A

PROJECT REPORT
ON
“A STUDY ON AWARENESS OF HEALTH INSURANCE, ITS
PRODUCTS AND SETTLEMENT PROCESS.”

Summer Internship Report submitted to the University of Mumbai in

Partial
Fulfillment the award of degree of

Master of Management Studies

Specialization: FINANCE

By
JADHAV SUNNY NANDKUMAR

Roll No:2022021

Batch:
2022-24

for the Summer Internship

Project Guide: Prof./Dr.MINAL PAREKH

ROHIDAS PATIL INSTITUTE OF MANAGEMENT STUDIES

(Affiliated to University of Mumbai, Approved by AICTE, New Delhi)
May,2023
 Shree Shankar Narayan Educational Trust

Rohidas Patil Institute of Management Studies

(Affiliated to University of Mumbai, Approved by AICTE, New Delhi)
Mahavidhyalaya Marg, Navghar Road, Bhayandar East, Thane – 401105.

CERTIFICATE

This is to certify that Mr.SUNNY NANDKUMAR JADHAV. is a bonafide

student of our Institute and the dissertation entitled “A STUDY ON
AWARENESS OF HEALTH INSURANCE, ITS PRODUCTS AND
SETTLEMENT PROCESS.” submitted by him / her is in partial fulfilment of
the semester IV for the Degree of MASTER OF MANAGEMENT STUDIES
IN FINANCE by the University of Mumbai during the Academic Year 2022-
24.

Place: Bhayandar, Thane Dr. Vanita Malik

Date: Director
Rohidas Patil Institute of Management
 GUIDE’S CERTIFICATE

This is to certify that the Dissertation entitled “A STUDY ON AWARENESS OF HEALTH

INSURANCE, ITS PRODUCTS AND SETTLEMENT PROCESS.” is a bonafide record of

independent research work done by Mr.SUNNY NANDKUMAR JADHAV, Roll. No.

2022021 under my supervision during Academic year 22-24, submitted to the University of

Mumbai in partial fulfilment of Semester IV for the Degree of MASTER OF

MANAGEMENT STUDIES IN FINANCE.

Place: Bhayandar,
Date : MINAL PAREKH
 DECLARATION

I Mr. SUNNY NANKUMAR JADHAV hereby declare that the dissertation “A STUDY ON

AWARENESS OF HEALTH INSURANCE, ITS PRODUCTS AND SETTLEMENT

PROCESS.” submitted to the University of Mumbai in partial fulfilment of the semester IV

for the Degree of MASTER OF MANAGEMENT STUDIES IN FINANCE is an original

work and that the dissertation has not previously formed the basis for the award of any other

degree, Diploma, Associate ship, Fellowship or other title.

Place: Bhayandar, Thane

_____________________
Date: SUNNY NANDKUMAR JADHAV.
 Evaluation Report
Summer Internship 2022-24

Basic Information

Name of the Student: SUNNY NANDKUMAR JADHAV

Academic Year and Roll No: 2023-2024/ 2022021

Name of the Company: AKORD & CO.Chartere Accountants

Name and Designation of the Training Supervisor:

Area of Training: VASAI- VIRAR

Special Project, if any:

Score Card

Please rate the following attributes on a scale of 01-05.

(01=Average, 02=Good, 03=Very Good, 04=Excellent and 05=Outstanding)

Sr. No. Attributes Score

1 Attendance
2 Punctuality
3 Attitude
4 Performance
5 Initiative
6 Interpersonal Skills
7 Diligence Level
8 Subject Knowledge
9 Personal Grooming
10 Communication Skills
Total Score(Out of 50)
Special remarks / Appreciation, if any:

Name & Signature of Training Supervisor Official Seal of the

Company
Date: Place:
 Evaluation of Dissertation

1. Name of the Candidate:Mr.Sunny Nandkumar Jadhav.

2. Seat Number: 2022021

3. Name / Code of the subject:

4. Title of the Dissertation:

5. Evaluation:

Sr. No. Parameters Maximum Marks

Marks Awarded

1 Introduction 05

2 Literature Review and Problem 05

Definition
3 Process Description 10

4 Project Profile 10

5 Findings & Conclusions 15

6 Learning Experience 05

Total 50

6. Name & Address of the Evaluator:

7. Signature of Evaluator with Date:

8. Signature of the Head of the Institution with seal:

Declaration
This is to certify that the Summer Project titled “A STUDY ON AWARENESS
OF HEALTH INSURANCE, ITS PRODUCTS AND SETTLEMENT
PROCESS”. is original work and being submitted in partial fulfillment for the
award of the degree, Master of Management Studies of the University of
Mumbai. This Summer Project report has not been submitted earlier either to
this university or to any other affiliated college of this university or to any other
university / institution for the fulfillment of the requirement of the MMS Course.

Date: (Signature of Student)

Place: (Name of the student)

 Acknowledgement

It has been an enriching experience for me to undergo my summer training at

AKORD & CO.Chartere Accountants , which would not have been possible
without the goodwill and support of the people around. As a student of “Rohidas
Patil Institute of Management Studies, Bhayander (E)”, I would like to express
my sincere thanks to all those who helped me during my summer internship. I
would like to express my gratitude to all those who encouraged me to complete
this project.

I would like to thank my college authorities for providing me the opportunity to

work with such a prestigious organization. I would like to express my gratitude
to Mr.Dilip Jain sir , for having given me the opportunity to do my project work
in the organization and lighted my way of progress with his guidance. My
sincere and deepest thanks to Prof./Dr.Minal Parekh of “Rohidas Patil Institute
of Management Studies, Bhayander (E)” for having spared his/her valuable time
with me and for all the guidance given in executing the project as per
requirements. I would like to give my special thanks to my parents, their love,
support and blessing enabled me to complete this project work.

Name of Student:Mr.Sunny Nandkumar Jadhav.

Signature:_______________________

Ref. No.
Date:

Internship Certificate
 TABLE OF CONTENTS

Sr. Content Page

no no

1 Executive Summary 1

2 Introduction 2-16

3 Industry Overview 17-18

4 Company Profile 19

5 Literature Review 20-21

6 Objectives of study 22

7 Process of Claim Settlement 23-25

8 Research Methodology 26

9 Data Analysis and 27-38

Interpretation
10 Suggestions 39

11 Limitations 40

12 Recommendation 41

13 Conclusion 42

14 References, Bibliography 43
15 44-46
Annexure
 EXECUTIVE SUMMARY

This study will discuss about the Health Insurance, its benefits and process of claim
settlement. Health Insurance is very important in today’s world especially after Covid
19 Pandemic. Awareness regarding Health Insurance in the people at a greater pace
will make it as an emerging sector in Insurance market.

Heath Insurance covers medical expenses, critical illness and provide Cash less
facility. The process of claim settlements are Cashless and Reimbursement. Cash less
treatment is for Planned / Emergency Hospitalization. Reimbursement treatment is for
normal purpose.

People are still not aware much about the Health Insurance and its benefits. Proper
advertisements and campaigns should be undertaken by Government just like Life and
General Insurance. As after pandemic, Health Insurance policy should be made by
each and every one.

1
 INTRODUCTION

What is Insurance?
Insurance is a means of protecting from financial loss. Insurance is a legal agreement
between two parties- the insurer and the insured, also known as insurance coverage or
insurance policy. The insurer provides financial coverage for the losses of the insured
the he /she may bear under certain circumstances.

What is Health Insurance?

Heath Insurance is a type of Insurance that covers medical expenses that arises due to
disorder or disease. These expenses could be related to hospitalization costs, cost of
medicines or doctor consultation fees.

How it works?
Health Insurance plan is a contract between an Insurer and the policy holder. Premium
is paid by the policy holders to the insurance company, in return insurer pays for
medical expenses.

Role of an agent.
An agent is called PoSP I.e. Point of Sales Person. PoSP has the authority to sell
insurance policies on behalf of the company. A person should have cleared the exam
conducted by IRDA and should have attended house training for 15 hours by the
company.

Benefits of Health Insurance.

i. It covers medical expenses without any strain on your finances.
ii. It covers critical illness I.e. life threatening diseases like kidney failure, bone
narrow transplant, stroke etc.
iii. Cashless claim facility.
iv. It offers additional protection over and above your employer cover through
Group Insurance Plan.
v. Tax benefits under sec 80D of Income Tax Act, 1961.

2
In an era marked by rapid advancements in medical technology and escalating healthcare
costs, access to comprehensive health insurance coverage has become indispensable. Health
insurance serves as a crucial financial safeguard against unforeseen medical expenses,
offering individuals and families the peace of mind that comes with knowing they can access
quality healthcare without bearing the full brunt of exorbitant bills. However, despite its
paramount importance, there exists a notable gap in awareness regarding health insurance, its
various products, and the intricate settlement processes involved.

Understanding the nuances of health insurance is essential for individuals to make informed
decisions about their healthcare needs and financial well-being. It is within this context that
this study aims to delve into the awareness levels surrounding health insurance, its diverse
array of products, and the intricacies of the claims settlement process.

1. Assessing Awareness Levels: The primary objective of this study is to gauge the level of
awareness among the populace regarding health insurance. This involves understanding the
extent to which individuals comprehend the concept of health insurance, its importance, and
the benefits it offers.

2. Exploring Product Knowledge: Another key objective is to explore the knowledge levels
pertaining to various health insurance products available in the market. This includes
understanding the differences between different types of policies, such as individual plans,
family floater plans, critical illness policies, and others.

3. Understanding Settlement Processes: Additionally, this study aims to delve into the
intricacies of the claims settlement process within the realm of health insurance. It seeks to
ascertain the understanding individuals have regarding claim procedures, documentation
requirements, and the factors influencing claim approvals.

3
 Awareness About Health Insurance:

1. Understanding the Concept:

 Many individuals may not fully understand what health insurance is and how it works.
Awareness involves knowing that health insurance is a contract between an individual
and an insurance company where the individual pays premiums in exchange for
coverage of medical expenses.

2. Importance of Health Insurance:

 Awareness includes recognizing the significance of health insurance in providing
financial protection against unexpected medical expenses. It ensures access to quality
healthcare without facing substantial financial burdens.

3. Coverage and Benefits:

 Awareness about health insurance extends to understanding the scope of coverage and
benefits provided by different insurance plans. This includes knowing what services
and treatments are covered, such as hospitalizations, doctor visits, prescription
medications, and preventive care.

4. Types of Health Insurance Plans:

 Being aware of the various types of health insurance plans available, such as HMOs,
PPOs, EPOs, and POS plans, enables individuals to choose a plan that best suits their
needs and preferences.

5. Costs and Financial Considerations:

 Awareness involves understanding the financial aspects of health insurance, including
premiums, deductibles, copayments, and coinsurance. Individuals should be aware of
how these costs affect their out-of-pocket expenses and overall healthcare spending.

6. Enrollment and Eligibility:

 Awareness about health insurance includes knowing when and how to enroll in a plan,
whether through employer-sponsored coverage, government programs like Medicare
or Medicaid, or individual marketplaces. Understanding eligibility criteria and
enrollment periods ensures timely access to coverage.

7. Networks and Providers:

 Awareness extends to knowing about provider networks and the importance of
choosing healthcare providers within the network to maximize coverage and minimize
out-of-pocket costs. Understanding how to find in-network providers and the
implications of using out-of-network services is essential.

8. Claims Process and Settlement:

 Awareness about the claims process involves understanding how to file claims, the
documentation required, and the steps involved in getting claims processed and
reimbursed. This includes knowing how to appeal denied claims and understanding the
rights and responsibilities of policyholders.

4
9. Health Insurance Literacy:
 Health insurance awareness also encompasses health insurance literacy, which
involves having the knowledge and skills to navigate the complexities of the
healthcare system, understand insurance terminology, compare plan options, and make
informed healthcare decisions.

10. Consumer Rights and Protections:

 Individuals should be aware of their rights as health insurance consumers, including
protections provided by laws such as the Affordable Care Act (ACA). This includes
knowing about coverage guarantees, preventive care benefits, and protections against
discrimination based on pre-existing conditions

5
 1. Coverage:

 Health insurance typically covers a range of medical expenses, including hospitalization,

doctor visits, prescription drugs, diagnostic tests, preventive care, and sometimes even dental
and vision care.
 Coverage can vary depending on the type of health insurance plan, with some plans offering
more comprehensive coverage than others.

2. Types of Health Insurance Plans:

 Health Maintenance Organization (HMO): HMO plans require members to choose a

primary care physician (PCP) and typically require referrals to see specialists.
 Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing
healthcare providers and usually cover a portion of the cost for out-of-network care.
 Exclusive Provider Organization (EPO): EPO plans offer a network of healthcare providers
but do not typically cover out-of-network care, except in emergencies.
 Point of Service (POS): POS plans combine features of HMO and PPO plans, requiring
members to choose a primary care physician but also offering some coverage for out-of-
network care.

3. Premiums, Deductibles, and Copayments:

 Premium: The amount paid periodically (monthly or annually) to maintain health insurance
coverage.
 Deductible: The amount that the insured must pay out-of-pocket for covered medical
expenses before the insurance company starts paying.
 Copayment (Copay): A fixed amount that the insured pays for covered services, typically
due at the time of service.

4. Enrollment Periods:

 Health insurance enrollment typically occurs during specific periods, such as the annual open
enrollment period or special enrollment periods triggered by qualifying life events (e.g.,
marriage, birth of a child, loss of other coverage).

5. Employer-Sponsored Health Insurance:

 Many employers offer health insurance benefits to their employees as part of their
compensation packages.
 Employer-sponsored health insurance plans often provide group coverage, which can be more
cost-effective than individual plans.

6. Government-Sponsored Health Insurance Programs:

6
 In many countries, governments offer health insurance programs to provide coverage to
specific populations, such as Medicare for seniors and Medicaid for low-income individuals
and families.
 Government-sponsored health insurance programs aim to ensure access to healthcare for
vulnerable populations who may not otherwise afford coverage.

7. Importance of Health Insurance:

 Health insurance provides financial protection against the high costs of medical care, reducing
the risk of financial ruin due to unexpected healthcare expenses.
 Having health insurance encourages preventive care and early intervention, leading to better
overall health outcomes.
 Health insurance coverage is often a prerequisite for accessing healthcare services and
facilities.

8. Considerations When Choosing a Health Insurance Plan:

 Coverage and benefits offered

 Premiums, deductibles, and copayments
 Provider network and access to preferred healthcare providers
 Prescription drug coverage
 Coverage for specific medical needs or conditions

7
 TYPES OF HEALTH INSURANCE

1. Individual Health Insurance:

 Purchased by individuals directly from insurance companies or through healthcare
marketplaces.
 Provides coverage for an individual's medical expenses, including hospital visits,
doctor's appointments, prescription drugs, and preventive care.
 Premiums, deductibles, and copayments vary depending on the plan chosen.
2. Family Health Insurance:
 Similar to individual health insurance but covers the medical expenses of an entire
family, including spouses and dependent children.
 Family health insurance plans often offer cost savings compared to purchasing
individual plans for each family member.
3. Employer-Sponsored Health Insurance:
 Provided by employers as part of an employee benefits package.
 Offers group coverage to employees and, in many cases, their families.
 Employers typically share the cost of premiums with employees.
 Employees may have a choice of plans offered by the employer.
4. Group Health Insurance:
 Similar to employer-sponsored health insurance but can be obtained through other
groups or organizations, such as professional associations or trade unions.
 Offers coverage to members of the group, often at lower rates than individual plans
due to economies of scale.
5. Medicare:
 A federal health insurance program primarily for individuals aged 65 and older, as
well as younger people with certain disabilities and individuals with end-stage renal
disease.
 Medicare consists of different parts, including:
 Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled
nursing facility care, hospice care, and some home health care.
 Medicare Part B (Medical Insurance): Covers outpatient medical services,
preventive services, and durable medical equipment.
 Medicare Part C (Medicare Advantage): Private health plans that offer
Medicare benefits and may include additional coverage options.
 Medicare Part D: Prescription drug coverage.
6. Medicaid:
 A joint federal and state program that provides health insurance coverage to low-
income individuals and families.
 Eligibility and benefits vary by state, but Medicaid typically covers a broad range of
medical services, including doctor visits, hospitalizations, and long-term care.

7. Health Maintenance Organization (HMO) Plans:

 Require members to choose a primary care physician (PCP) and obtain referrals from
the PCP to see specialists.
 Generally have lower out-of-pocket costs but limited provider networks.
8. Preferred Provider Organization (PPO) Plans:
 Offer more flexibility in choosing healthcare providers and do not require referrals to
see specialists.

8
  Typically have higher premiums and out-of-pocket costs but provide coverage for out-
of-network care, albeit at a higher cost.
9. Exclusive Provider Organization (EPO) Plans:
 Similar to HMO plans but do not require referrals to see specialists.
 Only cover services provided by in-network healthcare providers, except in
emergencies.

10. Point of Service (POS) Plans:

 Combine features of HMO and PPO plans.
 Require members to choose a primary care physician but offer some coverage for out-
of-network care, typically with higher out-of-pocket costs.

9
 Here's How Health Insurance Works In A Simplified Manner:

1. Premium Payments:
 Policyholders pay regular premiums to the insurance company, typically on a monthly
or yearly basis. These premiums contribute to a collective pool of funds used to cover
medical expenses for all members of the insurance plan.

2. Coverage and Benefits:

 In exchange for premium payments, the insurance company provides coverage for a
range of medical services and treatments outlined in the insurance policy. These
services may include hospitalizations, doctor visits, prescription medications,
preventive care, and other healthcare services.

3. Insurance Plan Types:

 There are various types of health insurance plans, such as Health Maintenance
Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider
Organizations (EPOs), and Point of Service (POS) plans. Each type of plan offers
different levels of flexibility and cost-sharing arrangements.

4. Provider Networks:
 Health insurance plans often have networks of healthcare providers, including doctors,
hospitals, clinics, and specialists, with whom they have negotiated discounted rates.
Policyholders may receive higher coverage benefits when using in-network providers
compared to out-of-network providers.

5. Out-of-Pocket Costs:
 In addition to premiums, policyholders may be responsible for out-of-pocket costs,
including deductibles, copayments, and coinsurance. These costs represent the portion
of medical expenses that policyholders must pay themselves before the insurance
company begins to cover expenses.

6. Deductibles:
 A deductible is the amount of money that policyholders must pay out of pocket before
their insurance coverage kicks in. For example, if a policy has a $1,000 deductible, the
policyholder must pay the first $1,000 of covered medical expenses before the
insurance company starts paying.

7. Copayments and Coinsurance:

 Copayments are fixed amounts that policyholders pay for specific services, such as a
doctor's visit or prescription medication. Coinsurance is a percentage of the cost of
services that policyholders must pay, typically after meeting their deductible.
10
8. Claims Process:
 When policyholders receive medical services, healthcare providers submit claims to
the insurance company for reimbursement. The insurance company reviews the claims
to ensure they meet the terms of the policy and processes payment to the provider.
Policyholders may receive Explanation of Benefits (EOB) statements detailing the
services provided and the amount covered by insurance.

9. Coverage Limits and Exclusions:

 Health insurance policies may have coverage limits and exclusions, which specify the
maximum amount the insurance company will pay for certain services or conditions.
Policyholders should review their policy documents carefully to understand any
limitations on coverage.

10. Renewal and Changes:

 Health insurance plans typically have annual renewal periods during which
policyholders can make changes to their coverage, such as switching plans, adding or
removing dependents, or adjusting coverage levels.

11
 Financial Considerations Related To Health Insurance Policies:

1. Premiums:
 Premiums are the regular payments policyholders make to the insurance company to
maintain their health insurance coverage. Premiums can vary based on factors such as
age, location, plan type, and coverage level.

2. Deductibles:
 A deductible is the amount of money that policyholders must pay out of pocket before
their insurance coverage begins. Higher deductible plans typically have lower
premiums, while lower deductible plans often have higher premiums.

3. Copayments:
 Copayments are fixed amounts that policyholders pay for specific healthcare services,
such as doctor visits, prescription medications, or specialist consultations. Copayments
are typically due at the time of service.

4. Coinsurance:
 Coinsurance is the percentage of the cost of covered healthcare services that
policyholders must pay after meeting their deductible. For example, if a policy has
20% coinsurance, the policyholder would pay 20% of the cost of covered services, and
the insurance company would pay the remaining 80%.

5. Out-of-Pocket Maximum:
 The out-of-pocket maximum is the maximum amount of money that policyholders are
required to pay for covered medical expenses in a given policy period. Once the out-
of-pocket maximum is reached, the insurance company typically covers 100% of
covered expenses for the remainder of the policy period.

6. Coverage Limits:
 Health insurance policies may have coverage limits or exclusions that specify the
maximum amount the insurance company will pay for certain services or conditions.
Policyholders should review their policy documents carefully to understand any
limitations on coverage.

7. Subsidies and Tax Credits:

 Depending on income and eligibility criteria, individuals may qualify for subsidies or
tax credits to help offset the cost of health insurance premiums. Subsidies are available
through government programs like the Affordable Care Act (ACA) marketplace
exchanges.

8. Plan Types and Cost-Sharing:

 Different types of health insurance plans, such as Health Maintenance Organizations
(HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations
(EPOs), and Point of Service (POS) plans, offer varying levels of cost-sharing
arrangements and associated costs.

12
9. Renewal and Changes:
 Health insurance plans typically have annual renewal periods during which
policyholders can make changes to their coverage, such as switching plans, adding or
removing dependents, or adjusting coverage levels. Changes in coverage may result in
changes to premiums and out-of-pocket costs.
10. Financial Assistance Programs:
 Some health insurance policies may offer financial assistance programs or
supplemental coverage options to help policyholders manage costs associated with
specific healthcare needs, such as chronic conditions or prescription medications.

13
 SLIST OF PRODUCTS OF STAR HEALTH INSURANCE

 Star Women care Insurance policy.

 Star Comprehensive Insurance Policy.

 Senior Citizen Red Carpet Health Insurance Policy.

 Family Health Optima Insurance Policy.

 Star Health Premium Insurance Policy.

 Super Surplus Insurance Policy.

 Super Surplus Insurance Policy.

 Medi Classic Insurance Policy.

 Star health Gain Insurance Policy.

 Star Criticare Plus Insurance Policy.

 Star Micro Rural and Farmer Care.

 Star Hospital Cash Insurance Policy.

 Star Care out Insurance Policy.

 Young Star Insurance Policy.

 Arogya Sanjeevani Policy.

14
 Star Health Assure Insurance Policy.

 Star Extra protect Add on Care.

15
SCOPE OF STUDY
The scope of study is to do the survey and to find the awareness of Health Insurance
Policies in Star Health and Claim settlement process of the policies.

PURPOSE OF THE STUDY

The purpose of the study is to describe the policies and the settlement process.

16
 INDUSTRY OVERVIEW

1818 saw the advent of life insurance business in India with the establishment
of the Oriental Life Insurance Company in Calcutta. 1870 saw the enactment of the
British Insurance Act. The Indian Life Assurance Companies Act, 1912 was the first
statutory measure to regulate life business.

The Indian Insurance Sector is divided in two categories:

A) Life Insurance.
B) Non-Life Insurance I.e. General Insurance.
IRDA (Insurance Regulatory and Development Authority of India) governs both Life
and General Insurance.
The insurance industry of India has 57 companies, of which 24 are Life Insurance
Companies while remaining 34 companies are Non-life insurance.
Health insurance expenditure in India is roughly 6% of GDP, much higher than most
other developed countries. There has been an almost total failure of the public health
care system in India. This creates an opportunity for the new insurance companies to
sell health insurance to a vast number of families
The life insurance business has accounted for less than 2%\r of the insurance premium
of the LIC (Mitra and Nayak, 2001). Term life - where the insurance company pays a
predetermined amount if the policyholder dies within a given time but it pays nothing
if he or she does not - accounts for more.

17
GROWTH

India allowed private companies in insurance sector in 2000, setting a limit on FDI to
26%, which was increased to 49% in 2014. IRDAI states – Insurance Laws
(Amendment Act, 2015) provides for enhancement of the Foreign Investment Cap in
an Indian Insurance Company.

LIC continues to dominate the Insurance sector in India, but the introduction of new
private insurers will see a vibrant expansion and growth of both life and non-life
sectors. The government also strives hard to provide insurance to individuals in a

below poverty line by introducing schemes like the PMJAY and PMSSBY.

18
 COMPANY PROFILE

Star Health and Allied Insurance Company Ltd is an Indian multinational health
insurance company. The company provides services in health, personal accident and
overseas travel insurance directly as well as through various channels like agents,
brokers and online. Star Health is also prominently into bancassurance having long
standing relationships with bank.

Industries
Financial services.

Company size
12800 plus Employees & 640+ branches all over India.

Headquarters
Tamil Nadu, Chennai.

Market Share
16%.

Type
Public Company.

LinkedIn Profile Link:

https://in.linkedin.com/company/star-health-and-allied-insurance-co--ltd

19
 LITERATURE REVIEW

Sonal Kala, (2015), had undertaken research on “Awareness of Heath Insurance

among people with special reference to Rajasthan”. This study's findings suggest that
respondents are aware of health insurance but have chosen not to purchase it or Medi
claim plans. In order to obtain health insurance, people more frequently rely on public
general insurance firms than on private general insurance businesses and insurance
programme. Respondents had limited knowledge of health insurance policies. Health
insurance firms are not transparent, according to their terms and conditions. In India,
health insurance is still more widespread but is supposed to be simple to grasp and
accessible.

Indumathi K, Hajira Saba, (2016) had undertaken research on “Awareness of

Health Insurance in rural population of Bangalore, India”. The study’s findings
explains us that health insurance awareness was influenced by education and
socioeconomic level. Despite the fact that this study demonstrates a rise in the
prevalence of health insurance awareness, there is still a grave need to raise people's
awareness of how health insurance works in rural areas. In order to educate people
about the importance of having health insurance and how to pay for increased medical
costs due to unforeseen injuries and illnesses, effective IEC initiatives must be
launched.

Dr. Bina Joy, (2018), had undertaken research on “Claim Settlement Mechanism of
Health Insurers in India - A critical analysis”. This study explains us that the claim
management performance of the Indian health insurance industry is still below par,
and profitability is rapidly declining. Over the years, there hasn't been much of a
change or improvement in the percentage of claims that insurers resolve. Unjustified
TPA pay out delays have made for a frustrating experience for the customer and
damaged the industry's reputation.

20
Dr. A. Arangasami, (2019) had undertaken research on “A study on customer
awareness towards Health Insurance with special reference to Chennai city”. The
study states that the Indian health insurance market is expanding quickly, and with it,
so are the problems and difficulties related to fostering systemic synergy. The only
viable option for financing health-care in a nation like India is through a health
insurance mechanism due to rising health care costs, an increase in disposable income,
and significant out-of-pocket expenses.

Dr. Pranam Dhar, Gautama Sharma, (2019) had undertaken research on “Claim
Settlement Mechanism and Indian Health Insurance sector - A critical insight”
This study explains us that the resolution of claims makes or breaks the contract
between the insured and the insurer. When enrolling customers in their policies, the
insurer should do due diligence, and claims should be quickly resolved. Unjustified
TPA pay out delays have made for a frustrating experience for the customer and
damaged the industry's reputation.

Girish Tarachand Bhavnani, Sambhaji Jadhav, (2019) had undertaken research on

“A study on awareness of Health Insurance among people with special reference to
Ulhasnagar (Thane)”. The study’s findings suggest that while respondents were
aware of medical insurance, they chose not to use either mediclaim or health
insurance. People depend on private general insurance companies. The terms and
conditions of medical coverage arrangements, as stated by health insurance firms,
were largely unknown to the respondents. Health insurance is thought to be more
widespread in India.

21
 OBJECTIVES OF THE STUDY

 To study about the awareness of Health Insurance products mainly in Star Health
Insurance Company.
 To understand the importance of Health Insurance in India.
 To understand the benefits of Health Insurance products in India.
 To find the awareness about benefits of Health Insurance plans.
 To study how claims are processed and settlements are done.

22
 PROCESS OF CLAIM SETTLEMENTS

Claim scenarios happen with cashless treatment as well as reimbursement cases.

a. CASH LESS TREATMENT.
Network hospitals are the ones wherein cashless treatment can be availed under a
health insurance plan. The bills generated in such cases are sent across to Star and the
policyholder or the claimant doesn't need to pay anything.
Procedure to file a claim under Cashless treatment. (Planned / Emergency
hospitalization).
1. A membership card must be brought with you or a policy number and member ID
must be provided to the network hospital.

2. Contact 1800 425 2255/1800 102 4477 for an emergency or expected admission
and fax the pre-authorization form to 1800 425 5522.

3. One will have to provide personal information and policy ID or member ID to the
hospital insurance office and complete a pre-authorization form in the client
section.

4. After the hospital completes the balance details, a pre-authorization form will be
faxed to Star.
5. In case of planned hospitalization, the insurer should be informed 24 hours before
being admitted to the hospital.
6. In case of emergency hospitalization, the insurer should be informed within 24
hours of being hospitalized.
7. Star's internal medical team will review records and documents received and
notify guardians and hospitals if approved, pending or denied.
8. In case of pending approval cases, Star will contact the hospital to furnish more
details and in cases of rejection, a claim reimbursement process needs to be
followed.

Claim Process for Cash less treatment.

1. Post the filling up of the pre-authorization form, the requisite details will be
verified by the hospital and the TPA.

23
2. A field doctor will be assigned to the policyholder to aid in the hospitalisation
procedure
3. After submitting the pre-authorization form, all communications will be handled
by Star regarding settlement of the bill.
4. If certain costs are not covered or are beyond the scope of the policy, they will be
communicated to the patient before or after discharge.

b. REIMBURSEMENT OF TREATMENT EXPENSES:

Treatments performed at hospitals outside of the Star Health Insurance network and
treatments that have not been approved for the cashless method may elect to be
reimbursed. The following procedure should be followed in such cases.
Procedure to File a Claim: The details required during this procedure will be the
following -

. Policyholder's name
. Claimant's name and customer ID
. Details of the hospital
. Details of diagnosis and treatment
. An approximation of the claim amount
. Date of admission

Collection of all related documents from the hospital to be done.

Documents Required:

The claim form can be downloaded from Star's website and along with the filled up
form, the following documents need to be provided -

. The original copy of the claim form, fully filled and duly signed
. Government approved valid photo ID proof
. Referral letter from medical practitioner advising hospitalization
. Letter from medical practitioner detailing the list of tests, medications and
consultations if any

24
 . Original copies of bills, receipts and discharge card from the hospital or the
medical practitioner.
. Original copies of tests and reports done along with payment receipts
. Indoor case papers.
. If applicable, the First Information Report and the Final Police Report
. Original copy of the post mortem report, if conducted.

The above list of documents are the bare minimum necessities. Star Health might
require additional documentation as and when needed.

Claims Process for Reimbursement Cases:

Once Star receives the complete claim form along with relevant documents, the claim
process will begin and the following will happen:

1. Star's internal medical team reviews the case and documents received at the nearest
Star Health office.
2. The application, if approved, will result in the processing of the refund and the
process to be completed within a period of one week and fortnight days. A similar
notice will be sent to the applicant.
3. In case the request has incomplete information, the same will be intimated to the
claimant and requisite details will be requested to ensure claim resolution at the
earliest.

25
 RESEARCH METHODOLOGY

 Research Methodology:
The methodology followed for conducting the study includes the specification of
research design, questionnaire design and data collection.
 Approach:
The nature of data collected is quantitative.
 Population:
The population of my research is people from different genders, various age groups,
different level of education, occupation etc.
 Sample Size:
Sample size is 75.
 Sample Area:
The population is selected from Mumbai and Pune only.
 Data Collection
The data collected for the study consists of both primary and secondary data.
 Primary Data:
In this study, primary data was collected through questionnaire with a sample size of
75 respondents. The research has used a questionnaire consisting of multiple- choice
based questions.
 Secondary Data:
Secondary data for this study was collected from: Previously published records,
research reports, articles and various verified internet sources.

26
 DATA ANAYLSIS AND INTERPRETATION

Data analysis and interpretation of the study conducted with the help of a
questionnaire is shown along with the interpretation respectively.

1. Age

It can be observed that out of 75 respondents which is 40 respondents (53.3%) were

from the age group of 25-30 years, whereas 24 (32%) respondents were from 30-45
age group and remaining 11(14.7%) respondents were from 45 & above.

TABLE NO.1

Parameters No of respondents Percentage

25-30 40 53.3%
30-45 24 32%
45 & above 11 14.7%
Total 75 100%

27
2. Gender

It can be observed from the study that the majority of the respondents belong to an
female gender group which is 49 respondents (65.3%), followed by male gender
group comprising of 26 respondents which accounts for (34.7%). In this way, the
study attempts to cover a broad and diverse view of the data and provide a
comprehensive analysis of it.
TABLE NO.2

Parameters No of respondents Percentage

Male 49 65.3%
Female 26 34.7%
Total 75 100%

28
 3. Education.

It is observed that out of 75 respondents 56 respondents (74.7%) have done

Masters,11 respondents (14.7%) have done Bachelors and 8 respondents (10.7%)
have done PhD. The majority is from Master’s degree from the respondents.
TABLE NO.3

Parameters No of respondents Percentage

Bachelors 11 14.7%
Masters 56 74.7%
PhD 8 10.7%
Total 75 100%

29
 4. Occupation.

It is observed that out of 75 respondents, 47 respondents (62.7%) are students, 14

respondents (18.7%) are Home maker, 6 respondents (8%) are from Service, 5
respondents (6.7%) are Professional and 3 respondents (4%) are retired. The majority
are students.
TABLE NO.4

Parameters No of respondents Percentage

Professional 5 6.7%
Service 6 8%
Student 47 62.7%
Home maker 14 18.7%
Retired 3 4%
Total 75 100%

30
 5. Health Insurance is an emerging sector in Insurance Industry.

It is observed that out of 75 respondents, 36 respondents (48%) prefer neutral, 14

(18.7%) respondents prefer Agree, 12 respondents (16%) prefer Strongly agree, 7
respondents (9.3%) prefer Strongly disagree and 6 respondents (8% ) prefer Disagree
on the above statement. The majority prefer to say neutral.

TABLE NO.5

Parameters No of respondents Percentage

Strongly Agree 12 16%
Agree 14 18.7%
Neutral 36 48%
Disagree 6 8%
Strongly Disagree 7 9.3%
Total 75 100%

31
 6. People are still not aware about Health Insurance in India.

It is observed that out of 75 respondents, 36 respondents (48%) prefer to say

neutral,14 respondents (18.7%) prefer Agree, 12 respondents (16%) prefer Strongly
agree, 6 respondents (8%) prefer Strongly disagree and 7 respondents (9.3% ) prefer
Disagree on the above statement. The majority of respondents prefer Neutral.

TABLE NO.6

Parameters No of respondents Percentage

Strongly Agree 12 16%
Agree 14 18.7%
Neutral 36 48%
Disagree 7 9.3%
Strongly Disagree 6 8%
Total 75 100%

32
 7. Health Insurance provide cash less claim facility.

It is observed that out of 75 respondents, 29 respondents (38.7) prefer neutral, 21

respondents (28%) prefer Agree, 11 respondents (14.7%) prefer Strongly agree, 5
respondents (6.7%) prefer Strongly disagree and 9 respondents (12% ) prefer Disagree
on the above statement. The majority of respondents prefer Neutral.

TABLE NO.7

Parameters No of respondents Percentage

Strongly Agree 12 16%
Agree 14 18.7%
Neutral 36 48%
Disagree 7 9.3%
Strongly Disagree 6 8%
Total 75 100%

33
 8. Health Insurance is beneficial post pandemic.

It is observed that out of 75 respondents, 27 respondents (36%) prefer to say neutral,

25 respondents (33.3%) prefer to say Agree, 11 respondents (14.7%) prefer to say
Strongly agree, 5 respondents (6.7%) prefer Strongly disagree and 7 respondents
(9.3% ) prefer Disagree on the above statement. The majority of respondents prefer to
say Neutral.

TABLE NO.8

Parameters No of respondents Percentage

Strongly Agree 11 14.7%
Agree 25 33.33%
Neutral 27 36%
Disagree 7 9.3%
Strongly Disagree 5 6.7%
Total 75 100%

34
 9. Health Insurance ensures the undergoing long term treatment does not throw
a family into a dire financial straits.

It is observed that out of 75 respondents, 24 respondents (32%) prefer neutral, 21

respondents (28%) prefer Agree, 13 respondents (17.3%) prefer Strongly agree, 8
respondents (10.7%) prefer Strongly disagree and 9 respondents (12% ) prefer
Disagree on the above statement. The majority of respondents prefer Neutral.

TABLE NO.9

Parameters No of respondents Percentage

Strongly Agree 13 17.3%
Agree 21 28%
Neutral 24 32%
Disagree 9 12%
Strongly Disagree 8 10.7%
Total 75 100%

35
 10. Are you aware of how the claims are processed and settlement is done in
Health Insurance?

It is observed that out of 75 respondents, 19 respondents (25.3%) say Yes they are
aware of the process, 32 respondents (42.7%) say No i.e. they are not aware and 24
(32%) people say May be they are.

TABLE NO.10

Parameters No of respondents Percentage

Yes 19 25.3%
No 32 42.7%
May be 24 32%
Total 75 100%

36
 11. Are you aware about the tax benefit under Sec 80D of Income Tax Act 1961?

It is observed that out of 75 respondents, 49 respondents (65.3%) prefer Yes they are
aware of the benefits , 26 respondents (34.7%) respondents prefer No i.e. they are not
aware of the benefits. Maximum are aware of the tax benefit under sec 80D of Income
Tax Act 1961.

TABLE NO.11

Parameters No of respondents Percentage

Yes 49 65.3%
No 26 34.7%
Total 75 100%

37
 12. Heath Insurance or Life Insurance?

It is observed that out of 75 respondents, 54 respondents (72%) prefer Health

Insurance and 21 respondents (28%) people prefer Life Insurance. It is analysed that
now people prefer Health Insurance over Life Insurance.

TABLE NO.12

Parameters No of respondents Percentage

Health Insurance 54 7 2%
Life Insurance 21 28%
Total 75 100%

38
 SUGGESTIONS

As per my analysis, Health Insurance is still an emerging sector and because of

pandemic it came into light. There are many benefits of Health Insurance like cash
less claim facility and deduction under Sec 80D etc. People are still not aware of this
benefits. Once they are aware about this people will prefer Health Insurance more.
The process of claim settlement should be known to the people as they are not aware
about the process. The public must be educated through intensive campaign, similar to
Life and general insurance.

39
 LIMITATIONS

There may be some possible limitations in this study.

1. The sample taken for the purpose of study comprises only Mumbai and Pune city.

2. Some respondents were not ready to give their opinion about the survey because
of privacy.

3. Opinion may be biased.

4. Has a broad scope of study.

40
 Recommendation

1. Clear Project Objectives:

 Define clear and specific objectives for the study, outlining what you aim to achieve
and the questions you seek to answer. This will provide focus and direction to your
research efforts.
2. Comprehensive Literature Review:
 Conduct a thorough literature review to gain insights into existing research, studies,
and publications related to health insurance awareness. This will help you understand
the current state of knowledge, identify gaps, and refine your research methodology.
3. Methodological Rigor:
 Design a robust research methodology that employs both quantitative and qualitative
approaches to gather comprehensive data. Consider using surveys, interviews, focus
group discussions, or a combination of these methods to capture diverse perspectives
and insights.
4. Sampling Strategy:
 Develop a sampling strategy that ensures the representation of various demographic
groups, including age, gender, income level, educational background, and geographic
location. A diverse sample will enhance the validity and generalizability of your
findings.
5. Ethical Considerations:
 Adhere to ethical guidelines throughout the research process, ensuring informed
consent, confidentiality, and voluntary participation of respondents. Protect the
privacy and rights of participants at all stages of the study.
6. Data Collection and Analysis:
 Implement rigorous data collection procedures, including pilot testing of survey
instruments and interviewer training to maintain consistency and reliability. Employ
appropriate statistical and qualitative analysis techniques to interpret the data and
derive meaningful insights.
7. Stakeholder Engagement:
 Engage with relevant stakeholders, including policymakers, insurance providers,
healthcare professionals, and consumer advocacy groups. Their input and
collaboration can enrich the study design, validate findings, and facilitate the
dissemination of results.
8. Dissemination of Findings:
 Effectively communicate the findings of the study through comprehensive reports,
presentations, academic publications, and policy briefs. Share insights with key
stakeholders to inform decision-making, policy development, and public awareness
initiatives.
9. Longitudinal Perspective:
 Consider the possibility of conducting follow-up studies or longitudinal research to
track changes in awareness levels, perceptions, and behaviors over time. Longitudinal
data can provide valuable insights into the effectiveness of interventions and trends in
health insurance literacy.

41
 CONCLUSION

The Indian health insurance market is expanding quickly, and with it, so are the
problems and difficulties related to fostering systemic synergy. Given the rising cost
of health care, increased disposable income, and high out-of-pocket expenses for
paying for health care, in a nation like India, the only viable method of financing
health care is through a health insurance system.

People are not aware of the claim settlement process. If the process is made
understood to the people, they will prefer Health Insurance more. As per the research
today people prefer Health Insurance over Life Insurance. The products of Health
Insurance should be advertised more as people will get aware of it and will buy it. It is
also seen that people are know to the benefits of Health Insurance. The cash less claim
facility is the most benefited one.

It is also observed that some people are still not aware about Health Insurance and its
products. Due to pandemic, it emerged as fastest booming sector. Therefore, Health
Insurance is growing at a faster pace.

42
 REFERENCE
1. Sonal Kala, Dr. Premila Jain, “Awareness of Health Insurance among people with
special reference to Rajasthan.”, International Journal of Business Quantitative
Economics and applied Management Research, Vol-1, Issue 12, 2015, pp. 21-31.
2. Indumathi K, Hajira Saba, Arun Gopi and Mangala Subramanian , “Awareness of
Health Insurance in rural population of Bangalore, India.”, International Journal
of Medical Science and Public Health, Vol-5, Issue 10,2016, pp.2162-2167.
3. Dr. Bino Joy, “Claim Settlement Mechanism of Health Insurers in India : A
critical analysis.”, International Journal of Research in Social Science, Vol-8,
Issue 4, 2018, pp.988-997
4. Dr. A.Arangasami, Mr. J. Nandakumar,”A study on customer awareness towards
Health Insurance with special reference to Chennai city.”,s Infokara Research,
Vol-8, Issue 10, 2019, pp.530-539.
5. Dr. Pranam Dhar, Goutam Sharma,”Claim Settlement Mechanism and Indian
Health Insurance sector : A critical insight.”, Research Explorer, Vol-VII, Issue
23, 2019, pp.50-54.
6. Girish Tarachand Bhavnani and Dr. Sambhaji S. Jadhav,”A study on awareness
of Health Insurance among people with special reference to Ulhasnagar
(Thane).”,Think India Journal, Vol-22, Issue 40, 2019, pp.221-225.

BIBLIOGRAPHY
https://www.insurancedekho.com/health-insurance/articles/10-benefits-of-buying-
Health-insurance-in-2021-1218
https://www.learntechlib.org/p/176727/
https://www.emerald.com/insight/content/doi/10.1108/XJM-07-2020-
0021/full/html#sec001
https://www.bankbazaar.com/insurance/star-health-insurance/claims-procedure.html

43
 ANNEXURE
Following are the questions used for the research

1. Age *

25-30

30-45

45 & above

2. Gender *

Female
Male

3. Education *

Bachelor’s degree

Master’s degree

PhD

4. Occupation *

Professional

Service Student
Home maker
Retired

5. Health Insurance is an emerging sector in Insurance Industry. *

Strongly Agree

Agree

Neutral
Disagree
Strongly Disagree
6. People are still not aware about Health Insurance in India. *

Strongly Agree

Agree

Neutral

Disagree

Strongly disagree

7. Health Insurance provide cash less claim facility. *

Strongly Agree
Agree

Neutral

Disagree

Strongly Disagree

8. Health Insurance is beneficial post pandemic. *

Strongly agree

Agree

Neutral
Disagree

Strongly disagree

9. Health Insurance ensures that undergoing long term treatment does not throw
* A family into dire financial straits.

Strongly agree

Agree

Neutral

Disagree
Strongly disagree
10. Are you aware of how the claims are processed and settlement is done in *
Health insurance?

Yes
No
Maybe

11. Are you aware about the tax benefit under Sec 80D of Income Tax Act *
1961?

Yes
No

12. Health Insurance or Life Insurance? *

Healthinsurance
Lifeinsurance