A Study on Awareness of Health Insurance Products and Claim Settlement Process

8/12/2019 A Study on Awareness of Health Insurance Products and Claim Settlement Process

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http://www.bized.co.uk

Copyright 2006 Biz/ed

University guide:Dr. M. Dharmalingam

Presented By:Md Mubarak HussainMBA (IM), 2ndYearReg. 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 Insuranceproducts and claim settlement process with

reference to the United India Insurance Company

Limited, Moradabad (UP).


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ont nt

Introduction Company Profile Scope, objectives Limitation ofstudy 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 thefinancial 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 Insuranceis 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 governments Insurance Information

Bureau, Indiashealth 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 peopleMr. Milind Kharat (CMD)


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Contd

United India Insurance Company Limited (UIIC) ( A Govt. OfIndia 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 onawareness 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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Limitations

There 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 theHealth 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 medicalexpenses 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 fornetworked 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 theTPA 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 amountdisallowed 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, finalhospital 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 Percentage

Simple Correlation

Chi Square Test


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Data Sources

The 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 DataThe 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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10

12

Graduation

Post 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 GovernmentEmployee

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%

YES

NO

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%

No18 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


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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%

0

20

40 Highly Satisfied

Satisfied

Neutral

Dissatisfied

Highly Dissatisfied


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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.

I nference: There is a significant relationship between annualpremium and sum insured.


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Correlation technique to find the correlation

between duration of the policy and selection ofUnited 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 Crosstabulation

Count

Satisfaction Level

TotalHighly

Satisfied Satisfied Neutral DissatisfiedHighly

Dissatisfied

Occupation

Govt.

Employee3 5 1 4 2 15

Corporate

Employee6 14 2 5 2 29

Self

Employee4 5 1 2 1 13

Others 1 2 1 0 1 5

Total 14 25 5 11 6 62


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Contd

H0: There is no significant relation between occupation and satisfaction level ofclaim 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) isaccepted.

I nference :There is no significant relation between occupation

and satisfaction level of the respondents.

Chi-Square Tests

Value dfAsymp. Sig. (2-

sided)

Pearson Chi-

Square5.783

a 12 .927

Likelihood

Ratio6.216 12 .905

Linear-by-

Linear

Association

.058 1 .809

N of Valid

Cases62

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 Crosstabulation

Count

Surveyor Reach

TotalWithin 3Hrs.

3 - 8 Hrs.8 - 24Hrs.

Above 24hrs.

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 10

Total 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


minimum expected count is 1.60.


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Since the P value 0.493 is greater than 0.05, the null hypothesis H0is

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

Crosstabulation

Count

Satisfaction level

TotalHighly

Satisfie

d

Satisfied Neutral Dissatisfied

Highly

Dissatisfie

d

Time

period of

Claim

Within 7

Days5 4 2 2 2 15

7 - 15 Days 7 9 3 4 2 25

15 - 30 Days 3 10 0 2 0 15Above 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 andsatisfaction level of respondents.

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-

Square16.046

a 12 .189

Likelihood Ratio 18.863 12 .092

Linear-by-Linear

Association .008 1 .927

N of Valid Cases 62


minimum expected count is .56.


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Since the P value 0.189 is greater than 0.05, the null hypothesis H0is accepted.

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

level of respondents.


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Findings

1. It is concluded that most of the respondents are aware about the healthinsurance 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 ofrespondents 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 andsatisfaction 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-lifeinsurance 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, NewDelhi 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