealth index (poorest). For those with insurance cover, majority are
in statutory insurance types, these are, employer based NHIF and NSSF. Hence, it is
possible that they are covered not by choice but by state requirements.

64
15)Ms.Swati Dattatray Kedare (2012) in her research “Health Insurance- Identifying
awareness preferences and buying pattern in Mumbai.” The condition of Health
Insurance in India is not so good.85%of Indian population does not use health insurance
to finance their medical expenditure these people pay for their medical expenditure
from their pocket. Reason for poor growth of Health Insurance is lack of regulation and
because of lack of product benefit to customer. So customer’s are not ready to buy the
policy. Suggested that advertisement should be done about Health Insurance so people
will buy the policy.

16)J. Yellaiah, G. Ramakrishna (2012) in their study “Socio economic determinants

of health insurance in India: the case of Hyderabad city” they had concluded that the
determinants of demand for health insurance in Hyderabad are occupation, income,
health expenditure, and awareness on health insurance scheme. These variables
influence health insurance significantly. The variables such as age, education, and age
square are statistically not significant though they had expected signs. Therefore
occupation, income, health expenditure, and awareness on health insurance scheme play
a vital role in determining of health insurance schemes.

17)Jangati Yellaiah (2012) research journal about “Awareness of Health Insurance in

Andhra Pradesh.” In her study she conclude that the determinant of awareness of health
insurance were: religion, type of the family, education ,occupation, annual income.
Higher education and higher annual income increase awareness of health insurance also
will increase. The health insurance companies should come out with clear cut policy
details, as many of the respondents does not have clear ideas about the various benefits
and risks involved in a policy

18)Dagmar Dzurova , Petr Winkler,and Dusan Drbohlav (2012) in their research

study “Immigrants’ Access to Health Insurance: No Equality without Awareness” the

65
study find that some of the respondents may not have been clear what kind of health
insurance system they belong to. This, however, would be highly improbable for such
a great number of respondents, i.e., 30% of those with a permanent residence status and
50% of those with employee status. Second, some of the respondents who have been
found to still be in the system of commercial insurance or uninsured despite the fact
they were entitled to public health insurance on the basis of their employment status,
might actually have reported employment status, although they were working
irregularly.

19)Dr. G.Kasirajan (2012) in his study “Health insurance –an empirical study of
consumer behavior in Tuticorin district” the conclude The health insurance companies
should come out with clear cut policy details, as many of the respondents had vague
ideas about the various benefits and risks involved in a policy. The middle and low
socio-economic groups are a potential market to be tapped as they are ready to spend a
reasonable amount as premium payable per annum rather than huge medical expenses
in case of any adversities. If the private insurance players want to venture in the market,
they should try to imbibe trust in the people as most of the respondents preferred
government health insurance schemes

20)Suwarna Madhukumar, Sudeepa D, Vaishali Gaikwad (2012) study on

“Awareness and perception regarding health insurance in Bangalore rural population”
they stated that majority population were males (94.9%), Hindus (60%), literate
(85%),and manual workers (79.5%).Only one third of the houses were aware of health
insurance but only 22% had health insurance coverage. The coverage was not for all
family members. The subscription depended on education, socio–economic status, type
of family. The willingness to pay a premium was Rs 500 per year in 31% of the families.

21)Ankit Jain, Selva Swetha , Zeena Johar, Ramesh Raghavan (2013) in their
journal study on “Acceptability of, and willingness to pay for, community health
insurance in rural India .”they have stated that Acceptability of insurance can also be

66
enhanced by targeting benefits toward children health and well-being; a population
group whose health needs were privileged across income levels within this sample..
Other ways to enhance acceptability of CHI is to educate potential enrollees about the
importance of, and coverage for, preventative services and regular treatment and
follow-up.

22)Maumita Ghosh (2013) in her research journal “Awareness and Willingness to Pay
for Health Insurance: A Study of Darjeeling District.” According to her health
insurance is not a new concept and with the time more and more people are getting
aware about it, but this awareness has not reach to that extent that people subscribe for
it. As a result it was found from this study that just 18.5% are being covered by some
form of health insurance and large portion of the population is still financing health care
expenditure out of pocket.

23)Maheshkumar L choudhary, Kalpesh I Goswami, Sudha B Khambhati,Viral R

Shah,Naresh R Makwana, Sudha B Yadav (2013)in their research “ Awareness of
health insurance and its related issues in rural areas of Jamnagar District” they conclude
that awareness regarding health insurance is poor (57.25%); therefore awareness
creation is needed. Education, socio-economical status and occupation were favorable
determinants for opting health insurance. Reason for opting for health insurance was
mainly related to medical care and financial aspects. Media seemed to have played an
important role in dissemination of information. This calls for effective information,
education, and communication activities which will improve understanding of
insurance by the public.

24)Harshal T Pandve and Chandrakant V Parulekar (2013) in their study “Health

insurance: Is Indian rural population aware?” they stated that the health insurance
awareness are few in number, and majority of them were carried out in the urban areas.
According to them in present, only 11% were aware about health insurance and only
6% actually had any health insurance policy. The awareness regarding health insurance
in rural population is very low. There is an urgent need to educate the rural population
about the importance of health insurance.
67
25)Dr. Y. Nagaraju (2014) in his study “A Study on Performance of Health Insurance
Schemes in India.” The Government Sponsored Health Insurance Schemes also work
on the same Ten Commandments that will make easy integration. The duty of the
Government does not end by just by implementing health insurance schemes. It is also
expected to ensure the proper working of the same. The health system should be
regulated and higher amount of transparency and standardization needs to be ensured.
Because Successful health reform must not just make health insurance affordable,
affordable health insurance has to make health care affordable.

26)Shamika Ravi & Sofi Bergkvist (2014) research on “Are Publicly Financed Health
Insurance Schemes Working in India?” Different state governments in India have rolled
out state financed health insurance schemes since 2003, and the national government
rolled out the largest of such schemes, the Rashtriya Swasthya Bima Yojna (RSBY) in
2008. The intention of this paper is to carefully analyze whether these publicly financed
health insurance schemes have worked in India.

27)L. Sivaramakrishnan and Ti. M. Swaaminathan (2015) in their research

“Awareness and public receptivity for health insurance products a study with reference
to Kanchipuram town, India” they had conclude that Unlike an unhealthy individual
can think of only how to recover his/ her health. Any health ailment makes the person
physically weak. As it is a new product the company has to apply many promotional
and adverting techniques in order to market and sell this product. In this tough
competition in private life insurance sector the company has to focus on the
demographic profile of clients and target those customers. Tax saving benefits could be
highlighted more for promoting the insurance products.

28)Geoffrey Setswe, Samson Muyanga , Jacqueline Witthuhn , Peter Nyasulu

(2015) in their study “Public awareness and knowledge of the National Health
Insurance in South Africa” The study showed that the levels of awareness of the NHI
68
were high in the first two years of its introduction in South Africa. However, knowledge
of what the NHI was all about was generally poor. Public awareness campaigns about
the NHI were generally good while the education campaigns to increase knowledge and
understanding of the scheme were narrow and did not penetrate many communities
where information about the NHI was sought. Public awareness campaigns about the
NHI focused more on what the NHI would pay on behalf of users.

29)Ashish Bansal, Shewtank Goel, Abhishek Singh, Anurag Ambroz Singh, Anil
Kumar Goel, Sulabha M Naik, Virender K Chhoker, Shelesh Goel (2015) in their
research study The findings of the study highlight the current status of low prevalence
of awareness toward health insurance among study subjects. Definitely there is an
alarming need to improve the awareness with regard to their knowledge about health
insurance covering the medical expenses in the rural communities. It is a need of the
hour to launch IEC activities in order to make them aware of the need of health
insurance to meet the ever rising medical expenses in view of unpredictable illness and
injuries.

30)Pradeep Panda , Arpita Chakraborty and David M. Dror (2015) in their study
“Building awareness to health insurance among the target population of
communitybased health insurance schemes in rural India” they find that Awareness
campaigns are important prerequisites to the successful launch of CBHI among the poor
in rural India. r evidence points that improvements in awareness after the campaigns
were independent of the level of education. There is a real difference between
understanding insurance principles and understanding CBHI.

31)Sudhir Gowda (2015)in his research article “ Awareness about health insurance in
rural population of South India” He found that awareness about health insurance was
high among the respondents but still looking at the expenditure pattern for health is
mainly out of pocket. This shows that although the respondents are aware of health
insurance but they are not utilizing the same. In order to bridge this gap it is important
to educate them in order to bring about behavior change among the respondents. There
should be implementation of health insurance policies which can benefit rural India.

69
31)Mrs.A. Priya & Dr. R. Srinivasan (2015) in their journal “A study on Customer
Awareness towards Health Insurance with special reference to Coimbatore City.”
According to them Around 24% of all people hospitalized in India in a single year below
the poverty line due to hospitalization. Only 11% of population is presently covered
with Health Insurance. There is an urgent need to expand the health insurance in India.
It is suggested that an advisor must available in all hospitals who can clearly explain
and suggest a suitable policy for the person or the family.

32)Suraj Sirohi, Chakresh Jain,Aditya Khatri, Sanjay Dixit, &Shailesh Rai (2016)
research article “Awareness of Health Insurance in Indore: A Cross-Sectional
Descriptive Study.” Many people aware but had incomplete information regarding
various aspects of health insurance & its importance. Hence it is important to increase
the awareness community on various aspects of health insurance in view to meet the
ever rising medical expenses in view of unpredictable illness & injuries. study suggest
that need of the hour is to launch information, education and communication activities
The major source of information was media (television and newspaper).

33)Indumathi K, Hajira Saba I, Arun Gopi, Mangala Subramanian (2016) their

research on “Awareness of health insurance in a rural population of Bangalore, India”.
According to them The determinants of awareness of health insurance were education
and socioeconomic status. Though the study shows increased of awareness of health
insurance, there is still an need to improve the awareness with regard to their knowledge
about health insurance covering the medical expenses in the rural communities. It is a
need to launch effective awareness activities to make them aware of the need of health
insurance to meet the ever rising medical expenses in view of unpredictable injuries and
illness.

34) K.Swathi, R.Anuradha (2016) “Health Insurance in India-An Overview.”

According to them Rising healthcare costs can punch a big hole in your pocket. Paying
a small health insurance premium is the simplest way to mitigate the financial losses

70
and to achieve peace of mind. Avail health insurance to save yourself from worries of
hospitalization & suggested some point to increase health insurance are Private
companies should build the confidence in the public to increase the health insurance
coverage like public companies

35) V. Sini & Dr. C. R. Karpagam (2016) their study on “A study on policy
holders awareness and preference towards health insurance .” In their study they find
out that the respondents are neutral about tax benefit, risk coverage & saving, security
with high return which shows that they are unaware about the aspects and if the
company tries to give more advertisements about the products then the level of
awareness about the product can be increased in future period of time and if the
company tries to reduce the claim span of the respondents then the level of satisfaction
of the policy holders can be increased in future period of time.

36)Rohit Kumar,K. Rangarajan,Nagarajan Ranganathan (2016) in their research

“Health Insurance in India—A Study of Provider’s Perceptions in Delhi & the NCR.”
According to the study The level of awareness among the insured population is low
with regard to policy terms and conditions. It is quite evident that the final bill generated
for an insured patient is higher than that of a patient who pays out-of-pocket. Most of
the insured do not care for the treatment cost as they are covered under a health
insurance policy.

37)Shefali Malhotra, Ila Patnaik, Shubho Roy and Ajay Shah (2018) “Fair play in
Indian Health Insurance” In their research they had explore that some of the reasons for
the such poor quality of insurance products: regulatory failure. This creates incentives
for insurers to reject valid claims. We propose changes which may reduce such behavior
of insurance companies. India has very limited health insurance plans, which most
consumers can buy. It covers only hospitalization costs.

71
38)Rabindra Ghimire (2018) “Health insurance awareness among the university
teachers in Pokhara Valley.” Based on the study it can be concluded that majority of
the respondents are conscious to their personal health and showed willingness for health
treatments through insurance and significant number of respondents are not unhappy
on spending on health care. Majority of the respondents are aware about the government
health insurance program launched in Pokhara.

39)P N.Roopalekha Jathanna, Januka Devi Dhamala (2018) research study on

“Awareness and utilization of health insurance among selected population of State of
Sikkim, India ”Stated that on an average, 10% Indians are covered under different types
of health insurance schemes, mostly inadequate. This low coverage might be because
of lack of awareness about health insurance or might be because of lack of financial
literacy significant for awareness of health insurance. Enhancing the financial literacy
and to create awareness and benefits of health insurance among the people of the
selected region is important.

40)Surendar R (2019) research journal “Awareness on Health Insurance among a

selected Urban Population in Puducherry.” This study shows that even though half of
the respondents are aware of health insurance, they are not utilizing the same. Media
seemed to have played an important role in dissemination of information. There was a
significant association between type of Family, Educational status and awareness about
Health Insurance.

Research Gap:

This chapter provides information about various researches undertaken by the

academicians and institutions in India, which are relevant to this study. Researches are
done on many Awareness of health insurance in cities like Puducherry, Darjeeling, &
on many states like Gujarat, Rajasthan but there is no research which is reference to
Mumbai city & Some researches are done on the specific community people like
teachers, urban population, rural population but this research among the Lower income
people group. This research is about awareness of health insurance among lower
insurance people in specific area of Mumbai City.

72
 CHAPTER-4

DATA ANALYSIS & INTERPRETATIONS

Survey means going into depth of the responses and collecting inner expression for the
purpose of knowing attitude of the respondents about which the survey is conduct.

The purpose of conducting the survey is the in-depth study of the respondents
perception towards health insurance.

For conducting the survey questionnaire was prepared was given to 100 respondents.
The entire area covered by the survey is classified into different parts and respondents
were given the format of questionnaire and were requested to fill it & return to us.

The survey has been successful carried out and the respondents gave good and realistic
answer to the questions.

Question 1: Age

Figure 4.1: Showing age of respondent

Age of Respondents

4%

18%

30% A 18 - 20
B 21 - 40
C 41-60
D Above 60
48%

73
 Table:4.1
YEARS PERCENTAGE

18 – 20 18

21 – 40 48

41-60 30

Above 60 4

TOTAL 100

Interpretation:

In the above data, we can see that 18% of respondents are between the age of 18 to 20
years. 48% of respondents are between the age of 21 to 40 years. 30% of respondents
are between the age of 41 to 60 years. 4% of respondents are of age above 60 years.

Majority of respondents are between the age of 21 to 40 years.

74
 Question 2: Gender
Figure 4.2: Showing gender of respondents

Gender of Respondents

44%
A Male

56% B Female

Table: 4.2

GENDER PERCENTAGE

Male 56

Female 44

TOTAL 100

Interpretation:

The above data show information about the Gender of the respondents, As we can see
that 56% of respondents are male and 44 % of respondents are female.

Majority of respondents are Male.

75
Question 3: Qualification

Figure 4.3:Showing qualification of respondents

Qualification of respondents

2%
7%

A Below SSC
24%
B SSC
35%
C HSC
D Graduate
E Post-Graduate

32%

Table: 4.3

QUALIFICATION PERCENTAGE

Below SSC 7

SSC 24

HSC 32

Graduate 35

Post-Graduate 2

TOTAL 100

76
Interpretation:

In the above data, information is about the Qualification of the respondents is shown,
As we can see 7% of respondents are have not studied up-to SSC i.e Below SSC. 24%
of respondents are qualified with SSC. 32% of respondents are qualified with HSC.
35% of respondents are qualified with Graduation & graduate respondents are more.
Minimum 2 % of respondents are qualified with Post-Graduation.

Majority of respondents are Graduate qualified.

77
4: Employment

Figure 4.4:Showing employment of respondents

Employment of respondents

2%

7%

A Government
34% Employee
B Corporate Employee
57%

Table: 4.4

EMPLOYMENT PERCENTAGE

Government Employee 2

Corporate Employee 34

Self-Employee 57

Other 7

TOTAL 100

78
Interpretation:

In the above data information about Employment of the respondents are shown. Least
number of respondents 2% are Government Employee. 34% of respondents are
Corporate Employee. Majority number of respondents i.e 57 % of respondents are
SelfEmployee. 7% of respondents are not employed as they are Housewife, Retired or
Student.

Majority of respondents are Corporate Employee.

79
5: Annual Income

Figure 4.5: Showing annual income of respondents

Annual Income of respondents

20%

A Below 1 lakh
43%
B 1 – 3 lakhs
C 3 – 5 lakhs

37%

Table: 4.5

ANNUAL INCOME PERCENTAGE

Below 1 lakh 43

1 – 3 lakhs 37

3 – 5 lakhs 20

TOTAL 100

80
Interpretation:

In the above data, information shown about the Employment of the respondents. 43%
of respondents have Below Rs 1.lakh annual income. 37% of the respondent earn Rs. 1
– 3 lakhs annual income. 20% of respondents have Rs. 3 – 5 lakhs as their annual
income. Majority of respondents have annual income of below Rs. 1 lakh.

81
6 : Are you aware about Health Insurance?

Figure 4.6: Showing respondents aware of health insurance

Respondent aware about Health Insurance

37%
A Yes

63% B No

Table: 4.6

AWARE PERCENTAGE

Yes 63

No 37

TOTAL 100

82
Interpretation:

The above data shows the how many respondents are aware of the Health Insurance.
63 % of respondents are aware about the Health insurance but 37 % of respondents are
not aware about the Health Insurance because of the education level.

Majority of the respondent are aware about the Health Insurance

83
7 What are the source of awareness?

Figure 4.7: Showing source of awareness of health insurance

Source of Awareness

7%

12% 24%
A TV
B Newspaper
C Agent
7%
D Family & Friends
E Consultants & Doctor
38% 12%
F College

Table: 4.7
SOURCE OF
AWARENESS
PERCENTAGE

TV 24

Newspaper 7

Agent 12

Family & Friends 38

Consultants & Doctor 12

College 7

84
 TOTAL 100

Interpretation:

The above data shows the information about the source of awareness of about Health
Insurance to the respondents. 24% of the respondents are aware from the TV
advertisement. 7% of respondents are aware from the Newspaper. 12% of the
respondents get aware with the help of the Insurance Agent. 38% of respondent are
aware from the Family & friends. 12% of the respondents are get aware from the
Consultants & Doctors. 7% of respondents are aware from the College.

Majority of the respondents get to know about Health Insurance from Family & friends

85
8 Why you have not taken Health Insurance?

Figure 4.8: Showing reasons of not buying health insurance policy

Reason of not buying Health Insurance

26% A Low salary

35%

B Don’t like to buy

C Don’t feel need of it

10% D Prefer to invest money

in some other area
29%

Table: 4.8

REASONS PERCENTAGE

Low salary 26

Don’t like to buy 29

Don’t feel need of it 10

35
Prefer to invest money
in some other area

TOTAL 100

86
Interpretation:

In the above data, reason behind not buying Health Insurance even after aware about it.
26 % of respondents didn’t buy health insurance because they have low salary. 29% of
respondents didn’t buy because they don’t like to buy health insurance. 10 % of
respondents didn’t buy health insurance because they don’t feel that they need health
insurance. 35% of respondents didn’t buy because they prefer to invest money in some
other areas like gold, etc,

Majority of respondent prefer to invest money in some other area rather that to buy
health insurance.

87
 :

Question 9 If you plan to buy Health Insurance, according to which

factor would you select the policy?

Figure 4.9:Showing factor to select health insurance policy

Factors to select the policy

36%
45%
A Premium
B Company Name
C Customer Satisfaction

19%

Table: 4.9

FACTORS PERCENTAGE

Premium 36

Company Name 19

Customer Satisfaction 45

TOTAL 100

Interpretation:

88
In the above data, information about the factors consider to select health insurance
policy is shown. 36% of respondents consider premium while selecting health insurance
policy. 19 % of respondents consider the Company name while selecting health
insurance policy. Customer Satisfaction is consider by 45 % respondent while selecting
the health insurance policy.

Majority of respondents consider Customer Satisfaction while selecting Health

Insurance policy.

89
10 :Do you have Health Insurance Policy?

Figure 4.10: Showing respondents having Health insurance policy

Respondents having Health Insurance policy

33%

A Yes
67% B No

Table: 4.10
HAVE HEALTH
INSURANCE PERCENTAGE

Yes 33

No 67

TOTAL 100

Interpretation:

The above data shows that how many respondents have health insurance policy. Only
33 % of the respondents have health insurance policy & 67 % of the respondents don’t
have health insurance policy because some of them have low salary, some don’t like to

90
buy health insurance, some feel they don’t need for it & some prefer to invest money
in some other area. Majority of respondents don’t have health insurance

91
Question11: Who is your Insurer?

Figure 4.11: Showing insurer of the respondents who have health insurance policy

Insurer of Respondent who have Health

Insurance Policy

37%

A Public Company
63% B Private Company

Table: 4.11

INSURER PERCENTAGE

Public Company 63

Private Company 37

TOTAL 100

Interpretation:

The above data shows the information shows that who is the insurer of the respondents
those who have health insurance. 63 % of respondents have health insurance policy
from Public company like United India Insurance Company, National Insurance
Company, etc. 37% of respondent have health insurance policy from Private company

92
Apollo Munich Health Insurance Company, Star Health & Allied Insurance Company
Ltd, etc. Majority of respondent have health insurance policy from Public Company

.
93
Question 12: Which type of Health Insurance do you have?

Figure 4.12: Showing type of health insurance policy respondent are holding

Type of Health Insurance policy respondents

have

4%

18%
A Individual Health
Insurance
30%
B Mediclaim Insurance

C Family Floating
Insurance
48% D Unit Linked Health Plan

Table: 4.12

TYPES OF POLICY PERCENTAGE

Individual Health Insurance 18

Mediclaim Insurance 48

Family Floating Insurance 30

Unit Linked Health Plan 4

TOTAL 100

94
Interpretation:

In the above data shown the different types of health policy that the respondents have.
18% of respondents have Individual Health Insurance policy.48% of respondents have
Mediclaim Insurance policy. 30% of respondents have Family Floating Insurance
policy & Only 4 % of respondents have Unit Linked Health Plan Policy.

Majority of respondents have Mediclaim Insurance policy.

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Question13:Who influence you to buy the policy?
Figure 4.13: Showing influence of buying health insurance policy

Influence to buy Health Insurance

23% 24%
A Yourself
B Family & friends
C Advertisement
D Agent
15%
20% E Doctor

18%

Table: 4.13

INFLUENCE BY PERCENTAGE

Yourself 24

Family & friends 15

Advertisement 18

Agent 20

Doctor 23

TOTAL 100

96
Interpretation:

The above data show the information about by which the respondent influence to buy
the Health Insurance. 24% of respondents are influence by themselves to buy health
insurance. 15% of respondents are influence buy the Family & friends to buy health
insurance. 18% of respondents are influence by the Advertisement to buy health
insurance. 20% of respondents are influence by Agents to buy health insurance. 23%
of respondents are influence by doctor to buy health insurance.

Majority of respondents are influence by themselves.

97
Question 14 : How long you carry this Health Insurance Policy?

Figure 4.14: Showing respondents carrying health insurance policy ( in years)

Years carrying the Health Insurance policy

12% 12%

A Below 1 year

18% B 1 – 5 years

C 5 – 10years

58%

Table: 4.14

NO. OF YEARS PERCENTAGE

Below 1 year 12

1 – 5 years 58

5 – 10years 18

Above 10 years 12

TOTAL 100

98
Interpretation:

In the above data, shows that from how many years the respondents is carrying the
health insurance. 12% of the respondents are carrying the policy from below 1 year.
58% of respondents are carrying the policy from 1 – 5 years. 18 % of respondents are
carrying the policy from 5 – 10 years. 12% of respondents are carrying the policy from
more than 10 years.

Majority of respondents are having their policy from last 1 – 5 years

99
Question15: What is your Annual Premium?

Figure 4.15: Showing annual premium paid by respondents

Annual premium
2%

4%

A Below 5000 Rs.

42%
B 5000 – 10000
Rs.
52%
C 10000 – 15000
Rs.

Table: 4.15

ANNUAL PREMIUM PERCENTAGE

Below 5000 Rs. 42

5000 – 10000 Rs. 52

10000 – 15000 Rs. 4

Above 15000 Rs. 2

TOTAL 100

100
Interpretation

The above data show the information about annual premium pay by the respondents.
42% of respondents pay annual premium of Below Rs.5000. 52 % of respondents pay
annual premium between 5000 – 10000 Rs. 4 % of respondents pay annual premium of
between 10000 – 15000Rs. 2% of respondents pay annual premium above 15000Rs.

Majority of the respondents pay annual premium of Rs. Between 5000 – 10000.

101
Question 16: What is your coverage Sum Insured?

Figure 4.16: Showing sum assured for respondents

Sum Assured

3%

18%

33% A Below 1 lakh

B 1 – 5 lakhs
C 5 – 10 lakhs
46% D Above 10 lakhs

Table: 4.16

SUM ASSURED PERCENTAGE

Below 1 lakh 18

1 – 5 lakhs 46

5 – 10 lakhs 33

Above 10 lakhs 3

TOTAL 100

The above data show the information about Sum Assured by the health insurance policy
of the respondents. 18 % of respondents have sum assured of below than Rs 1 lakh.

102
46% of respondents have sum assured of Rs. 1 – 5 lakhs. 33% of respondents have
sum assured of Rs 5 – 10 lakhs. 3% of respondents have sum assured of Rs. More than
10 lakhs.

Majority of respondents have Sum Assured of Rs. Between 1 lakh to 5 lakhs.

103
Question17: Are you satisfy with our policy facilities?

Figure 4.17: Showing respondents satisfy with the policy

Satisfy with the policy

10%

A Yes
B No

90%

Table: 4.17
SATISFY WITH
POLICY PERCENTAGE

Yes 90

No 10

TOTAL 100

104
The above data show the information that how many respondents are satisfy with their
policy. Moreover 90% of the respondents those who have health insurance are satisfy
with their policy.10 % of respondents those who have health insurance are not satisfy
with their policy because they want additional benefit like ambulance charge, easy
claim settlement.

Majority of respondents are satisfy with the policy.

Conclusion:

This chapter present a detailed statistical analysis & interpretation of the data which
was attempted for collection of primary data through the questionnaire method.
Statistical analysis & interpretation of the data Shows data about age of respondents,
gender of respondents, qualification of respondents, employment of respondents,
annual income of respondents, number of respondent aware of health insurance, the
source of awareness of health insurance, reasons of not buying health insurance policy,
factor to select health insurance policy, how many respondents have health insurance
policy, insurer of the respondents who have health insurance policy, type of health
insurance policy respondent are holding, influence of buying health insurance policy,
for how many years respondents are carrying health insurance policy, annual premium
paid by respondents Showing sum assured for respondents, how much respondents are
satisfy with the policy.

105
 CHAPTER-5

FINDINGS, SUGGESTIONS & CONCLUSION

FINDINGS:

➢ 63 % of respondents are aware about the Health insurance but 37 % of

respondents are not aware about the Health Insurance because of the education
level.

➢ Majority of respondents i.e. 38% of the respondents are aware about Health
Insurance from the Family & friends & 24% of the respondents are aware
from the TV advertisement.

➢ 35% of respondents didn’t buy health insurance because they prefer to invest
money in some other areas like gold, etc, . 29% of respondents didn’t buy
because they don’t like to buy health insurance.

➢ 36% of respondents consider premium while selecting health insurance

policy.19 % of respondents consider the Company name while selecting policy.
Customer Satisfaction is consider by 45 % respondent while selecting the
policy.

➢ Only 33 % of the respondents have health insurance policy & 67 % of the

respondents don’t have health insurance policy because some of them have low
salary, some don’t like to buy health insurance, some feel they don’t need for it
& some prefer to invest money in some other area.

➢ Majority of respondent i.e. 63 % of respondents have health insurance policy

from Public Company. 37% of respondent have health insurance policy from
Private company.

106
 ➢ Respondents who have Health Insurance policy from that Majority of
respondents i.e 48% of respondents have Mediclaim Insurance & Only 4 % of
respondents have Unit Linked Health Plan Policy.

➢ Majority of respondents i.e 24% of respondents are influence by themselves to

buy health insurance & 23% of respondents are influence by doctor to buy
health insurance.

➢ Majority of respondents i.e 58% of respondents are carrying the policy from 1
– 5 years. 12% of respondents are carrying the policy from more than 10 years
&same for below 1 years.

➢ 46% of respondents have sum assured of Rs. 1 – 5 lakhs & Only 3% of

respondents have sum assured of Rs. More than 10 lakhs.

➢ 90% of the respondents those who have health insurance are satisfy with their
policy.10 % of respondents those who have health insurance are not satisfy
with their policy because they want additional benefit like ambulance charge,
easy claim settlement.

SUGGESTION:

 Private companies should build the confidence in the public to increase the health
insurance coverage like public companies.

 Government should still conduct awareness programmes to inform the people

about the benefits of health insurance.

 The government can also take the assistance of NGOs, gram panchayats,
cooperatives, etc. in the marketing and delivery of health scheme for the
financially weaker and unorganized section of the society.

107
 Agents and private players should target new markets in rural and semi-urban
areas, rather than tapping the same market. This will increase the penetration of
health insurance.

 More spreading of message on preventive healthcare measures is also an important

task of the hospitals.

 Customers should make use of the grievances cell in the case of any dissatisfaction
relating to health insurance.

 An individual should take health policy at very young age and covering all
members of the family.

 Government companies should improve their customer support services, introduce

money back policies, develop short claim settlement process, develop more
cashless facilities network and issue health insurance card like identity card to
Indian citizens.

 An advisor must be available in all hospitals who can clearly explain and suggest
a suitable policy for the person or the family.

 As senior citizens cannot afford the cost of premiums, but they badly need some
kind of Insurance, the Government may subsidize premium.

 Health is valuable present for human life. People can have money, houses, some
luxurious things but they cannot buy health. Once getting a serious disease,
everything becomes nothing immediately. So agree with the point that Prevention
is better than cure .

108
CONCLUSION:

It’s reveled from the study that Majority of the respondents are aware about the Health
insurance but they don’t buy because of some reasons like they don’t like to buy Health
Insurance, they feel there is no need to buy health insurance, some of them don’t buy
because they have low salary, some prefer to invest money in other area. From the
respondents who are aware about the health insurance only 33% of respondent have
health insurance policy majority of respondents have medicliam insurance Moreover
90% of the respondents those who have health insurance are satisfy with their policy.10
% of respondents those who have health insurance are not satisfy with their policy
because they want additional benefit like ambulance charge, easy claim settlement. the
factors consider to select health insurance policy is premium ,Company name &
majority of respondents consider Customer Satisfaction while selecting the health
insurance policy. Majority of people get to know about the health insurance from their
family & friends.

“Health coverage to all” should be the motto of the health insurance sector. There
should be easy access to healthcare facilities and cost control measures should be in
place. Health insurance is going to develop more in the current liberal economic
scenario. But, a completely unregulated or very less regulated health insurance sector
may concentrate only on those who have the ability to pay for the insurance cover. So,
the challenge is in helping the benefits percolate to the economically weaker sections
of the population. Transparent and accountable government and non-government
participation should be encouraged. Developing and marketing social health insurance
schemes through cooperatives and rural association would go a long way in benefiting
the vast unorganized employment sectors currently neglected under the existing
schemes. Also althorough revamp of schemes like ESIS and CGHS is necessary for
them to be more purposeful and efficient. If the government, service provider, health
care industry and the health insurance customers can incorporate all these suggestions
given in the study, then the concept of health insurance will reach new heights in the
near future and Mother India will be definitely, the most healthiest nation in the world.
Suitable data ideas were suggested to improve the health insurance sector.

109
 ANNEXURE

QUESTIONNAIRE

A STUDY ON AWARENESS OF HEALTH INSURANCE AMONG

LOWER INCOME GROUP PEOPLE (Annual Income Below 5 lakhs)

Dear Respondent,

Kindly spare sometime to provide sincere answer to academic question leading to

my research project and I assure you that the identity and the data provided will be kept
confidential and will be used strictly for Academic Research purpose.

A) PERSONAL INFORMATION

1. Name :
___________________________________________________

2. Age : 18 - 20 years 21 – 40 years

41 – 60 years Above 60 years

3. Gender : Male Female

4. Qualification : Below SSC SSC HSC

Graduate Post-Graduate

5. Employment : Government Employee Corporate Employee

Self-Employee Other ________________

6. Annual Income : Below 1 lakh 1 – 3 lakhs 3 – 5 lakhs

110
 7. Do you have Health Insurance Policy? Yes No

IF ABOVE ANSWER IS LIFE INSURANCE, Ask Part (B) OTHERWISE Part

(C)

B) SECONDARY INFORMATION
8. Are you aware about Health Insurance? Yes No

9. If yes, what are the source of awareness? TV Newspaper

Agent
Family & Friends
Consultants & Doctor
College

10. Why you have not taken Health Insurance? Low Salary Don’t like to buy

Don’t feel need of it Prefer to invest money in some other area

Other ______________

11. If you plan to buy Health Insurance, according to which factor would you select
the policy?
Premium Company Name Customer Satisfaction Other
___________

C) HEALTH INSURANCE POLICY RELATED DETAIL

12. Who is your Insurer? Public Company Private Company

13. Which type of Health Insurance do you have? Individual Health

Insurance
Mediclaim Insurance
Family Floating Insurance
Unit linked Health Plan
14. Who influence you to buy the policy? Yourself

111
 Relatives & Friends

Advertisement

Agents

Other_______

15. How long you carry this Health Insurance Policy?

Below 1 year 1 – 5 years 5 – 10 years Above 10 years

16. What is your Annual Premium? Below 5000 Rs. 5000 – 10000 Rs.
10000 – 15000 Rs. Above 15000 Rs.

17. What is your coverage Sum Insured? Below 1 lakhs 1 – 5 lakhs

5 – 10 lakhs

Above 10 lakhs

18. Are you satisfy with our policy facilities? Yes No

19. Suggest what improvement to do what in your

policy:______________________
_________________________________________________________________
_________________________________________________________________

112
 BIBLOGRAPHY & REFERENCE

BIBLOGRAPHY:

https://cleartax.in/s/health-insurance

https://encryptedtbn0.gstatic.com/images?q=tbn:ANd9GcTKCOsV4gV10IfeEiZkqgb
MHQ1qOU-WhKSDaxI4MbNZQuJorke7&s

https://iedunote.com/types-of-insurance

https://images.slideplayer.com/34/10166270/slides/slide_20.jpg

https://pocketsense.com/the-disadvantages-of-health-insurance-3896464.html

https://shodhganga.inflibnet.ac.in/bitstream/10603/67509/12/12_chapter%203.pdf

https://sol.du.ac.in/mod/book/view.php?id=1226 https://www.bankbazaar.com/health-

insurance/maternity-insurance-plans.html

https://www.bankbazaar.com/insurance/critical-illness-health-insurance.html

https://www.bankbazaar.com/insurance/individual-health-insurance.html

https://www.bankbazaar.com/insurance/senior-citizen-health-insurance.html

https://www.definitions.net/definition/health

https://www.dr-hempel-network.com/health-policies-in-india/health-insurance-inindia-
future/

https://www.dr-hempel-network.com/health-policies-in-india/health-insurance-inindia-
future/

https://economictimes.indiatimes.com/tdmc/your-money/eight-reasons-to-buy-

healthinsurance-before-you-turn-30/tomorrowmakersshow/47298428.cms

https://www.google.com/amp/s/www.hdfcergo.com/amp/health-insurance

https://www.insurancedekho.com/health-insurance/articles/why-is-public-awarenessof-

113
health-insurance-a-must-in-india-363

https://www.investopedia.com/terms/i/insurance.asp

https://www.irdai.gov.in/admincms/cms/uploadedfiles/annual%20reports/IRDAI%20

English%20Annual%20Report%202018-19.pdf

https://www.medicalnewstoday.com/articles/150999.php

https://www.onewithnow.com/awareness-what-does-it-mean-to-you/

https://www.policybazaar.com/health-insurance/family-health-insurance-plan/

https://www.reliancegeneral.co.in/Insurance/Knowledge-

Center/InsuranceReads/Benefits-Of-Buying-A-Health-Insurance-Policy-Online.Aspx/

https://www.scrabblerules.net/words/insurance/

REFERENCE:

 Adgaonkar Ganesh(2015),Insurance awareness of India. ISSN Online: 23945869

 Ahuja & Rajeev (2005), Health Insurance for the poor in India: An analytical
Study.
 Anil Gumber & Veena Kulkarni (September-2000),Health Insurance for Informal
Sector.
 Ankit Jain, Selva Swetha, Zeena Johar, Ramesh Raghavan (August-2013),
Acceptability of, and willingness to pay for, community health insurance in rural
India, ISSN:2210-6006
 B Reshmi, Ragil Raghunath, B Unnikrishnan (September-2009), Awareness of
Health Insurance among Inpatients at a Tertiary Care Hospital in Coastal
Karnataka
 B. Reshmi,N. Sreekumaran Nair, K.M. Sabu, and B. Unnikrishnan
(2007),Awareness of Health Insurance in South Indian population- a community
based study.

 Dr. G.Kasirajan (April-2012),Health insurance –an empirical study of consumer

behavior in Tuticorin district,ISSN:2230-7850

114
 Dr. Sumninder Kaur Bawa & Ms. Ruchita (June-2011),Awareness and
Willingness to pay for Health Insurance- An Empirical Study with reference to
Punjab ,India.
 Dr. Y. Nagaraju (April-2014),A Study on Performance of Health Insurance
Schemes in India,ISSN:2321-2926
 Geoffrey Setswe, Samson Muyanga , Jacqueline Witthuhn , Peter Nyasulu
(September-2015), Public awareness and knowledge of the National Health
Insurance in South Africa, ISSN:1937-8688
 Indumathi K, Hajira Saba I, Arun Gopi, Mangala
Subramanian
(2016),Awareness of health insurance in a rural population of Bangalore, India. 
IRDAI English Annual Report 2018-2019
 Jangati Yellaiah (June-2012),Awareness of Health Insurance in Andhra Pradesh.,
ISSN: 2250-3153
 K.Swathi, R.Anuradha (2016),Health Insurance in India-An Overview.,
ISSN:2319-7668
 Kiplagat Jebiwott Isabella (September-2011), Determinants of heath insurance
choice in KENYA
 L. Sivaramakrishnan and Ti. M. Swaaminathan (May-2015),Awareness and public
receptivity for health insurance products a study with reference to Kanchipuram
town, India. ISSN: 2347-3215 Volume 3
 M. Kent Ransona,, Tara Sinhab, Mirai Chatterjeeb, Akash Acharyac,Ami
Bhavsarb, Saul S. Morrisd, Anne J. Millsa (June-2007),Making health insurance
work for the poor: Learning from the Self-Employed Women’s Association’s
(SEWA) community-based health insurance scheme in India.
 Maheshkumar L choudhary, Kalpesh I Goswami, Sudha B Khambhati,Viral R
Shah,Naresh R Makwana, Sudha B Yadav (June-2013), Awareness of health
insurance and its related issues in rural areas of Jamnagar District,
 Maumita Ghosh (2013), Awareness and Willingness to Pay for Health Insurance:
A Study of Darjeeling District, ISSN:2279-0845
 Mrs.A. Priya & Dr. R. Srinivasan (July-2015),A study on Customer Awareness
towards Health Insurance with special reference to Coimbatore City,ISSN:
2319-7668.

115
 Ms.Swati Dattatray Kedare (2012),Health Insurance- Identifying awareness
preferences and buying pattern in Mumbai.
 Pradeep Panda , Arpita Chakraborty and David M. Dror (August-2015) Building
awareness to health insurance among the target population of community-based
health insurance schemes in rural India
 Rabindra Ghimire (2018),Health insurance awareness among the university
teachers in Pokhara Valley.”
 Ramesh Bhat & Nishat Jain (2006), Factor affecting the demand for insurance in
a micro health insurance schemes.
 Rohit Kumar,K. Rangarajan,Nagarajan Ranganathan (March-2011), Health
Insurance in India—A Study of Provider’s Perceptions in Delhi & the NCR
 Shamika Ravi & Sofi Bergkvist (June-2014) , Are Publicly Financed Health
Insurance Schemes Working in India?
 Sonal Kala & Dr.Premila Jain (May-2005), Awareness of Health Insurance among
people with special reference to Rajasthan(India), ISSN: 2349-5677
 Sudhir Gowda (December-2015), Awareness about health insurance in rural
population of South India, ISSN:2394-6040
 Suraj Sirohi, Chakresh Jain,Aditya Khatri, Sanjay Dixit, &Shailesh Rai
(June2016), Awareness of Health Insurance in Indore: A Cross-Sectional
Descriptive Study, ISSN:2394-6776
 Surendar R (2019),Awareness on Health Insurance among a selected Urban
Population in Puducherry, ISSN:2277-3517
 Suwarna Madhukumar, Sudeepa D, Vaishali Gaikwad (2012),Awareness and
perception regarding health insurance in Bangalore rural population.
 V. Sini & Dr. C. R. Karpagam (2016),A study on policy holders awareness and
preference towards health insurance, ISSN:2455-5630
 Yellaiah, G. Ramakrishna (2012), Socio economic determinants of health
insurance in India: the case of Hyderabad city, ISSN:2168-8662

116