i

A PROJECT REPORT ON

“A STUDY ON VARIOUS HEALTH INSURANCE

OFFER BY ICICI PRUDENTIAL.”

SUBMITTED TO

UNIVERSITY OF MUMBAI FOR PARTIAL COMPLETION

OF THE DEGREE OF

BACHELOR IN COMMERCE (BANKING AND

FINANCE) UNDER THE FACULTY OF COMMERCE

BY

MS. PRANALI SUNIL PASHILKAR

ROLL NO. 32
UNDER THE GUIDANCE OF

PROF. SHRADDHA BHOME

SATISH PRADHAN DNYANASADHANA COLLEGE,

THANE OFF EASTERN EXPRESS HIGHWAY,

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DNYANASADHANA MARG,THANE 400604.

SATISH PRADHAN DNYANASADHANA COLLEGE,

THANE (ARTS, SCIENCE AND COMMERCE)

OFF EASTERN EXPRESS HIGHWAY,

DNYANASADHANA MARG, THANE 400604.

CERTIFICATE

This is to certify that Ms. Pranali Sunil Pashilkar has

worked and duly completed her Project Work for the degree
of Bachelor in Commerce (Accounting and Finance) under
the faculty of Commerce in the subject of

Investment Avenues and her project is entitled, “A study on

Various Types of health insurance provided by ICICI
Prudential.” under my supervision.

I further certify that the entire work has been done by the
learner under my guidance and that no part of it has been
submitted previously for any Degree or Diploma of any
University.
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It is her own work and facts reported by her/his personal

findings and investigations.

Name and Signature of Guiding

Teacher

Date of Submission:

DECLARATION BY LEARNER

I the undersigned Miss. Pranali Sunil Pashilkar here by,

declare that the work embodied in this project work titled “A
study on Various types of health insurance provided by
ICICI Prudential.” , forms my own contribution to the
research work carried out under the guidance of Prof.
Shraddha Bhome is a result of my own research work and
has not been previously submitted to any other university for
any other Degree/Diploma to this or any other University.

Wherever reference has been made to previous works of

others, it has been clearly indicated as such and included in the
bibliography.

I, here by further declare that all information of this document

has been obtained and presented in accordance with academic
rules and ethical conduct.

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Name and Signature of the learner

Ms. Pranali Sunil Pashilkar

Certified by:

Name and Signature of the Guiding Teacher.

ACKNOWLEDGMENT

To list who all have helped me is difficult because they are so

numerous and the depth is so enormous.
I would like to acknowledge the following as being idealistic
channels ad fresh dimensions in the completion of this project.

I take this opportunity to thank the University of Mumbai for

giving me chance to do this project.

I would like to thank my Principal, Dr. H. K. CHITTE for

providing the necessary facilities required for the
completion of this project.

I take this opportunity to thank our Coordinator Dr. Shraddha

Mayuresh Bhome for her moral support and guidance.
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I would also like to express my sincere gratitude towards my

project guide Prof. Manoj Shivdas Wagh whose guidance
and care made the project successful. I would like to thank
my College Library, for having provided various reference
books and magazines related to my project especially my
parents and peers who supported me throughout my project.

Pranali Sunil Pashilkar

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CHAPTER NO. TITLE OF THE CHAPTER

1. TITAL PAGE

2. CERTIFICATE

3. DECLARATION BY LEARNER

4. ACKNOWLEDGEMENT

1 INTRODUCTION TO HEALTH INSURANCE

INTRODUCTION
TYPES OF HEALTH INSURANCE
MANAGED CARE
HEALTH INSURANCE PRODUCTS AVAILABLE IN INDIA

2 OBJECTIVES OF HEALTH INSURANCE

Granting Security To People

Minimization Of Losses

Diversifying The Risk

Reduces The Anxiety And Fear

Mobilizes The Saving

3 IMPORTANCE OF HEALTH INSURANCE

Provide safety and security

Generates financial resources

Life insurance encourages savings

Promotes economic growth

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Medical support

Spreading of risk

Source of collecting funds

4 RESEARCH METHODOLOGY
Introduction
Objective of The Study

Hypothesis of The Study

Scope of The Study

Limitation of The Study

Research Methodology
Universe of the Region
Method of Sampling
Sample Size
Method of Data Collection
Primary Data
Secondary Data

Method of Data Analysis

5 Review of Literature

Review of Research Papers

Review of Books

Review of Thesis

6 Data Analysis and Interpretation

7 FINDINGS AND CONCLOSION

Findings

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Conclusion

Suggestion

8 BIBLOGRAPHY

9 ANEXURE

 Introduction to health insurance

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Life of an individual and a family is generally peaceful unless any kind of

health issue arises which is indecisive 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:

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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

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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

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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
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individual policies for each family member under individual med claim
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

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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
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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
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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
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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.
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 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.

 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.

 Universe of the region:

The research universe was thane region. The responses

were collected by the buyers and sellers of thane region

only.

 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
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or by probability and therefore this sampling technique is also sometimes

known as a method of chance.

 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.

 Method of data collection:

Data was collected by using two main methods i.e.,

primary data and secondary data.

 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.

 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.

 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.

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 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
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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
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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

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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

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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
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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)

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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

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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 incurred claims ratio means the ratio of the net claims settled by the
insurance company to the net premiums collected in a financial year. The
formula for calculation is:

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
27
 140%

28 120%

Net ICR in percentage

100%
ICR of government and group businesses is also observed. The net ICR of
group business
80% without government business showed an improvement
Govt. Business
from 107% in the year 2017-18 to 102% in the year 2018-19.
60% Group Business
Individual Business
40%

20%
(d) State wise distribution of health insurance in India
0%
2014-15 2015-16 2016-17 2017-18 2018-19

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

-1 in FY 2018
9

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.

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 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.

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 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.

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31

 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.

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32

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

32
33

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

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34

$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

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35

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

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36

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.

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37

<$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

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38

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

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39

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

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40

My co-pay is affordable.

Strongly Disagree

Disagree

Neutral

Agree
Strongly Agree

40