CHAPTER TITLE OF THE CHAPTER PAGE

NO.
NO.
1. TITAL PAGE

2. CERTIFICATE i

3. DECLARATION BY LEARNER ii

4. ACKNOWLEDGEMENT iii

5. INDEX iv-v

6. LIST OF TABLES vi-vii

7. LIST OF ABBREVIATION viii

1 INTRODUCTION to HEALTH INSURANCE 1-27

TYPES OF HEALTH INSURANCE

MANAGED CARE
Importance of Health insurance
2 Objectives of Insurance

Granting Security To People

Minimisation Of Losses

Diversifying The Risk

Reduces The Anxiety And Fear

Mobilises The Saving

3 Importance of Insurance
Provide safety and security

Generates financial resources:

Life insurance encourages savings:

Promotes economic growth:

Source of collecting funds:

2. RESEARCH METHODOLOGY

2.1. Introduction

2.2. Objective of The Study

2.3. Hypothesis of The Study

2.4. Scope of The Study

2.5. Limitation of The Study

2.6. Research Methodology

2.6.1. Universe of the Region
2.6.2. Method of Sampling
2.6.3. Sample Size
2.6.4. Method of Data Collection
2.6.4.1. Primary Data
2.6.4.2. Secondary Data

2.7. Method of Data Analysis

Introduction to health insurance
Life of an individual and a family is generally peaceful unless any kind of
health issue arises which isindecisive and cannot be predicted before its
occurrence. Needs such as desire of owning a house or a motor car or any
other instrument of social status or other consumer durables of comfort can be
postponed if the family has shortage of savings and limited sources of income.
But, this is not the case with the unforeseen medical obligations which need
immediate cash flows and have an adverse impact on the savings of the
family. Financial commitments on medical grounds can certainly ruin long
term financial goals of a family which may include education or marriage of
children and retirement plans besides desires stated supra. One may wonder
about a solution to overcome such situations and the answer to this is none
other than health insurance which will help in maintenance of good health of
an individual and a family without creating any possibility of financial crisis and
hindering financial stability.
Health insurance is a product of general insurance that covers expenses
related to medication and surgery of an insured which could be an individual,
family or a group of people. It is an arrangement where an individual, family or
a group purchase health care coverage in advance by payment of a fee called
as premium. In other words, health insurance is an arrangement that helps to
delay, defer, reduce or avoid payment related to medical expenses of an
insured. The insurer will either ensure cashless treatment of medical ailments
or provide a reimbursement of medical expenses incurred under the policy in
any of the network hospitals across the country.

Health insurance (sometimes called health coverage) pays for some or all of
the cost of the health services you receive, like doctors’ visits, hospital stays,
and visits to the emergency room. It helps keep your health care costs
predictable and affordable. You may have to pay several different amounts for
health insurance:
1. You will generally pay a premium, a monthly fixed payment to the
insurance company.
2. You may have to pay a deductible. This is a fixed amount that you pay out
of pocket before your health insurance begins to pay for your health
services.
3. After you have met the deductible, you and your insurance company
typically share the cost of covered health services. Your insurance pays
most of the cost first, and then you pay the remaining cost. The amount
that you pay is either a copayment (a fixed amount) or a coinsurance (a
percentage of the cost of the service).
Medicare is a type of health insurance administered by the federal
government.

Many consumers who will buy health insurance through Covered California
will be doing so for the first time. Some consumers will also be underinsured
and looking for better coverage through Covered California plans. Many will
need help in understanding the difference between health insurance plans,
how health insurance plans work and the value of having health insurance.
Health insurance pays for some or all of a person’s covered health care costs.
In the Marketplace, the covered person will pay a premium (a monthly amount
paid in advance in order to secure health insurance) and may share other
costs for care, such as paying a $15 copayment for a doctor visit or
prescription. Many preventive care and wellness services are available with
no out-of-pocket cost. In addition to preventive care and wellness services,
one of the most important advantages of health insurance is protection from
unexpected and overwhelming medical costs. Costs related to unexpected
injuries or illnesses, such as injuries sustained in an accident or illness due to
a chronic condition can quickly surpass the total cost of health insurance
premiums. For example, a short hospital stay, even just a couple of days, can
cost several thousand dollars. With health insurance, most of the cost is
covered. Without it, families can quickly accumulate huge medical debt often
leading to personal bankruptcy.

TYPES OF HEALTH INSURANCE

 Private health insurance is provided by health insurance companies to
individuals, families and businesses. Some people buy private insurance
directly as an individual or as a family; others get insurance through their
employers.
 Public health insurance is provided by the government. An example is
Medicare, which provides coverage to people age 65 years and older, as well
as people with disabilities. Medi-Cal in California is another type of public
health insurance that assists low-income individuals. Both Medicare and Medi-
Cal contract with private health insurance companies to provide these
government programs for most of the people enrolled.

MANAGED CARE
In India, the majority of health plan products offered through both private and
public health insurance are a type of managed care plan. All managed care
plans use a network of doctors and hospitals to provide care to members.
Elements of managed care plans include:
 The networks are created by the health insurance company to provide
quality care and predictable costs.
 In-network doctors, hospitals, and other providers contract with the
health insurance company to coordinate care and provide services at
negotiated rates. Some health plans employ their doctors and staff.
 Health insurance companies help ensure the health services provided
are medically necessary.  Some services or procedures may require
preapproval from the health insurance company before they will be
covered.
 Most managed care plans provide education and other programs to help
people build healthy habits, as well as offer special support for people
with chronic illnesses.
 Health insurers must provide access to qualified providers, including
specialists, within a certain timeframe. Consumers can call their
insurance company to help coordinate care if they are having difficulty
getting an appointment.
 Providers must meet quality standards to be included “in-network” with a
plan. A Health Maintenance Organizations (HMO), a Preferred Provider
Organization (PPO) and an Exclusive Provider Organization (EPO) are
 examples of the most common managed care plans. The amount paid
by the person who is insured versus what the health insurance company
pays depends on the value level of the health plan.
 Health Maintenance Organization (HMO). An HMO typically assigns or
allows the member to select a primary care physician (PCP) or a team
of physicians who work for or contract with the HMO. The PCP directly
provides and coordinates the member’s care.
 Doctors, specialists and hospitals in the HMO network provide all
services.
 HMOs generally require that a member receive a referral from the PCP
before seeing other doctors, except in an emergency.
 HMOs generally do not cover out-of-network care (visits to doctors who
are not part of that HMO) except in an emergency.
 HMOs require members to live in its geographic service area to be
eligible for coverage.
 All HMOs provide preventive care. For example, if Joe has a sports
injury and wants to see a sports medicine specialist, he must first be
seen by his Primary Care Physician (PCP) or at his designated medical
facility. Joe’s PCP will assess Joe’s injury and, if necessary, refer him to
a sports medicine doctor in the HMO network

Health insurance products available in India

For the purpose of avoiding risk aroused of health issues, there are different type of policies and plans
for the risk coverage by public sector as well as private sector insurance companies. The financial
products offered by these companies regarding health insurance give protection to individuals, family or
group of persons. Different types of insurance plans have been discussed as under:

1. Individual health insurance plan

This plan offers risk coverage to an individual towards hospitalization and other incidental expenses
during the course of hospitalization subject to the sum insured.In this policy, one can buy different
independent policies for each member of a family. These plans are basically indemnity plans and are
generally offered on cashless basis.

2. Family floater health insurance plan

In this policy, single sum insured covers all the members of the family in one policy. The sum assured is
available to any one member or to all members in case of any eventuality during the term of the policy.
The premium amount paid under this policy is generally lower as compared to individual policies for
each family member under individual mediclaim policy.

3. Group medical plan

These plans are generally taken by business owners, private companies, government companies and
departments, to provide a financial cover to their employees and their dependent family members on
nominal deduction from salary towards premium.

4. Unit linked health plan (ULHP)

In this form of health insurance, the insured gets the benefit of investment along with health care
coverage. In this plan, a part of premium paid is invested and the balance is used to buy health cover.
The return enables the insured to pay medical expenses over and above the sum assured. These kinds of
plans are new and considered to be under development stage in India. Returns under a ULHP depend on
the performance of stock market.

5. Critical illness plan

The expenses involved in treating a life-threatening diseases like cancer, organ failure, permanent
paralysis etc. are covered by a critical illness policy. The insured is paid a lump sum amount on the
diagnosis of any of the serious diseases covered in the policy document.

6. Super top up plan

These policies provide additional coverage to an insured over the regular policy and help in increasing
the sum insured. Super top up policies can be availed only after the sum assured in the basic policy gets
exhausted.

7. Senior citizen health insurance plan

IRDA guidelines require health insurers to provide health insurance plans up to 65 years of age. Various
health issues arise in older ages that involve expensive treatments. Keeping this in mind, health
insurance companies have designed special health insurance plans for senior
citizens above the age of 65 years. The rate of premium in senior citizen health insurance plans is
generally higher as compared to other insurance policies.

8. Hospital daily cash benefit plan

As evident from the name itself, this kind of policy pays a definite sum of money for everyday of
hospitalization irrespective of the actual cost incurred by the insured.

9. Maternity insurance plan

These plans are specially designed for women planning to have a child or are bearing one. This policy
covers all expenses before and after the pregnancy, pre and post natal care, expenses for delivery,
nursing and consultation etc. The policy also includes congenital or a critical disease diagnosed in the
newborn child.

10. Personal accident plan

A personal accident insurance policy covers the expenses incurred on medical treatment of injuries
occurred due to an accident. This policy generally offers benefits against three events that include
total disability, partial disability and death. Besides individuals, these policies are also offered for a
group.

Objectives of Insurance
 Granting Security To People
Insurance primarily serves the purpose of granting security against losses and
damages to people. It is an agreement enters into by two parties in which one
promises to protect other from losses in return for premium paid by other
party. One party is insurance company and other one is insured. Insurance
companies guarantee the insured of compensation in case of any
unfavourable contingency. Insured need to pay premium to insurance
companies in return for guarantee of compensation.
 Minimisation Of Losses

Insurance aims at minimisation of losses arising from future risks and

uncertainties. It adds certainty of payments to people for happening of
uncertain events. Insurance assures the individuals for compensation of
losses. It minimises the risk through proper planning and administration.
Insurance companies suggest people for taking safety measures like
installation of fire detection devices, alarm and cameras system etc. They also
join hands with various organisations like fire brigade, health and various
organisations which work for reducing losses and damages. This way
insurance works toward minimising the happening of various losses.
 Diversifying The Risk

Insurance works towards diversifying the risk among large number of people.
It aims at reducing the adverse effects of any future contingency by spreading
the overall risk associated with it. It is medium through which people share
their risk with others. Insurance companies compensate the insured for losses
out of premium they charged from their different policy holders. The loss
incurred by single individual is diversified among large peoples by insurance
companies by utilising the collected premium amount for paying
compensations.

 Reduces The Anxiety And Fear

Insurance policies relieves the individuals of any tension and fear regarding
the future risks and uncertainties. It guarantees them of compensation in
occurrence of any unfavourable contingencies. Assurance of compensation is
the most relieving factor for tensed and worried people. They are certain of
payment on occurrence of various uncertain events. It makes them confident
and they focus on their activities with full attention.
 Mobilises The Saving

Mobilisation of savings is another important objective of insurance. It attracts

people for investments by presenting them with numerous insurance policies
guarantying of compensation for losses. Large number of people takes this
insurance policy in order to insure them against losses and damages.
Insurance companies are able to generate large amount of funds in the form
of premium that they charged from their policy holders regularly. These funds
are then invested by these companies into securities and stock in market and
earn incomes. Ideal lying resources with public are employed by insurance
companies towards income generating sources.
Generation Of Capital

Insurance companies leads to capital generation by collecting large amount of

funds from public. They regularly charges premium from their large customers
for providing them protection against losses. These funds are invested for
industrial development by subscribing to shares of companies. Companies are
able to get their required capital through insurance industry as this invests in
companies for earning dividends and other incomes. This boosts the industry
performance and economic growth of country. Also, bigger investments lead
to creation of various employment opportunities.
Importance of Insurance

 Provide safety and security:

Insurance provide financial support and reduce uncertainties in business and

human life. It provides safety and security against particular event. There is
always a fear of sudden loss. Insurance provides a cover against any sudden
loss. For example, in case of life insurance financial assistance is provided to
the family of the insured on his death. In case of other insurance security is
provided against the loss due to fire, marine, accidents etc.

 Generates financial resources:

Insurance generate funds by collecting premium. These funds are invested in

government securities and stock. These funds are gainfully employed in
industrial development of a country for generating more funds and utilised for
the economic development of the country.
Employment opportunities are increased by big investments leading to capital
formation.

 Life insurance encourages savings:

Insurance does not only protect against risks and uncertainties, but also
provides an investment channel too. Life insurance enables systematic
savings due to payment of regular premium. Life insurance provides a mode
of investment. It develops a habit of saving money by paying premium. The
insured get the lump sum amount at the maturity of the contract. Thus life
insurance encourages savings.

 Promotes economic growth:

Insurance generates significant impact on the economy by mobilizing

domestic savings. Insurance turn accumulated capital into productive
investments. Insurance enables to mitigate loss, financial stability and
 promotes trade and commerce activities those results into economic growth
and development. Thus, insurance plays a crucial role in sustainable growth
of an economy.

 Medical support:

A medical insurance considered essential in managing risk in health. Anyone

can be a victim of critical illness unexpectedly. And rising medical expense is
of great concern. Medical Insurance is one of the insurance policies that cater
for different type of health risks. The insured gets a medical support in case of
medical insurance policy.

 Spreading of risk:

Insurance facilitates spreading of risk from the insured to the insurer. The
basic principle of insurance is to spread risk among a large number of people.
A large number of persons get insurance policies and pay premium to the
insurer. Whenever a loss occurs, it is compensated out of funds of the insurer.

 Source of collecting funds:

Large funds are collected by the way of premium. These funds are utilised in
the industrial development of a country, which accelerates the economic
growth. Employment opportunities are increased by such big investments.
Thus, insurance has become an important source of capital formation.
2.6. Research Methodology:
The present study is descriptive in nature and based on analysis of
secondary data available on internet. For the purpose of studying current
scenario of health insurance pertinent information has been collected for
last five years mainly through the reports of Insurance Regularity and
development Authority (IRDA), journals published on the subject, books
published and annual reports of various health insurance providers
available on the websites of the company.

2.6.1. Universe of the region:

The research universe was thane region. The responses were

collected by the buyers and sellers of thane region only.

2.6.2. Method of sampling:

Simple random sampling method is a sampling technique where every item in

the population has an even chance and likelihood of being selected in the
sample. Here the selection of items completely depends on chance or by
probability and therefore this sampling technique is also sometimes known as
a method of chance.

2.6.3. Sample Size:

Keeping in mind all the constraints the size of the sample of my study was
selected as 100. The sample size was classified on the basis of age, gender,
education qualification, occupation of the respondents.

2.6.4. Method of data collection:

Data was collected by using two main methods i.e., primary data
and secondary data.

2.6.4.1. Primary Data:

There are number of sources of primary data from which the
information can be collected. I choose the following resources for
my research.

Questionnaire: I researched using a set of some simple questions and

requested the respondents to answer these Questions with correct
information. The questionnaire was uploaded on Survey Heart. This
questionnaire was sent to the respondents through various social networking
apps i.e., WhatsApp, mail, messaging app, etc.

2.6.4.2. Secondary Data:

The secondary data was collected by referring various research papers, e-

books, journals, articles and surfing on internet. The secondary data collected
is aimed just for reference purpose.

2.7. Method of data analysis:

The data analyzing techniques used were bar graphs, pie charts, percentage
method and column method. The data collected form primary source is
represented by using bar diagrams, graphs, pie charts, etc.
Review of Literature
K Swathi and R Anuradha (2017), Health insurance in India- An overview. The
paper highlights the concept and benefits of health insurance besides
presenting an overview of health insurance sector in India. A brief of number
of persons covered under various schemes such as government sponsored,
group insurance, family insurance, individual policies is portrayed. Sector wise
health insurance policies along with number of persons covered by public,
private and specialized insurers are depicted. Suggestions of the study are for
government to introduce new health insurance schemes for welfare of the
common people. The Insurance Regularity and Development Authority (IRDA)
is suggested to take initiatives to promote competition in health insurers as
available in telecom service providers. Government is also advised to conduct
awareness campaigns to inform people about benefits of taking health
insurance policies.

Binny, Dr. Meenu Gupta (2017), Health insurance in India- Opportunities and
challenges. The paper is about present trends of health insurance sector in
India. Growth opportunities and challenges in the sector are identified. The
study is of the opinion that health insurance is a growing sector in India.
Companies are required to enhance their business by introduction of new
business models with innovative products. Need of a universal health
insurance program is recognized to cover families below poverty line. Medical
tourism is also a growing business in India and health insurance companies
can take advantage of this sector to enhance business. The sector is also
advised to have a common information bank for information sharing which
may help customers in assessment of prices, quality and services provided by
health insurance companies.

BC Lakshmanna, P Jayarami Reddy, P Sravan Kumar (2019), Operational

efficiency of selected general insurance companies in India. The study is
conducted on selected general insurance companies regarding pattern of
insurance premium, claim settlement procedure and evaluate performance of
companies. In percentage analysis of the insurance premium collected by
both public and private sector insurance companies showed a significant
growth from 13.55% to 24.29% during the years 2011 to 2013 which later
decreased to 13.42% in the year 2018. Average growth rate during the years
2010 to 2018 was 13.85%. After the study was conducted it was observed
that public sector general insurance providers required new and innovative
products in order to compete with their private counterparts. IRDA, being a
regulatory authority of the sector was suggested to formulate standard policies
and benchmarks to be followed by both public and private sector players.

Suman Devi and Dr. Vazir Singh Nehra (2015), The problems with health
insurance sector in India. The study narrates some of the new inventions in
the health insurance sector such as health insurance portability,
RashtriyaSwasthyaBimaYojna (RSBY), hybrid products and critical illness
cover. Problems associated with the health insurance are highlighted and
probable solutions are given. Examples of Bajaj Allianz, Cholamandalam MS
and Star Health are given that have eliminated Third Party Administrators
(TPAs) and have opted for direct settlement of claims. As per study, insurers
now have started visiting hospitals to meet patients for claims in the category
of group insurance. If any fault is found then policy renewal is stopped. There
are also pre-agreed rates for surgeries and treatments which prevents
differential charging of tariffs. Other problems like high claim pay-out ratio in
public sector insurers, unprofessionalism of TPAs, lack of development of
health insurance in rural areas, wrong selection of health insurance policies,
and lack of awareness about health insurance policies are highlighted.

SatakshiChatterjee, Dr. ArunangshuGiri, Dr. S.N. Bandyopadhyay (2018),

Health insurance sector in India: A study. The study is descriptive and
describes various health insurance products offered in India. It attempts to
analyze the insurance models of healthcare of selected other countries as
well. Non amalgamation between public and private companies is identified as
a major hindrance in development of the health insurance sector in the
country. Health insurance is regarded as an unsaturated market in India and
the middle income group i.e. the targeted population of this industry will
definitely create a boom in health insurance in years to come. It is estimated
that overall insurance sector will value around USD 280 billion by the end of
2020. The health insurance sector is required to be made universal
irrespective of the income level and background of individual and a family.
Vagner Figueredo de Santana, Ana Paula Appel, Luis Gregorio Moyano,
Marcia Ito, Claudio Santos Pinhanez (2018)5 Health insurance companies in
Brazil have their data about claims organized having the view only for service
providers. In this way, they lose the view of physicians' activity and how
physicians share patients. Partnership between physicians can be seen as
fruitful, when they team up to help a patient, but could represent an issue as
well, when a recommendation to visit another physician occurs only because
they work in same clinic. This work took place during a short-term project
involving a partnership between our lab and a large health insurance company
in Brazil. The goal of the project was to provide insights (with business impact)
about physicians' activity from the analysis of the claims database. This work
presents one of the outcomes of the project, i.e., a way of modeling the
underlying referrals in the social network of physicians resulting from health
insurance claims data. The approach considers the flow of patients through
the physician–physician network, highlighting connections where referrals
between physicians potentially occurred. We present the results from the
analysis of a claims database (detailing 18 months of activity) from the health
insurance company we partnered with. The main contribution presented in this
paper is the model to reveal mutual referrals between physicians. Results
show the proposed model reveals underlying characteristics of physicians'
activity from real health insurance claims data with multiple business
applications.
Data Analysis and Interpretation
(a) Trends of insurance premium collected under health insurance
Following is the table showing premium amount collected by different types of
organizations on account of health insurance. It does not include personal
accident and travel insurance business.

Table 1: Health insurance premium collected during FY2014-15 to

2018-19
 Trends of Health Insurance Premium
25000

20000
Premium in Rs. Crore

15000
Public Sector
10000
Private Sector

5000 Stand Alone Sector

0
2014-15 2015-16 2016-17 2017-18 2018-19

Year

Among other various contracts under general insurance, health insurance is

an emerging sector in India. As per the published records of the financial year
2018-19, general and health insurance companies collected ₹ 44,873 crore as
health insurance premium which is 21.2% above the premium collected on
this head during the financial year 2017-18. These figures exclude personal
accident and travel insurance business. During the years 2014-15 to 2018-19,
the growth of health insurance premium is over 20% in each year. It is a
positive sign for the growthof this sector and this indicates that people in India
are getting more sensitive towards their health protection.

The public sector general insurance companies (PSGICs) viz. New India
Assurance Company Limited (NIA), National Insurance Company Limited
(NICL), Oriental Insurance Company Limited (OICL) and United India
Insurance Company Limited (UIL) continued to hold a major share in total
market but their share has been consistently decreasing over the period of
study. It is an evident from the fact that has shown a decline from 64 % to
52% during the period. The share of private sector health insurers has
marginally increased from 22% in financial year 2014-15 to 24% in the
financial year 2018-19. But a remarkable growth has been recorded in the
business of stand-alone health insurers whose share in total market gone up
from 14% in financial year 2014-15 to 24% in financial year 2018-19. It
probably happened because of very good marketing practices of stand-alone
players and some alluring schemes offered by them.

(b) Number of policies issued and lives covered under health insurance
contracts
The data shown in the following table exhibit the policies issued under
different channels and number of people covered under these policies. It
excludes Personal accident and travel insurance business.
Table 2: Number of lives covered under different channels (Modes)
During the Financial year 2018-19, the health insurance companies issued
around 2.07 crore health insurance policies covering a total number of around
47.21 crore lives. Three fourth of the lives were covered under government
sponsored schemes and rest one fourth lives were covered under individual
and group policies issued by public and private health insurers.It is a gray side
of this sector that people are still hesitant in purchasing health insurance
policies from their own pocket. A very low percentage of population is
concerned about their health

issues, that too when in India there are nominal provisions of health facility
from the government agencies. It is because of the fact that a substantial part
of our population including lower class and lower middle class is not even able
to arrange their basic needs. They seldom think of their unforeseen problems
that may occur any time.
(c) Net incurred claims ratio under health insurance business
Under this head the researchers attempted to find out the percentage of the
amounts of the net insurance claims settled by companies over total amount
of premium received by them on the heads concerned. These claims arise
due to the health problems occurred with the insured people. Again these
values don’t include the receipts or payments on account of personal accident
and travel insurance business.
Table 3: Net incurred claims ratio

Net ICR of businesses

140%

120%
age

100%
 Net ICR in per
80%
Govt. Business

60% Group Business

Individual Business
40%
Net incurred claims ratio means the ratio of the net claims settled by the
insurance
20% company to the net premiums collected in a financial year. The
formula for calculation is:
0%
2014-15 2015-16 2016-17 2017-18 2018-19

Incurred claim ratio = Net claims incurred in a year / Net premiums collected in
a year

In comparison to financial year 2017-18, there is an improvement in net

incurred claims ratio (ICR) during the year 2018-19. Marginal decrease in ICR
of government and group businesses is also observed. The net ICR of group
business without government business showed an improvement from 107% in
the year 2017-18 to 102% in the year 2018-19.

(d) State wise distribution of health insurance in India

It is an attempt to find out distribution of total health insurance business

among various states highlighting those major states which are leading ones.
It has included only health insurance again excluding personal accident and
travel insurance policies. State wisedistribution has been shown in the
following chart:
 State wise Share in health insurance premium
-19 in FY
2018

Delhi
8% Gujarat
6%

Rest of India
34%
Maharashtra
31%

Tamil
11% Karnataka
Nadu
10%

NCT of Delhi, Gujarat, Maharashtra, Karnataka and Tamil Nadu are five states that have

contributed 66% of total health insurance premium in the financial year 2018-
19. The rest of 31 UTs and States have contributed the balance of 34% in
premium amount fund. As per data published by IRDA, Maharashtra itself has
contributed ₹ 13,708.44 crore which is 31% of total health insurance premium
collected during the financial year 2018-19.

Conclusion
Health insurance in India is an unsaturated market to a large extent. This
sector has a bunch of opportunities as is the evident in thedata shown above.
The present study clearly indicates that there is a large proportion of
population still uncovered from the health insurance products. However over a
period of last years, this sector has witnesseda rapid expansion. Attracting
from the potential growth in this sector, a good number of private health
insurers with foreign collaborations have been able to create their market
share. Though the relative share of indigenouspublic sector insurance
companieshas declined even then in absolute terms their business (in terms
of no. of policies and premium amount) has significantly increased.Innovation
in the health insurance products can be very significant in further growth and
development of this sector in India. Competition, which is predominant in the
health insurers, will also add in insuring new people enabling further
penetration of health insurance products among Indian population. Taking a
health insurance cover and subsequent payment of health insurance premium
on regular basis is an easy way to mitigate any kind of financial losses due to
health issues in future which may affect peace of mind and health as
collateral. Thus, health insurance could be a breakthrough for common public
at large who can avail best in class medical facilities in any part of the country
to the extent of sum assured in the policy document without bothering to any
loss of savings leading to financial and mental disability.

Key Suggestions

• In a country like India, there is a need of universal health insurance

program at low cost to be made compulsory with an intention to insure
each and every citizen of the country especially people residing below the
poverty line.
• Innovation in products and services catering to the distinguished needs of
public will definitely attract those who are still in dilemma. The health
insurers are advised to adopt new business models to enhance their
customer base, revenue and business.

• Public health insurance companies are advised to be cautious in dealing

with the present and potential customers to eliminate any possibility of
churn rate or customer turnover.

• Health insurance companies should popularize health insurance portability

by highlighting their specialties and advantages to attract new customers.

• IRDA should frame policies to promote competition among health

insurance sector just like competition prevalent in telecom sector of the
country.

• Both the Central and State governments should include chapters on

insurance in the textbooks at appropriate levels of education besides
conducting awareness programs at micro levels to inform public about the
benefits of health insurance.

BIBLIOGRAPHY

1. https://www.reliancegeneral.co.in/Insurance/Knowledge-Center/Insurance-
Reads/Types-Of-HealthInsurance-Covers.Aspx
2. https://www.acko.com/articles/health-insurance/5-types-of-health-
insurance-plan-in-india/
3. https://www.iifl.com/blogs/types-of-health-insurance-plans
4. https://www.hdfchealth.com/knowledge-center/health-insurance-basics/
types-of-healthinsurance.aspx

5. https://www.paisabazaar.com/health-insurance/
6. https://www.iciciprulife.com/health-insurance/types-of-health-
insurance.html
7. https://www.policybazaar.com/health-insurance/general-info/articles/how-
to-calculate-incurredclaim-ratio-in-health-insurance/

8. K Swathi and R Anuradha (2017), Health insurance in India- An overview.

9. Binny, Dr. Meenu Gupta (2017), Health insurance in India- Opportunities
and challenges.
10. BC Lakshmanna, P Jayarami Reddy, P Sravan Kumar (2019), Operational
efficiency of selected general insurance companies in India.

11. Suman Devi and Dr. Vazir Singh Nehra (2015), The problems with health
insurance sector in India.

12. SatakshiChatterjee, Dr. ArunangshuGiri, Dr. S.N. Bandyopadhyay (2018),

Health insurance sector in India: A study.

13. IRDA annual reports.

 ANNEXURE

Please take a few minutes to fill out this survey on health insurance coverage. We value your feedback
and your responses will be used to serve you better. Thank you for your input.

Please provide us with the following information.

1. What is your gender?

Male

Female

4. What is the highest level of education you have attained?

Primary school

Some high school

High school diploma or GED

Some college

2 year college degree

4 year college degree

Graduate level degree

Other

5. What is your marital status?

Married
Widowed

Divorced

Separated

Single never married

6. Are you disabled?

Yes

No

7. Please mark your annual gross income?

0 to $10,000

$10,001 to $25,000

$25,001 to $50,000

$50,001 to $100,000

$100,001 to $250,000

$250,001 +

I prefer not to answer

8. Which of the following group of race best describes you?

White

Black or African American

American Indian

Asian

Hispanic or Latino

Two or more races

9. Which health coverage are you currently enrolled with?

Medicaid

Medicare

Affordable Care Act

Uninsured

Private health insurance

Other

10. How difficult is it for you to pay health insurance cost?

Very difficult
Somewhat difficult

Neutral

Somewhat easy

Very easy

11. Do you have a child 26 years and below that you have been unable to include in your coverage?

Yes

No

12. Has any of your family members been dropped out of coverage after a diagnosis of some illness?

Yes

No

13. Has lack of health insurance cover made you consider one of the following?

Skip a doctor’s appointment

Cancel an appointment with a doctor

Delay a doctor appointment

Not purchase medicine

Health Insurance Evaluation

Please indicate your age range.

18-25

26-34

35-44

45-54

55-65

65+

Please indicate your gender.

Male

Female

Other

Please indicate your annual income range.

<$20,000

$20-49,999

$50-74,999

$75-99,999

$100-149,999
$150,000+

How long have you been with your insurance?

Less than one year

One to nearly two years

Two to nearly five years

Five to nearly ten years

Ten years or more

How do you receive your insurance?

Work

Personal

Family plan

On a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with
the following statements.

I have easy access to the information on my plan.

Strongly Disagree

Disagree
Neutral

Agree

Strongly Agree

I can easily find doctors in my area.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I can easily find doctors I work well with.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I can find specialists that work with the doctors and my plan.
Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am happy with the plan I have.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My co-pay is affordable.

Strongly Disagree

Disagree

Neutral
Agree

Strongly Agree