A STUDY ON AWARENESS OF HEALTH INSURANCE PRODUCTS AND CLAIM SETTLEMENT PROCESS WITH REFERENCE TO THE...

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http://www.bized.co.uk Copyright 2006 – Biz/ed University guide: Dr. M. Dharmalingam Presented By: Md Mubarak Hussain MBA (IM), 2 nd Year Reg. No. 12395019 Pondicherry University Karaikal Campus Company guide: Mr. P. K Saxena (Development Officer)

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Transcript of A STUDY ON AWARENESS OF HEALTH INSURANCE PRODUCTS AND CLAIM SETTLEMENT PROCESS WITH REFERENCE TO THE...

Page 1: A STUDY ON AWARENESS OF HEALTH INSURANCE PRODUCTS AND CLAIM SETTLEMENT PROCESS WITH REFERENCE TO THE UNITED INDIA INSURANCE COMPANY LIMITED

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University guide:Dr. M. Dharmalingam

Presented By:Md Mubarak HussainMBA (IM), 2nd YearReg. No. 12395019Pondicherry University

Karaikal Campus

Company guide: Mr. P. K Saxena

(Development Officer)

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TITLE OF THE PROJECT

“A study on awareness of Health Insurance products and claim settlement process” with reference to the United India Insurance Company Limited, Moradabad (UP).

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Content

• Introduction• Company Profile• Scope, objectives &

Limitation of study• Research Methodology• Data Sources• Sampling Design

• Data Collection• Data

Representation• Data Analysis• Findings• Conclusion • Suggestions • Reference

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Definition of Health Insurance

“Health Insurance is an insurance, which covers the financial loss arising out of poor health condition or due to permanent disability, which results in loss of income.”

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Health Insurance Industry-Introduction

The term Health Insurance is used to describe a form of insurance that pays for medical expenses. It is used more broadly to include insurance that covers disability or long-term nursing. In simple words, if we are covered under Health Insurance, we pay some amount of premium every year to an insurance company and if we have an accident or if we have to undergo an operation or a surgery, the insurance company will pay for the medical expenses.

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Contd… According to the government’s Insurance Information

Bureau, India’s health insurance market is growing fast. In 2010, private insurance companies had 6.8 million policies covering nearly 55 million Indians (or 4.6 percent of the population).

The Indian government also provides subsidized health coverage to 25.3 million poor families.

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Health Insurance Product

Family medicare

Senior citizen

Topup

Super topup

Gold

Platinum

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Company Profile

Type - Public

Industry - Insurance

Founded - 1938

Headquarter Chennai

Employee 17,361

Key people Mr. Milind Kharat (CMD)

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Contd… United India Insurance Company Limited (UIIC) ( A Govt. Of

India Undertaking) is the one among the 4 public General Insurance Companies of India and a leading General Insurance player. With the net worth of Rs 4,587 crores as on September 30, 2011.

United India Insurance Company Limited was incorporated as a Company on 18 February 1938.

12 Indian Insurance Companies, 4 Cooperative Insurance Societies and Indian operations of 5 Foreign Insurers, besides General Insurance operations of southern region of Life Insurance Corporation of India were merged with United India Insurance Company Limited.

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Ratings

United India Insurance Co. Ltd. has been awarded 'iAAA`

rating for its claims paying ability by ICRA (Investment Information and Credit Rating Agency) for the third successive year.

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Vision

The most preferred insurer in India with global footprint & recognition.

Trusted brand admired by all stakeholders. The best-in-class customer service provider leveraging

technology & multiple channels. The provider of a broad range of innovative products to

meet the needs of all customer segments. Great place to work with highly motivated and empowered

employees. Recognized for its contribution to the society.

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Mission

To provide Insurance protection to all. To ensure customer satisfaction. To function on sound business principles. To help minimize national waste and develop the Indian

economy.

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Management Team

Chairman cum Managing Director Mr. Milind A Kharat Director & General Manager Mr. S. Surenther Director & General Manager Mrs. Asha Nair General Manager Mr. N Tondan General Manager Mr. B. Krishnamurthy Chief Vigilance Officer Mr. Rajasekharan Deputy General Manager Mr. S.P. Nanda

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Scope, Objectives & Limitations of the Study

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Scope

The purpose of the study is to know the Survey on awareness of health insurance and claim settlement with reference to Moradabad.

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OBJECTIVE

The main objectives of the study are:-To find awareness level of health insurance for Moradabad

(UP) location. To estimate the percentage of population having health

insurance product.To study claim settlement process in the health Insurance

policy.To determine the satisfaction level of the customer regarding

Claim settlement.

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LimitationsThere were certain limitations in undertaking this research work. As it is understood that the limitations are a part of the project, they have been overshadowed by the benefits of the study.

 The survey conducted may not be considered as

comprehensive as only limited respondents could be contacted because of the time constraint.

Objectives, the purposes of the study and the questions had to be explained to the respondents and in this context their responses may be biased.

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Contd… Some of the respondents were reluctant to give their

responses.

Only limited sample size had been considered for the study and therefore, the conclusions drawn based on this may not be a reflection of the entire population.

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Claim settlement process in the Health Insurance policy

The United India Insurance Company Limited provides tow types of health claim:-

Cashless and Reimbursement

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Cashless Claim:

In the event that an insured is hospitalized in a network hospital/ nursing home, he/ she need not to pay the medical expenses up to the sum insured amount specified under the policy.

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Process of Cashless Claim Search the networked hospital, as cashless is available only for

networked hospitals. For planned hospitalisations, intimations to be sent to the TPAs in

advance with Name and address of the hospital. In case of an emergency hospitalisation, intimation to be sent to the

TPA immediately on admission. On admission, a Pre-Authorisation Request for cashless is to be sent

to the TPA by the hospital. On discharge from Hospital, pay (if any) the difference of amount

disallowed under the policy or limited by the sum insured. All documents in original to be submitted within 7 days to TPA,

after completion of Post Hospitalisation treatment.

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Reimbursement Claim

In the event that an insured is hospitalized in any hospital / nursing home (within India) and pays the treatment expenses at the time of discharge, he/she needs to file a claim with United India Insurance Company Limited for the amount due under the policy.

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Process of Reimbursement Claim Written intimation about hospitalisation to be sent to TPA

immediately, and within 24 hours of hospitalisation in the case of emergency hospitalisation.

Before leaving the hospital, Discharge Summary, Copy of investigation report and other relevant documents may be obtained from the hospital authorities. All the documents in original to be submitted to TPA / Office within 7 days from date of discharge.

Documents include claim form issued by insurer, discharge summary of hospital, doctor's certificates and prescriptions, final hospital bills, laboratory and other investigation reports and bills, pharmacy bills and all related documents.

All documents in original to be submitted within 7 days after completion of Post Hospitalisation treatment.

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RESEARCH METHODOLOGY:-• RESEARCH DESIGN:- Descriptive Research

• SAMPLING DESIGN:- Non Probability sampling in particular convenient sampling techniques is used.

• Sample size:-The sample size of the survey is 80.

• Population:-Our target population belongs to Moradabad (UP).

It covers all the groups of the society such as income, occupation, and age.

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Methods/ tools of analysis:-

Tools used for analysis are:-Charts & DiagramsSimple PercentageSimple CorrelationChi Square Test

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• Data SourcesThe main source of information for this study is based on the data collection. Data collected are both primary and secondary in nature. 

• Primary DataPrimary data have been directly collected from insured by survey method through structured questionnaire.

• Secondary Data The secondary data was collected from various websites, books,

magazines, journals and daily newspapers published and unpublished literature from the company, IRDA & III.

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ANALYSIS & INTERPRETATION

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0

20

40

60

Below 20 yr.21 - 40 Yrs.41 - 60 Yrs.Above 60 Yrs.

12

40

21

7

1. Age of the respondents

Inference: From the above graph It is shown that maximum number of respondent 40

( i.e 50%) is coming under age group of 26 - 45 years and minimum number of respondents 7 (i.e 8.7%) above age group of 60 years.

A Below 25 year 12 15%B 26 – 45 year 40 50%C 46 – 60 year 21 26.3%D Above 60 year 7 8.7%

Total 80 100%

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1012GraduationPost graduation

22.5%

23.8

41.2%

2. Educational Qualification of Respondents

Inference:From the above table and graph we can conclude that the maximum number of respondents are graduates with a percentage of 41.2 and minimum are SSC with percentage of 12.5.

A SSC 10 12.5%B HSSC 19 23.8%C Graduate 33 41.2%D Post graduate or Above 18 22.5%

Total 80 100%

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3. Occupation of Respondents

Inference:Here we can find out that more number of respondents are corporate employee (42.5%) and less no of respondents among our target population is Others (8.8%) .

A Government Employee

22 27.5%

B Corporate Employee

34 42.5%

C Self Employee 17 21.2

D Others 7 8.8%

Total 80 100%

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4. Aware about Health Insurance Plan available in the market

Inference:From the above graph it is evident most of the respondent (87.5%)

are aware about the Health insurance plan.

87.5%

12.5%YESNO

Yes 70 87.5%No 10 22.5%Total 80 100%

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5. Having Health Insurance Policy

Inference:From the above graph It is shown that most of the respondents (77.5%) have health insurance policy i.e. 62.

22.5%

77.5%

YES NO

YesT 62 77.5%

No 18 22.5%

Total 80 100

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6. Annual premium of the policy.

Inference:Table shows that most of the respondents are handling policies with a maximum premium of 5 to 10 thousand annually (45.2%) , and respondents with minimum premium <5 thousand per annum (14.5%).

A Below 5000 9 14.5%B 5001 – 10,000 28 45.2%C 10,001 – 25000 15 24.2%D Above 25,000 10 16.1%

Total 62 100%

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7. Coverage Sum Insured in Lakhs

Inference:Among our respondents we can conclude that 32.25% have sum assured 5-10 lakhs and respondents who have sum assured above ten lakhs are 14.5%.

A Below 1 Lakh 17 27.41%B 1 - 5 Lakhs 20 32.25%C 5 - 10 Lakhs 16 25.8%D Above 10 Lakhs 9 14.5%

Total 62 100%

17

20 16

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8. Satisfaction levels of the customers towards claim settlement

Inference:Table shows here that 43.3% of respondents are satisfied with claim settlement towards their health insurance policy and some 8.7 % of respondent are neither satisfied nor dissatisfied with this process.

Satisfaction level No of Respondents Percentage Highly Satisfied 15 24.2%

Satisfied 25 40.3%Neutral 5 8.1%

Dissatisfied 11 17.7%Highly Dissatisfied 6 9.7%

Total 62 100%

0102030

Series 1

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Coefficient of Correlation

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Correlation technique to find the correlation between Annual Premium and Sum Insured.

H0: There is no significant relationship between Annual premium and Sum Insured.

H1: There is a significant relationship between Annual premium and Sum Insured.

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From the above table correlation result shows that annual premium and sum insured of health insurance product are positively correlated with each other because, the correlation value is greater than 0.5.

Inference: There is a significant relationship between annual premium and sum insured.

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Correlation technique to find the correlation between duration of the policy and selection of

United India Co.H0: There is no significant relationship between duration of the policy and selection of United

India Co.H1: There is significant relationship between duration of the policy and selection of United

India Co.

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Contd…

From the above table correlation result shows that duration of the policy and selection of United India Co are negatively correlated with each other. Since the correlation value is less than 0.5, the correlation is not significant

Inference : There is no significant relationship between duration of the policy and selection of United India Co.

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CHI-SQUARE TEST

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Chi-Square Test for comparing the occupation and satisfaction level of claim settlement.

Occupation and satisfaction level CrosstabulationCount

Satisfaction LevelTotalHighly

Satisfied Satisfied Neutral Dissatisfied Highly Dissatisfied

Occupation

Govt. Employee 3 5 1 4 2 15

Corporate Employee 6 14 2 5 2 29

Self Employee 4 5 1 2 1 13

Others 1 2 1 0 1 5Total 14 25 5 11 6 62

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Contd…H0: There is no significant relation between occupation and satisfaction level of

claim settlement of the respondents.

H1: There is a significant relation between occupation and satisfaction claim settlement of of the respondents.

20

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Since the P value 0.927 is greater than 0.05, the null hypothesis (H0) is accepted.

Inference : There is no significant relation between occupation and satisfaction level of the respondents.

Chi-Square Tests

  Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 5.783a 12 .927

Likelihood Ratio 6.216 12 .905

Linear-by-Linear

Association.058 1 .809

N of Valid Cases 62    

a. 15 cells (75.0%) have expected count less than 5. The minimum expected count is .40.

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Chi-Square Test for comparing the Annual Premium and surveyor reach.

Annual Premium * How soon reach the surveyor CrosstabulationCount

 Surveyor Reach

TotalWithin 3 Hrs. 3 - 8 Hrs. 8 - 24

Hrs.Above 24

hrs.

Annual Premium

Below 5000 1 2 3 3 9

5000 - 10,000 6 8 7 7 28

10,000 - 25,000 6 5 4 0 15

Above 25,000 3 2 4 1 10Total 16 17 18 11 62

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H0: There is no significant relation between Annual Premium and surveyor reach.H1: There is a significant relation between Annual Premium and surveyor reach.

Chi-Square Tests  Value df Asymp. Sig. (2-

sided)

Pearson Chi-Square 8.416a 9 .493

Likelihood Ratio 10.813 9 .289

Linear-by-Linear Association 3.307 1 .069

N of Valid Cases 62    a. 13 cells (81.2%) have expected count less than 5. The

minimum expected count is 1.60.

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Since the P value 0.493 is greater than 0.05, the null hypothesis H0 is accepted.

Inference:Hence, There is no significant relation between the annual

premium and surveyor reach.

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Chi-Square Test for comparing the time period of claim settlement and satisfaction level of the respondent.

Claim being settled * Satisfaction level towards claim settlement

CrosstabulationCount

 

Satisfaction level

TotalHighly Satisfie

dSatisfied Neutral Dissatisfie

d

Highly Dissatisfie

d

Time period of

Claim

Within 7 Days 5 4 2 2 2 15

7 - 15 Days 7 9 3 4 2 2515 - 30 Days 3 10 0 2 0 15

Above 30 Days 0 2 0 3 2 7

Total 15 25 5 11 6 62

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H0: There is no significant relation between time period of claim and satisfaction level of respondents.H1: There is a significant relation between time period of claim and satisfaction level of respondents.

Chi-Square Tests  Value df Asymp. Sig. (2-

sided)Pearson Chi-

Square 16.046a 12 .189

Likelihood Ratio 18.863 12 .092Linear-by-Linear

Association .008 1 .927

N of Valid Cases 62    a. 16 cells (80.0%) have expected count less than 5. The

minimum expected count is .56.

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Since the P value 0.189 is greater than 0.05, the null hypothesis H0 is accepted.

Inference: There is no significant relation between time period of claim and satisfaction level of respondents.

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Findings1. It is concluded that most of the respondents are aware about the health

insurance plans.2. It is founded that almost all the respondents are satisfied towards claim

settlement.3. The major findings of the study is that the maximum number of

respondents are Graduates while the minimum number of respondents are SSC.

4. It is observed that most of the respondents are handling policies with a maximum premium of Rs. 5001- 10,000.

5. It observed most of the respondents have health insurance policy.6. Among our respondents we can conclude that most of them have sum

assured 5-10 lakhs and less number of respondents have sum assured above 10 lakhs.

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Contd…7. There is a significant relationship between annual premium and sum

insured.8. There is no significant relationship between duration of the policy

and selection of United India Co.9. There is no significant relation between occupation and

satisfaction level of the respondents.10. 10. There is no significant relation between the annual premium and

surveyor reach.11. There is no significant relation between time period of claim and

satisfaction level.

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Conclusion:- The study has been able to accomplish its objectives, by thoroughly

analyzing and identifying the awareness of the customers of United India Insurance Company Limited strengths and weaknesses of health policy among the clients of United India Insurance company and to identify claim settlement process of health policies.

The outcome of the study has proved that the performance of the company is outstanding in making awareness about health insurance plan in the non-life insurance segment and that the company has a higher reputation among customers and company have great awareness among respondents. We can also conclude that respondents of the study are satisfied with Company products and services.

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Contd… It is also concluded that the company could initiate various steps based

on the suggestions. The company by adopting some of the recommendations, if not all, can further improve its performance and occupy a leading position among other competitors in the non-life insurance market in future years. 

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Suggestions The company should conduct an effective research for making more and

more awareness about its products among potential customers by means of advertisements and efficient insurance agents, which in turn will help in increasing its customers.

Company may motivate all the agents and intermediaries to suggest the policy according to individual requirement.

Company has to do new process and strategies to create a product with less expensive and which gives more coverage.

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Managerial Implications: The outcome of the present research is useful for the decision makers in

the company to understand the satisfaction level and accordingly they can formulate their strategies for promoting their business.

This research results will enable the marketing personal to explore the ways to satisfy the existing customers and consequently, to attract new customers with the motive of financial inclusion.

Further, the research outcome will be very useful to the general insurance business involved in them to know the existing customers and new customers expecting from the company.

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Reference BOOKS: IC-27 (Health insurance), Insurance Institute of India: Mumbai. Kothari. C.R. Research Methodology, New Age International Publishers, New

Delhi 2004 WEBSITES: www.uiic.co.in

www.irdaindia.org www.economywatch.com/insurance/general-insurance MAGAZINES AND JOURNALS Outlook Money. IRDA Journal. Insurance watch Insurance world