INTRODUCTION OF THE STUDY

TOPIC

This project works deals with the topic ―Study of the Cost benefits ANALYSICS of Star
health insurance.” in Hubli market.

(a) Objective of the Study

Every study is done with certain objectives. The study without objectives preset is a futile
exercise, as it will end in no conclusion.

In this competitive environment whole market is consumer oriented. This time

they are the king of the market. So, by this study I would like to know what is there
actual role into the market and what is their behaviour towards the products and services
are getting from respective companies and how they benefited to insurance services it
will easier to analysics the through objective.

 Objectives

1) To understand the star health insurance policies.

2) To understand the cost benefit analyses of health insurance.
3) To find out the customer satisfaction level of star health and allied insurance co.
4) To identify the problem level of customer benefits.
5) To analyses the star health insurance policies.
6) To promote the star health insurance policies.
7) To meet benefiters get feedback of star health insurance co.
 Scope of the Study

The scope of the study for management student gets to apply all their theoretical
knowledge in the company‘s summer training. During training they solve the particular
problem given by the company and come to know the various thing practically.

The study gives the company a true and unbiased picture of its position and standing in
especially at hubli Market and also its image in the society

Type of Research – exploratory

Type of Data – Primary

Method of Data collection – Survey

Research Instrument - Structured Schedule

Sampling Method – non parametric

Sample Size – 50

Sampling Unit – consumer of star health insurance

 Methodology

For the preparation of project report especially in case of Marketing every steps should be
anticipated closely. In this anticipation of formulation there may arise some problems,
since these are two types of information.

(i) For Primary Information :

I have used personal interview method. This survey conducted on 50 consumers

across Hubli Area. I used a set questionnaire containing some questions for
consumers. These data are expensive and time consuming but these data are most
important and reliable.

(ii) The Secondary Information:

This secondary data were collected from the internal sources (Company‘s
Documents) of as well as some external sources (Paper & Magazines). This
collection of these data is for easier and less time consuming.

POPULATION AND SAMPLE

The sample size taken for survey includes 50 consumers. The sample takes into
consideration all the consumers consist of beneficers of star health insurance
SAMPLING TECHNIQUE

In this study simple random sampling is used to select the sample size.

Simple Random sampling:

Simple Random sampling is one the simplest sampling designs and can work well for
relatively small populations. Simple Random Sampling is a process which ensures that
each of the sample of size and has an equal probability of being picked up as the chosen
sample.

RESEARCH INSTRUMENTS:

The investigator has used questionnaire as the research instrument. The types of
questions used in the questionnaire are multi-ended questions. In this type of questions
the respondents will be given four choices for answer in which they have to choose one.

The questionnaire used is a structure and closed-end one. It is one on which there are
definite, concrete and predetermined question.
 Limitation of the Study

Limitations are always accompanied with any work. I had completed his study within
short span of 8weeks & it was not possible to understand practically all aspects of the
subjects. Each and every factor has been carried out carefully as much as possible
limitation to the study are beyond control.

As all the primary data has been collected by discussion and interviews, there is a choice
of error as people hesitate in granting correct data and sometime exaggerate the
information. Although I tried to convince the respondents that the study is only meant for
academic purpose, some respondents were not ready to furnish other information like
competitors of Star health insurance products, how Star health insurance is better than
other products, regarding cost benefits of anlysics in the star insurance etc. The
investigator hopes that the study will yield dependable and useful results.

The successes of any research work depend on the response of the respondent.
But sometime the response is not sufficient due to these following reasons

 Respondents generally have less time to respond.

 Sometimes they are confusing in their response due to lack of knowledge.
 Some persons are not willing to disclose the truth.
 Their attitude towards people representing a company.
 The time constraint faced in the project might have affected the comprehensiveness of its
findings.
Introduction to Insurance
Definition:-

Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in
exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large,
possibly devastating loss.

Insurance appears simultaneously with the appearance of human society. We know of two types
of economies in human societies:

 Money Economies

With markets, money, financial instruments and so on.......

 Non-Money Or Natural Economies

Without money, markets, financial instruments and so on........

The second type is a more ancient form than the first. In such an economy and
Community, we can see insurance in the form of people helping each other. For example, if a
house burns down, the members of the community help build a new one. Should the something
happen to osne's neighbor, the other neighbors must help Otherwise; neighbors will not receive
help in the future. This type of insurance has survived to the present day in some countries where
modern money economy with its financial instruments is not widespread.

For Example: - Countries in the territory of the former Soviet Union.

Turning to insurance in the modern sense (i.e., insurance in a modern money economy, in
which insurance is part of the financial sphere), early methods of transferring or distributing risk
were practiced by Chinese and Babylonian traders as long ago as the 3rd and 2ndmillennia BC,
respectively. Chinese merchants travelling treacherous river rapids would redistribute their wares
across many vessels to limit the loss due to any single vessel‘s capsizing. The Babylonians
developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and
practiced by early Mediterranean sailing merchants. If a merchant received a loan to fund his
shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to
cancel the loan should the shipment be stolen.

Achaemenian monarchs of Iran were the first to insure their people and made it official by
registering the insuring process in governmental notary offices.
 The Greeks and Romans introduced the origins of health and life insurance in 600 AD when
they organized guilds called "benevolent societies" which cared for the families and paid funeral
expenses of members upon death.

Insurance as we know it today can be traced to the Great Fire of London, which in
1666devoured 13,200 houses. In the aftermath of this disaster, Nicholas Barbon opened an office
tonsure buildings. In 1680, he established England's first fire insurance company, "The Fire
Office," to insure brick and frame homes

Insurance, in law and economics, is a form of risk management primarily used to hedge
against the risk of a contingent loss. An Insurer is a company selling the insurance; an Insured
is the person or entity buying the insurance.

Premium:-

The insurance rate is a factor used to determine the amount to be charged for certain
Amount of insurance coverage, called the premium.

Indemnity:-

The technical definition of "indemnity" means to make whole again. There are two types of
insurance contracts;

1. an "indemnity" policy and

2. A "pay on behalf" or "on behalf of‖ policy.

The difference is significant on paper, but rarely material in practice. An "indemnity" policy will
never pay claims until the insured has paid out of pocket to some third party. Under the same
situation, a "pay on behalf" policy, the insurance carrier would pay the claim and the insured
both. Most modern liability insurance is written on the basis of "pay on behalf" language.

Insurers make money in two ways:

(1) through Underwriting, the process by which insurers select the risks to insure and decide
how much in premiums to charge for accepting those risks and

(2) by investing the premiums they collect from insured parties.

Claims: - Finally, claims and loss handling is the materialized utility of insurance; it is the actual
"product" paid for, though one hopes it will never need to be used.

Commercially insurable risks typically share seven common

Characteristics:-
 Limited risk of catastrophically large losses.

 Calculable Loss

 Affordable Premium

 Large Loss

 Accidental Loss

 Definite Loss

 A large number of homogeneous exposure units

CHAPTER 2
 Health Care Insurance
Definition:-

The term health insurance is generally used to describe a form of insurance that pays
For medical expenses.

A health insurance policy is a contract between an insurance company and an

Individual, By estimating the overall risk of healthcare expenses, a routine finance structure
(such as a monthly premium or annual tax) is developed, ensuring that money is available to pay
for the healthcare benefits specified in the insurance agreement. The type and amount of health
care costs that will be covered by the health plan are specified in advance, in the member
contract or Evidence of Coverage booklet.

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlain
from the Peter Chamberlain family. Accident insurance was first offered in the United States by
the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered
insurance against injuries arising from railroad and steamboat accidents. Before the development
of medical expense insurance, patients were expected to pay all other health care costs out of
their own pockets, under what is known as the fee-for-service business model. During the middle
to late 20th century, traditional disability insurance evolved into modern health insurance
programs.

Today, most comprehensive private health insurance programs cover the cost of
routine, preventive, and emergency health care procedures, and also most prescription drugs, but
this is not always the case.

The basic concept of health insurance is population solidarity. There are inherent risks
in a population but the population absorbs the cost of risks to an individual by spreading the
impact of incurred costs amongst the insured population. However, if the population is split into
insured and uninsured groups, or into selectively groups (as with private insurance with pre-
insurance selection either by the insurance company or the insured) the concept of population
solidarity breaks down. The insurance balances costs across a large, random sample of
individuals. For instance, an insurance company has a pool of 1000 randomly selected
subscribers, each paying Rs.100 per month. One person becomes very ill while the others stay
healthy, allowing the insurance company to use the money paid by the healthy people to pay for
the treatment costs of the sick person. However, when the pool is self-selecting rather than
random, as is the case with individuals seeking to purchase health insurance directly, adverse
selection is a greater concern. Insurance systems must then typically deal with two inherent
challenges: adverse selection and ex-post moral hazard.

Because of adverse selection, insurance companies employ medical underwriting, using

a patient's medical history to screen out those whose pre-existing medical conditions pose too
great a risk for the risk pool. Before buying health insurance, a person typically fills out a
comprehensive medical history form that asks whether the person smokes, how much the person
weighs, whether the person has been treated for any of a long list of diseases and so on. In
general, those who present large financial burdens are denied coverage or charged high
premiums to compensate.

Moral hazard occurs when an insurer and a consumer enter into a contract under symmetric
information, but one party takes action, not taken into account in the contract, which changes the
value of the insurance. A common example of moral hazard is third-party payment—when the
parties involved in making a decision are not responsible for bearing costs arising from the
decision. An example is where doctors and insured patients agree to extra tests which may or
may not be necessary. Doctors benefit by avoiding possible malpractice suits, and patients
benefit by gaining increased certainty of their medical condition. The cost of these extra tests is
borne by the insurance company, which may have had little say in the decision. Co-payments,
deductibles, and less generous insurance for services with more elastic demand attempt to
combat moral hazard, as they hold the consumer responsible.

Insurance companies like to compare buying health insurance after being diagnosed
with a serious medical condition like HCV to trying to buy fire insurance on a burning house.
That sounds really logical….except….most fire insurance policies are never used as most houses
don‘t burn down. Everyone has medical problems, however, at one time or another.

To prevent a person from buying health insurance only when they need it, the insurance
Industry uses a procedure called ―medical underwriting.‖ Loosely translated into plain English, it
means ―discriminating against anyone we feel may cost us money.‖ And this type of
discrimination against people with health problems is perfectly legal.

The French model of health insurance has been ranked by the World Health Organization as the
best in the world, because it permits a high quality of care and nearly total patient freedom. . It
was a compromise between Gaullist and Communist representatives in the French parliament.
The Conservative Gaullists were opposed to a state-run healthcare system, while the
Communists were supportive of a complete nationalization of health care along a British
Beverage model. The resulting programme was profession-based. All people working were
required to pay a portion of their income to a health insurance fund, which mutualised the risk of
illness, and which reimbursed medical expenses at varying rates. Children and spouses of insured
people were eligible for benefits, as well. Each fund was free to manage its own budget and
reimburse medical expenses at the rate it saw fit.
Health Care Insurance Scenario In India

The health care system in India is characterized by multiple systems of medicine, mixed
ownership patterns and different kinds of delivery structures. During the last 50 years India has
developed a large government health infrastructure with more than 150 medical colleges, 450
district hospitals, 3000 Community Health Centers, 20,000 Primary Health Care centers and
130,000 Sub-Health Centers. On top of this there are large number of private and NGO health
facilities and practitioners scatters though out the country. Over the past 50 years India has made
considerable progress in improving its health status.

Public sector ownership is divided between central and state governments, municipal
and Panchayat local governments. Public health facilities include teaching hospitals,
Secondary level hospitals, first-level referral hospitals (CHCs or rural hospitals), dispensaries;
primary health centres (PHCs), sub-centres, and health posts. Also included are public facilities
for selected occupational groups like organized work force (ESI), defense, government
employees (CGHS), railways, post and telegraph and mines among others.

The private sector (for profit and not for profit) is the dominant sector with 50 per cent of
people seeking indoor care and around 60 to 70 per cent of those seeking ambulatory care (or
outpatient care) from private health facilities.

India spends about 6% of GDP on health expenditure. Private health care expenditure
is 75% or 4.25% of GDP and most of the rest (1.75%) is government funding. At present, the
insurance coverage is negligible. Most of the public funding is for preventive, promotive and
primary care programes while private expenditure is largely for curative care. Over the period
the private health care expenditure has grown at the rate of 12.84% per annum and for each one
percent increase in per capital income the private health care expenditure has increased by
1.47%. Number of private doctors and private clinical facilities are also expanding exponentially.
Indian health financing scene raises number of challenges, which are:

1) Increasing health care costs,

2) High financial burden on poor eroding their incomes,

3) Increasing burden of new diseases and health risks and

4) Neglectof preventive and primary care and public health

functions due to under funding of the government health
care.

Around 24% of all people hospitalized in India in a single year fall below the poverty line
due to hospitalization (World Bank, 2002). An analysis of financing of hospitalization shows that
large proportion of people; especially those in the bottom fourincome quintiles borrow money or
sell assets to pay for hospitalization (World Bank, 2002).

Given the above scenario exploring health-financing options becomes critical. In light of
the fiscal crisis facing the government at both central and state levels, in the form of shrinking
public health budgets, escalating health care costs coupled with demand for health-care services,
and lack of easy access of people from the low-income group to quality health care, health
insurance is emerging as an alternative mechanism for financing of health care.

Health insurance is very well established in many countries. As global insurance premiums grew
by or 5% in real terms to reach $3.7 trillion due to improved profitability and a benign economic
environment characterized by solid economic growth, moderate inflation and strong equity
markets. Advanced economies account for the bulk of global insurance. The top four countries
accounted for nearly two-thirds of premiums in 2006. The U.S. and Japan alone accounted for
43% of world insurance, much higher than their 7% share of the global population. Emerging
markets accounted for over 85% of the world‘s population but generated only around 10% of
premiums. But in India the health insurance market is very limited covering about 10% of the
total population. 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 by government budget. In many other low and middle income countries
contribution of social health insurance is much higher.
 Table 1
Percentage of total health expenditure funded
through public/social
insurance and direct government revenue
COUNTRY Social Health Government
Insurance Budget

Algeria 37% 36%

Bolivia 20% 33%
China 31% 13%
Korea 23% 10%
Vietnam 2% 20%
India 3% 18%

It is estimated that the Indian health care industry is now worth of Rs. 96,000 crier and
expected to surge by 10,000 crore annually. The share of insurance market in above figure is
insignificant. General Insurance Corporation (GIC) and its four subsidiary companies and Life
Insurance Corporation (LIC) of India have various health insurance products. These are
Ashadeep Plan II and Jeevan Asha Plan II by Life Insurance Corporation of India and various
policies by General Insurance Corporation of India as under: Personal Accident Policy, Jan
Arogya Policy, Raj Rajeshwari Policy, Mediclaim Policy, Overseas Mediclaim Policy, Cancer
Insurance Policy, Bhavishya Arogya Policy and Dreaded Disease Policy (Srivastava 1999) Etc.

Of the various schemes offered, Mediclaim is the main product of the GIC. The Medical
Insurance Scheme or Mediclaim was introduced in November 1986 and it covers individuals and
groups with persons aged 5 – 80 yrs. Children (3 months – 5 yrs) are covered with their parents.
This scheme provides for reimbursement of medical expenses (now offers cashless scheme) by
an individual towards hospitalization and domiciliary hospitalization as per the sum insured.
There are exclusions and pre-existing disease clauses. Premiums are calculated based on age and
the sum insured, which in turn varies from Rs 15 000 to Rs 5 00 000.
 Star Health & Allied Insurance Company
Star Health and Allied Insurance Co. is a joint venture between Oman Insurance Company, Mr.
Syed Mohamed Salahuddin, Mr. Essa Abdullah Al Ghurair,leading Indian industrialists and
business houses. It is thier endeavor to provide dedicated, affordable and quality health insurance
that preserves and values human lives. This company aim to be the most favored brand in the
health insurance segment. We offer a wide range of health insurance services and related
products at affordable prices. Our prime objective is to offer services in the health segment that
enable you to manage stressful situations.

Star Health and Allied Insurance Company Limited (Star Health) has a capital base of Rs.108
crores, more than what is adequate to form a General Insurance Company. However, Star Health
has chosen to be in the field of Health and was the First stand-alone Health Insurance
Company in India and deals in Personal Accident, Mediclaim and Overseas Travel Insurance.

Mr. V. Jagannathan, Chairman cum Managing Director. He is a doyen of the Insurance

industry with over 40 years of experience in Insurance. He has held various positions of
authority, including that of CMD of one of India's largest Public Sector insurance companies.

BOARD OF DIRECTORS

Mr. Syed Mohamed Salahuddin - Chairman - Emeritus. Managing Director of ETA ASCON
and ETA STAR group of Companies in Dubai, U.A.E

Mr. Essa Abdullah Al Ghurair was educated in San Diego, USA. The Al Ghurair family has
business interests in Banking, Food & Beverages and Real estates.

Dr. M. Y. Khan is currently the Chairman of the Banking and Advisory council of YES Bank
Ltd.

Mr. D. R. Kaarthikeyan is currently a visiting professor in many prestigious institutions.

Mr. V.P. Nagarajan is the Executive Director of ETA ASCON and ETA STAR group of
Companies headquartered in Dubai, UAE.

Mr. Mohammed Hassan is a prominent educationalist and industrialist and has wide
knowledge in the respective fields for over three decades.
 Organizational Structure

Corporate Office

Zonal Offices

Area Offices

Branch Offices
+

SM Corporate
SM Station
Agents/Brokers

Agents MTs
 Star Health & Allied Insurance Company
 Is the first stand alone health insurance Company in India. It specializes in
Health Insurance, provides quality service at the best rates, and commits
itself to the service of the insured.

 Offers hassle free cashless settlement to the insured. There is no Third Party
Administrator involved, which means better service, in shorter time and no
hassles... at all!

 Provides a No Claim Discount - one that has never been offered before in
the country.

 Has a round-the-clock GP service, which provides counseling and advice.

When necessary the insured will be guided to the Company's large network
of doctors in different localities.

 Provides periodic health check up for the clients. Has a range of policies
suited to every age group, different health aspects and concerns.

. # And last but not the least, STAR HEALTH is first and foremost, a dedicated
insurer who cares for your health...in every way!
Exclusive Features

 Cashless service without TPA intervention the USP of the Company

 Direct tie-up with hospitals on all India basis

 24 hours General Practitioner's advice and medical counseling

 24x7 in-house Call Center

 Toll free telephone assistance

 Complete knowledge backed website to offer medical information, including health

tips.
 Our Vision
Protecting Health Promoting Health

Our Mission
Ultimate Customer Satisfaction

Trust and Ethics

We believe honesty and integrity
are essential to our success.

Conducive work environment

To create an environment that is conducive
to Customer Satisfaction, Innovation and
Belongingness.
 Commitment
We are committed to become a STAR in
health and related insurance.

The study will have following types of insurance policies :-

1. Mediclaim Policy

2. Family health optima insurance plan

3. Senior citizens red carpet

4. Personal accident insurance

Objectives

1. To study the underwriting Guidelines/procedure of selected policies which are being

practiced in the insurance company.

2. To calculate & suggest possible ways to decrease the turn around time in the
underwriting procedure for each policy.

3. To do a SWOT analysis for the purpose of comparison.

5. To study the existing web services & alerts for the purpose of policy underwriting & post
policy services.
UNDERWRITTING

The most complicated aspect of the insurance business is the underwriting of policies. There are 2
different methods of application that anyone looking for personal health insurance must be aware
of. These are

1. Full Medical Underwriting (FMU)

2. Moratorium (MOR).

Underwriting in relation to health insurance basically involves the disclosure of certain

information to an insurance company which they can then access to decide when pre-existing
conditions should be excluded from cover. With some policies one will be required to complete
an application form that details full medical history where as with a moratorium policy your
medical history will only become an issue at the point you need to make a claim.

Policies requiring a medical history declaration, or full medical underwriting, require the
applicant to complete an application form that details the full medical history for each applicant.
Private health insurance companies consult an applicant's GP in order to verify conditions or to
investigate an applicant's medical history further. Having submitted medical history a decision
will be made by the health insurance company as to whether or not they will cover any previous
medical conditions.

The rules surrounding ‗Duty of Disclosure' when applying for personal health insurance
are quite strict. It is one‘s duty to disclose any fact or circumstance about your health that is
known to you at your time of application. The main reason behind this disclosure is to identify if
you have any pre-existing conditions that will be excluded from treatment from your health
insurance policy.

Most health insurance providers will not pay benefits for any conditions that you have been
treated for in the past or have arranged treatment for prior to taking out your medical insurance
policy. This also includes any chronic conditions that have been diagnosed before the health
insurance policy was granted. If you fail to disclose details of any illness at the start of your
health insurance application then you could be denied a future claim or your personal health
insurance could be deemed invalid.

Some health insurance providers may agree to cover pre-existing conditions in exchange for
additional premiums, but this will depend entirely upon the condition in question and its severity,
how long you have had it and what treatment you have had or are still having for that condition.
Again, each health insurance company is different with different policies so make sure you
always do your homework with regards to what is and what is not included.

If you opt for a policy that requires full medical underwriting then all your medical history
will be available to your insurers up front enabling them to make an informed judgement before
confirming your policy. A moratorium policy is however a little bit different as this type of
application process does not require disclosure of medical history when joining. Instead any
illness is assessed at the point of making a claim.

With moratorium you do not need to fill in a health questionnaire. Instead, pre-existing
conditions for which you (and any dependant included in your application) have received
treatment and/or medication, or asked advice on, or had symptoms of (whether or not
diagnosed), during the four years immediately before your private health insurance cover started
will automatically be excluded from cover.

However, if you do not have any symptoms, treatment, medication, or advice for those pre-
existing conditions, and any directly related conditions, for two continuous years after your
policy starts, then insurers may reinstate cover for those conditions.

When choosing a personal health insurance provider it is vital that you understand the
differences between policies and which one is best suited. With any insurance company
though it is always better to be honest from the outset to avoid any disappointment or hefty
medical bills further down the line. With Full Medical Underwriting the boundaries are perhaps
clearer as everything will be documented from the outset and assessed by your insurer before the
policy is approved leaving you with a clear understanding of exactly what your personal health
insurance covers you for. Using a wide assortment of data, insurers predict the likelihood that a
claim will be made against their policies and price products accordingly. To this end, insurers
use actuarial science to quantify the risks they are willing to assume and the premium they will
charge to assume them. Data is analyzed to fairly accurately project the rate of future claims
based on a given risk. Actuarial science uses statistics and probability to analyze the risks
associated with the
range of perils covered, and these scientific principles are used to determine an insurer's overall
exposure. Upon termination of a given policy, the amount of premium collected and the
investment gains thereon minus the amount paid out in claims is the insurer's underwriting profit
on that policy. Of course, from the insurer's perspective, some policies are winners (i.e., the
insurer pays out less in claims and expenses than it receives in premiums and investment
income) and some are losers (i.e., the insurer pays out more in claims and expenses than it
receives in premiums and investment income).

 - incurred loss - underwriting expenses.

 ways:

 underwriting, the process by which insurers select the risks to insure and
 decide how much in premiums to charge for accepting those risks.

 investing the premiums they collect from insured parties.

Insurance companies also earn investment profits on ―float‖. ―Float‖ or available reserve is the
amount of money, at hand at any given moment, that an insurer has collected in insurance
premiums but has not been paid out in claims. Insurers start investing insurance premiums as
soon as they are collected and continue to earn interest on them until claims are paid out.

Some insurance industry insiders, most notably Hank Greenberg, do not believe that it is forever
possible to sustain a profit from float without an underwriting profit as well, but this opinion is
not universally held. Naturally, the ―float‖ method is difficult to carry out in an economically
depressed period. Bear markets do cause insurers to shift away from investments and to toughen
up their underwriting standards. So a poor economy generally means high insurance premiums.
This tendency to swing between profitable and unprofitable periods over time is commonly
known as the "underwriting" or ―insurance cycle‖
 Medial Underwriting:-

On receiving an application from an individual for health insurance, the insurance company
carefully scrutinizes the applicant's medical history and other factors to decide whether to offer
coverage or not and if yes, then on what rate and on what conditions. Each insurance company
develops its own underwriting guidelines to outline the characteristics the company considers
desirable and those that make an applicant ineligible for coverage. Health insurers avoid
individuals or groups that they think may be likely to make claims, either because of poor health
or because the person or company is financially unstable. Insurance companies use the term
"adverse selection" to describe the tendency for only those who will benefit from insurance to
buy it. Specifically when talking about health insurance, unhealthy people are more likely to
purchase health insurance because they anticipate large medical bills. On the other side, people
who consider themselves to be reasonably healthy may decide that medical insurance is an
unnecessary expense; if they see the doctor once a year and it costs Rs.250/-, that's much better
than making monthly insurance payments of Rs.40/- (example figures).

Because of adverse selection, insurance companies employ medical underwriting, using a

patient's medical history to screen out those whose pre-existing medical conditions pose too great
a risk for the risk pool. Before buying health insurance, a person typically fills out a
comprehensive medical history form that asks whether the person smokes, how much the person
weighs, whether the person has been treated for any of a long list of diseases and so on. One
large industry survey found that roughly 13 percent of applicants for comprehensive,
individually purchased health insurance who went through the medical underwriting in 2004
were denied coverage. Declination rates increased significantly with age, rising from 5 percent
for individuals 18 and under to just under a third for individuals aged 60 to 64. Among those
who were offered coverage, the study found that 76% received offers at standard premium rates,
and 22% were offered higher rates.

The premium structure is not designed for the extra risk assumed by insuring persons who drink
intoxicants to excess, who are victims of drug habits, who are reckless in their manner of living
or choice of associates or who have questionable reputations. Such persons are not eligible for
health insurance." All companies selling individual major medical insurance policies examine
the medical history of every applicant, using questions on the application, follow-up phone calls,
Medical Information Bureau reports, paramedical exams, and blood and urine samples. Medical
underwriting manuals are extensive and include detailed discussions of known illness for each of
the body's systems (circulatory, nervous, reproductive, etc.)
Moral hazard occurs when an insurer and a consumer enter into a contract under symmetric
information, but one party takes action, not taken into account in the contract, which changes the
value of the insurance. A common example of moral hazard is third-party payment—when the
parties involved in making a decision are not responsible for bearing costs arising from the
decision. An example is where doctors and insured patients agree to extra tests which may or
may not be necessary. Doctors benefit by avoiding possible malpractice suits, and patients
benefit by gaining increased certainty of their medical condition. The cost of these extra tests is
borne by the insurance company, which may have had little say in the decision. Co-payments,
deductibles, and less generous insurance for services with more elastic demand attempt to
combat moral hazard, as they hold the consumer responsible.

Underwriting is a way of determining the insurability of the client by reviewing his/her medical
and financial details using various risk classification models. This practice can be dated back to
1800 B.C, when undertaking risk, or underwriting risk, of ships with goods was done. From
those days, underwriting has evolved greatly and is presently categorized into life and non-life
underwriting, both including financial underwriting. Life underwriting can be further divided
technically into medical and non-medical underwriting.
Here are a few tips for prudent medical underwriting:

1. Use your analytical mind - Ask, “Does it make sense”

Always ask yourself whether the data given makes sense. In most of the cases the data presented
can be manipulated or it can be false positives. For example, a client can take a hypoglycemic
drug and go for a fasting blood glucose test or the value of nine given can be HbA1, when a
HbA1c test was to be performed.

2. Read between the lines

Analyze what is not given in the data provided or find the potential risks the medical reports
point to. For example, a 44-year-old female undergoing tooth extraction was also asked to
undergo an electrocardiogram and fasting blood sugar test. This data created a doubt and when
further investigated revealed diabetes mellitus.

3. Study medical history and genetic susceptibility

Carefully analyze the medical history as it can give you a lot of information about the client‘s
current health status and possible endothelial damage, which must have occurred in their body.
For example, in the case of diabetes, hypertension along with the date of diagnosis can provide a
clear idea on the risks involved. Also some disorders are genetically manifested, for example
arthritis, thallassemia, diabetes, arthritis and obesity to name a few. Hence understanding the
medical history of the client and his first line relatives can provide substantial data for classifying
the risk to him.
4. Do not look from a clinical point of view
Remember insurance medicine is different from clinical medicine. You as medical underwriter
are not required to identify the root cause of the disease, but to identify the pathology and
analyze how much risk it presents to the life of the client and also within how much time the
client is going to suffer from that expected disease.

5. Use probability principles

Use probability principles to evaluate the chances of death or susceptibility to critical illnesses
covered by the health insurance product proposed within that span of the coverage by the
company.

6. Do not think long term

A medical underwriter should not think from a long-term point of view. Remember you should
only be interested up to the extent of the duration of the plan proposed. In addition, you need to
evaluate if the risk cover age money (premium) is recovered within the first few years of the
plan. Then you should evaluate the risk and underwrite, taking into consideration only that
duration of time.

7. Correlate all findings

Human body mechanisms are complex and interrelated processes. Try to find the correlation
between the different pathologies and sum them up to find the total risk presented by the client.
For example, a person with diabetes mellitus and smoking presents a higher risk than that
presented by the person with only diabetes mellitus.

8. Apply Cost Benefit analysis

A medical underwriter is also required to have an understanding of financial terms like cost
benefit analysis and use them prudently to evaluate the risk.

Key Findings in Star Health & Allied

Insurance Company Ltd
It is the first stand alone health insurance company in India. It specializes in Health Insurance,
provides quality service at the best rates, and commits itself to the service of the insured.The
Company is led by a group of leading industrialists and business houses in the subcontinent.

Oman Insurance Company is one of the leading Insurance Companies in the Middle
East. Mr. Essa Abdullah Al Ghurair hails fssrom the prominent Al Ghurair family in the 0U.A.E.
With a net worth of USD 3.7 billion, the family has been ranked as one of the world's richest by
Forbes magazine...
The company has it‘s Head Office in Chennai, Corporate Office in Mumbai & Regional Office
in Pune from last three years. Looking at the potential of vidarbha region the company started its
branch office in nagpur in october 2008.

The organisational structure for this branch is as follows:

PolicyUnderwrite

The company has very strong financial backup & very good leadership which two are
the most important factors for any company to become successful. The company has recorded
itself as the fastest growing company with 400% of growth rate.

Looking at the indian scenario of Health insurance, which remained highly underdeveloped and
a less significant segment of the product portfolios of the nationalized insurance companies in
India, There was need of such type of company dealing only in health insurance. Therefore there
is overwhelming response from the consumers. Only in Nagpur from last 3 – 4 months over 400
policies are sold which comes around 4 – 5 policies per day.

Here comes the role of an underwriter as Health sector policy formulation, assessment and
implementation is an extremely complex task especially in a changing epidemiological,
institutional, technological, and political scenario. Further, given the institutional complexity of
our health sector programmes and the pluralistic character of health care providers.
\

Though policy underwriting is done in the branch office for those not requiring medical
examination as they are below 50 years of age, those proposers who are above 50 years of age,
their medical underwriting is done at regional office pune.

The work load here is though not much as the company is in its cradle phase still the underwriter
confirms the policy underwriting in minimum time which varies from half hour to 4 hours for
policies not requiring medical underwriting, & those requiring medical underwriting may vary
from 24 hours to 15 days. The major factor here of concern is delay from the proposer in
submitting medical documents. If time phase is considered from the submission of medical
reports to the issuing of policy it comes to around 12 hours to 48 hours.

UNDERWRITTING GUIDELINES FOR VARIOUS

PRODUCTS
1. Medi-Classic Individual
2. Family Health Optima

3. Senior Citizens’ Red Carpet

4. Accident Care

Medi-Classic Individual

 s a policy that aims to provide reimbursement

of hospitalization expenses incurred as a result of illness/disease/sickness and/or
accidental injuries.

 ons aged between 5 months and 75 years, residing in India, can take this
insurance.

 Premium Range

5 months 36 - 45 46 - 55 56-65 66 - 70 71 – 75 76 - 80
- 35 yrs yrs yrs yrs Yrs yrs
Sum Yrs
Insured
(in Rs)
100000 2169 2338 3574 4192 5933 6298 7596
150000 2843 3068 4641 5540 8371 9006 11563
200000 3461 3742 5972 6776 10675 11579 14776
250000 3596 3989 6686 8540 12473 13647 17793
300000 4158 4551 7383 9664 14653 16085 21180
350000 4664 5113 8776 11905 16669 18388 24433
400000 5169 5506 10225 13321 18703 20692 27686
500000 5956 6517 12473 16135 22765 25298 34168
 1000000 8838 9399 15355 19017 NA NA NA

 Cash: Provides for payment of Rs.500 for each completed day of

hospitalization. Premium ranging from Rs.200 to Rs. 350 per person, depending upon the
age.


after discharge from the hospital @ Rs 400 per day to a maximum of 5 days per
hospitalization. Premium Rs 300 per person.


newborn from birth up to the expiry of the policy period. The sum insured is restricted to
 10% of the sum insured in respect of the mother. Premium 10% of policy premium.

 Hospitalization Cover : In-patient hospitalization expenses for a minimum of 24 hours.

Includes room rent and boarding @2% of sum insured,subject to a maximum of
Rs.4000/- per day.

 Emergency ambulance charges for transporting the insured patient to the hospital upto a
sum of Rs 750/- per hospitalisation and overall limit of Rs 1500/- per policy period.

 Pre-hospitalisation medical expenses upto 30 days prior to date of admission

 .
 -hospitalization - a lumpsum calculated at 7% of the hospitalisation(excluding
roomcharges)subject to a maximum of Rs.5000 is payable

 -allopathic Treatments upto Rs.25,000/- per occurence, subject to a maximum of

 25% of sum insured per policy period.


hospitalisation. Premium ranging from Rs.200 to Rs. 350 per person, depending upon the
age.


after discharge from the hospital @ Rs 400 per day to a maximum of 5 days per
hospitalization. Premium Rs 300 per person.
 
newbornfrom birth up to the expiry of the policy period. The sum insured is restricted to
 10% of the sum insured in respect of the mother. Premium 10% of policy premium.


 Sectin 80D of the Income Tax Act.

Exclusions :-

 Expenses for the treatment of any illness/disease/condition,which is pre-existing

 Treatment of illness/disease/sickness contracted by the insured person during the first

30 days from the commencement date of this policy

 First Two Years Exclusions: Cataract,Hysterectomy for Menorrhagia or

Fibromyoma,Replacement surgery for knee and/or joint(other than caused by an
accident),Prolapse of intervertibral disc (other than caused by accident), Varicose Veins
and Varicose Ulcers

 FirstYearExclusions:Benign Prostate Hypertrophy,Hernia,Hydrocele,Fistula in

anus,Piles,Sinusitis and related disorders,Congenital internal disease/defect,removal of
gallstones and renal stone

 Naturopathy treatment

 Expenses which are purely diagnostic in nature with no positive existence of any
disease

 Treatment of Cogential external disease/defects/anomalies

 Expenses which are mainly cosmetic in nature

 Family Health Optima

Family Health Optima from Star Health is a health insurance plan that gives protection
for the entire family on the payment of a single premium under a single sum insured.
The sum insured floats among the family members insured. It‘s just one more way to
tighten the family bonds.

Any person aged between 5 months and 65 years residing in India can take this insurance

SUM INSURED 3LAKHS

AGE 5M-35 36-45 46-50 51-55 56-60 61-65
MEMBERS YRS YRS YRS YRS YRS YRS

2A 4200 5170 9085 9345 12090 18750

2A+1C 5300 5555 10565 10830 12830 NA
2A+2C 6565 6775 11340 11605 13390 NA
2A+3C 7465 7675 12240 12505 14290 NA
1A+2C 3875 4275 7010 7335 8645 NA
1A+1C 4910 5100 7810 8 9510 NA
770
 1A+3C 5670 5670 9555 9800 11225 NA

SUM INSURED 4LAKHS

AGE 5M-35 36-45 46-50 51-55 56-60 61-65
MEMBER YRS YRS YRS YRS YRS YRS

2A 5300 6350 12000 13000 15500 23200

2A+1C 6610 7375 13200 14250 17255 NA
2A+2C 7920 8525 14665 15185 17980 NA
2A+3C 8820 9425 15565 15885 18880 NA
1A+1C 4640 5005 8375 8685 9865 NA
1A+2C 5640 6000 9345 10875 12440 NA
1A+3C 7050 7245 11730 12650 14100 NA

SUM INSURED 5LAKHS

AGE 5M-35 36-45 46-50 51-55 56-60 61-65
MEMBER YRS YRS YRS YRS YRS YRS

2A 6885 7640 14290 14600 19145 25750

2A+1C 7710 8710 15350 15665 20225 NA
2A+2C 9210 9635 15760 16075 21070 NA
2A+3C 10210 10635 16760 1705 22070 NA
1A+1C 6510 7225 9565 11850 14500 NA
1A+2C 7435 7650 14000 14450 16335 NA
1A+3C 8560 8630 14895 15215 19650 NA

SUM INSURED 10LAKHS

AGE 5M-35 36-45 46-50 51-55 56-60 61-65

MEMBER YRS YRS YRS YRS YRS YRS

2A 8900 11000 18750 21000 28800 38550

2A+1C 11000 12875 20990 22700 30325 NA
2A+2C 12800 15380 22800 26440 35080 NA
2A+3C 15900 18100 25710 28850 37500 NA
1A+1C 8500 9700 15000 16810 23000 NA
1A+2C 10100 11000 16900 21000 26090 NA
 1A+3C 12575 13895 20100 25660 27775 NA

SUM INSURED 15LAKHS

AGE 5M-35 36-45 46-50 51-55 56-60 61-65
MEMBER YRS YRS YRS YRS YRS YRS

2A 10100 12500 24400 29895 36500 41135

2A+1C 12770 14500 27500 35000 41200 NA
2A+2C 16660 18300 31650 40700 47810 NA
2A+3C 19310 20950 34300 43350 50460 NA
1A+1C 10000 11240 19030 22875 28880 NA
1A+2C 12450 13750 21000 28050 32000 NA
1A+3C 15875 16550 25010 300080 34700 NA


Service tax extra

 Hospitalization Cover: Protects the insured person for in-patient hospitalization

expenses for a minimum of 24 hours. These expenses include room and boarding charges
as per policy conditions

 Nursing expenses

 Surgeon's fees, Consultant‘s fees, Anesthetist‘s and Specialist's fees

 Cost of medicines and drugs

 Emergency ambulance charges for transporting the insured patient to the hospital upto a
sum of Rs.750/- per hospitalization and overall limit of Rs.1500/- per policy period.

 Single Sum Insured

 Coverage for entire family

 Single Premium

 Considerable saving in premium as the family is covered under one policy

 Pre-hospitalization medical expenses upto 30 days prior to the date of admission

 Post-hospitalization calculated at 7% of the hospitalization expenses (excluding room

charges),subject to a maximum of Rs.5000 is payable.
  Proposer, spouse, dependent children upto 25 years those who are economically
dependent on their parents.

 A discount of 10% on Premium is allowed on renewal of the policy if there is no claim

in the immediately preceding year of the policy. This discount is not cumulative.

 Payment by cheque for this insurance is eligible for relief under Section 80D of the
Income Tax Act.

Exclusions:-

 Expenses for the treatment of any illness/ disease/condition which is pre-existing

 Treatment of illness/disease/sickness contracted by the insured person during the first

30 days from the commencement date of the policy

 First four Years Exclusions:Cataract,Hysterectomy for Menorrhagia or

Fibromyoma,Replacement surgery for knee and/or joint (other than caused by an
accident),Prolepses of intervertebral disc(other than caused by accident),varicose veins
and varicose ulcers

 First Year Exclusions:Benign Prostate Hypertrophy,Hernia,Hydrocele,Fistula in

anus,Piles,Sinusitis and related disorders,congenital internal disease/defects, removal
of gallstones and renal stone

 Naturopathy treatment

 Expenses which are purely diagnostic in nature with no positive existence of any
Disease

 Expenses incurred for non-allopathic treatment

 Treatment of external Congential disease/defects/anomalies

  Expenses which are mainly cosmetic in nature

Senior Citizens’ Red Carpet

Turning sixty is a major milestone and for people,a time to start being more careful about their
health.It is a matter of concern that insurance policies are hardly available to address this critical
requirement.STAR Health is proud to introduce India's first health insurance policy aimed
specifically at senior citizens.It provides cover for anyone over the age of 60 and permits entry
right up to the age of 69 with continuing cover after that.
It is our way of caring for a generation that has done so much to build the country.

 For people aged between 60 and 69 years

 Guaranteed renewals beyond 69 years

 No pre-insurance medical test required

 Treatment at network hospitals only

 All pre-existing diseases are covered from first year,except those for which treatment or
advice was recommended by or received during the immediately preceding 12 months
from the date of proposal

 Disease for which treatment or advice was recommended by or received during the
 immediately preceding 12 months from the date of proposal will be covered from second
year onwards

 Policy Premium – Including service tax

SUM INSURED(RS) PREMIUM(RS)

100000 4450
200000 8456
300000 12900
400000 15501
500000 18000

 Hospitalization Cover: In-patient hospitalization expenses for a minimum of 24

hours.Includes room rent and boarding @1% of sum

 ICU expenses per day @ 2% of sum insured

 Nursing expenses

 Surgeon's fees,consultant's fees,Anesthetist's and specialist's fees,per illness @ 25% of

sum insured

 Cost of blood,oxygen,pacemaker

 Cost of drugs and diagnostic tests @ 50% of sum insured per hospitalization

 Treatment for Cardiovascular Diseases / Cerebrovascular Accident/Cancer and

breakage of Bones : upto Rs.75,000/- where the sum insured is Rs.1,00,000/- and upto
Rs.1,50,000/- where the sum insured is Rs.2,00,000/-

 Cataract (both eyes included), up to Rs.15,000/-

 Renal Complications : upto Rs.75,000/- where the sum insured is Rs.1,00,000/- and
upto Rs.1,50,000/- where the sum insured is Rs.2,00,000/-

 All other Major Surgeries : upto Rs.60,000/- where the sum insured is Rs.1,00,000/- and
upto Rs.1,20,000/- where the sum insured is Rs.2,00,000/-

 Emergency Ambulance Charges for transporting thhe Insured Person to the Hospital
@Rs.600/- per Hospitalisation and Rs.1200/- per Policy period

 Post-hospitalization - a lumpsum calculated at 7% of the hospitalization

expenses(excluding room charges),subject to a maximum of Rs 5,00o is payable.
  A discount of 10% of the above premium will be allowed if the Proposer produces the
following documents to the satisfaction of the Company

 Stress Thallium Report*

 BP report*

 Sugar (blood & urine)*

 Blood urea & creatinine*

 Self-declaration or certification that surgeries related to Heart / Brain / Cancer has /

have not been done in the past *The tests should have been taken not before 45 days from
the date of proposal.

 Premium paid by cheque or credit card is eligible for relief as provided under Section
80 D of the Income Tax Act.

Exclusions:-

 Treatments currently availed or availed during the previous 12 months from date of
Proposal

 Any expenses incurred for treatment of illness/disease/sickness contracted by the

insured person during the first 30 days from the commencement date of the policy

 First Two-year exclusions : Hernia, Piles, Hydrocele, Congenital Internal

disease/defect, Sinusitis, Gall Stone/Renal Stone removal and Benign Prostrate
Hypertrophy

 Two-Year Exclusions:Hysterectomy,Cataract,Joint/Knee Replacement surgery(other

than caused by an accident),Prolapsed Intervertebral Discs,Varicose Veins,Ulcers

 Naturopathy treatement

 Expenses which are purely diagnostic in nature with no positive existence of any
disease

 Expenses for treatments that are mainly cosemtic in nature

 50% co-payment applicable for pre-existing diseases conditions

  30% co-paument applicable for all other claims.

Accident Care

An accident can put anyone‘s future at risk. While an accident can be sudden, guarding against
them can be a conscious deliberate decision. STAR Health Accident Care
Insurance provides compensation in the event of death, permanent disability and injuries suffered
due to accidents

 Accidental death

 Permanent disability – total or partial – following an accident

 Temporary total disablement – the Insured Person is eligible for a weekly benefit at 1%
of Capital Sum Insured (following an accident) subject to maximum of Rs.5000/- per
week for a for 100 weeks

 Educational grant to children (1 Child – Rs.5000/-, 2 Children– Rs.10,000/-)

 Transportation expenses of mortal remains (Rs.3000/-)

 Travel expenses of one relative (Rs.1000/-)

 Cumulative Bonus of 5% accrues to the Insured Person for every claim free year,
subject to a maximum of 50%


  For purpose of rating, persons proposed for insurance are classified under three risk
Groups

 Risk Group I – Persons engaged primarily in administrative functions

 Risk Group II – Persons engaged in manual work other than what is specifically
provided for under Group III

 Risk Group III – Persons working in explosives industry, mines workers, high tension\
electric supply, horse racing including jockeys, athletes and occupations of similar
hazards

 The Insurance may be renewed under mutual consent

Exclusions

 Expenses incurred on events occurring before the commencement of the cover or

otherwise outside the Period of Insurance

 Any claim in respect of Pre-existing condition

 Any claim if the insured acts against the advice of a physician

 Any claim arising out of Accidents that the Insured Person has caused intentionally or
by committing a crime or as a result of drunkenness or addiction (drugs, alcohol, etc)

 Any claim arising out of mental disorder, suicide or attempted suicide self inflicted
injuries, or sexually transmitted conditions, anxiety, etc

 Participation in Hazardous Sport/Hazardous activities

 Persons who are physically and mentally challenged unless specifically agreed and
endorsed in the policy

2.Overseas Health Insurance :-

 Star Corporate travel Protect

Star Family Travel Protect

Star Student Travel Protect

Star individual Travel Protect

Star Corporate travel Protect

Globalization and business expansion have increased the need for traveling between countries.
People who travel also hold positions of high responsibility in their organizations. While all risks
cannot be avoided, STAR Health protects corporate executives during their travel by covering
them against most risks arising out of travel so they can focus on the job at hand and accomplish
their objectives.

Features

 Emergency medical expenses whilst you travel/stay abroad

 Emergency medical transportation to India

 Repatriation of mortal remains

 Any dental emergency expenses following an accident

 Compensation following accidental injuries

 Cost of loss of traveler's checked-in baggage

 Reasonable expenses incurred for obtaining new passport

  Expenses on emergency purchase of consumables due to any delay in handing over
traveller's checked in baggage by the carrier for more than 12 hours

 Delay in flight

 Expenses relating to travel and accommodation incurred due to missed

departure/connection

 Hijack distress

 Any legal liability that may be fastened upon the travellers, if he/she causes any bodily
injury or property damage to any third party whilst on an insured trip

 Any travel expenses incurred in sending a substitute employee following the covered
Sickness/accidental injuries of the insured employee

Eligibility

All Corporate Executives residing in India aged between 18 and 70 years traveling
abroad on business purposes can take this insurance

Is it necessary to undergo medical tests?

Generally not required. However any proposal with adverse medical history, irrespective of the
age should be accompanied by an ECG, Fasting and Postprandial Blood Sugar, Urine Strip Test
and Cholesterol Profile reports duly certified by a cardiologist.
 Star Student Travel Protect

Students traveling abroad are already on their own and need help if they are ever laid low by an
illness. STAR Health has a specially designed Student Travel Protect Insurance that protects
them during a crucial phase because medical treatment abroad can be prohibitively expensive in
most cases.

Medical Benefits

Emergency medical expenses

Emergency transportation back to India

Repatriation of mortal remains

Dental emergency expenses following an accident

Travel Related Benefits

For injuries caused by accidents

For checked in baggage

Compassionate Benefits

Visit of one immediate family member, in case of hospitalization

 Repatriation due to medical reasons or death of family member, resulting in interruption in
study

Reimbursement of tuition fee for the balance period in the event of death of the sponsor

Legal Claims

For bodily injury to third parties or damage to their property, if you happen to be the
Cause

Cost of bail bond following false arrest or wrongful detention.

Star individual Travel Protect

These days a lot more families vacation abroad. While this is the perfect opportunity for
enjoyment, there is a clear need to protect the family from risks that may be merely
inconvenience, like the loss of a passport or something more serious like a member of the family
falling ill and needing hospitalization. To be prepared for any crisis STAR Health offers
financial protection under Family Travel Protect Insurance Policy

Eligibility

All Indian Nationals and their families - aged between 6 months and 60 years, traveling
abroad on holiday can avail this insurance

Family consists of insured person, spouse and two dependent children (Children below 18
years)

Additional children can be covered on payment of extra premium at 25% additional premium
per child up to a maximum of two additional children
 Claims Procedure

Inform the ID number for easy reference

on toll free number

In case of planned hospitalization, it should

be informed 24 hours prior to admission into
hospital

In case of emergency hospitalization,

information to be given within 24 hours after
hospitalization

In non-network hospitals, payment must be

made upfront and then reimbursement will be
effected on the submission of documents.
 The Medical Officer will personally visit the
hospital for overlooking & taking proper follow
up of the claim & fills the field visit report

The Medical Officer will personally visit the

hospital for overlooking & taking proper follow
up of the claim & fills the field visit report

KEY INTERPRETATIONS

 There is still much scope to explore the market as the city population is above
30,00,000 & only 2 – 5% of population is covered under any kind of health insurance
coverage.

 Various marketing activities are done to promote the company.

 Underwriting procedures are done cautiously for overall risk assessment & if found out
of the box full efforts are taken to cover that person under some different plan

 Personal freedom is given to the Sales Managers to explore his / her talent and generate
business by his / her innovative ideas.

 Underwriting guidelines are user friendly and fitted into the software called PREMIA.

 The software sometimes becomes trouble creator due to inefficiency of either internet
connectivity or continuous power supply.

 Medical underwriting is taken care by qualified doctors at Pune due to under load of
work.

 Company possesses reminder software which generates alerts before expiry of the
policy after one year for renewal.
  There is a fixed prototype of policy underwriting due to software in which changes can
only occur through higher centers.

Some Suggestions for considerations:-


market.

 As the work load goes up unedrwritting procedures should be more cautiously done for
not accepting doubtful cases so the repudiation rate of the claims can also be reduced
thereby reducing disappointment for the policy holders.

 d 12 15
cases per day reduce the turn around time required for policy issuing.

 -network hospitals should be empanelled as soon as possible after confirming their

genuiness to reduce incidences of moral hazards.

 The company totally depends on web services for their underwriting, there should be
some backup if the system fails to continue the work.
  SWOT – Analysis

STRENGTHS WEAKNESSES
Stand alone health insurance company in health companies
the field. offering health insurance.
Experience, expertise and support of
Big financial group.
Latest Technology and Infrastructure to companies.
support & fasten the services.
All the range of health products under one
roof. branch offices
Cashless service without TPA intervention
i.e. in-house claim settlement.
24 hours General Practitioner's advice and
medical counseling
24x7 in-house Call Center
Toll free telephone assistance
Complete knowledge backed website to
offer medical information, including health
tips.
Large range of premiums through different
products for every class of people.
Direct discount on premium for no claim
benefit
Welcome discount for the proposers shifting
from other company with all the
continuation benefits.
Innovative products even for chronic
noncurable
diseases like diabetes, AIDS etc.
Availability of tailor made policies.

OPPORTUNITIES THREATS
Established general insurance
services. companies having brand name.

Non-availability of any major health

insurance service provider. regularly done in this form of insurance
practices.
Willingness of Corporates to have a
tie-up with the company.
insurance thinking of wastage of
money.
covered under health insurance & even
is unaware of the benefits.
age group.who are in real need of
health care expenses.
and hence availing Overseas policies.

have
accidents & increased cost of healthcare mindset of availing policies from public
facilities sector companies.