CHAPTER 1

INTRODUCTION

INSURANCE

Health insurance may be the most important type of insurance you can own. Without proper

health insurance, an illness or accident can wipe you out financially and put you and your

family in debt for years. So what is health insurance and how does it work?

Health insurance is a type of insurance that pays for medical expenses in exchange for

premiums. The way it works is that you pay your monthly or annual premium and the

insurance policy contracts healthcare providers and hospitals to provide benefits to its

members at a discounted rate. This is how hospitals and healthcare providers get listed in

your insurance provider booklet. They have agreed to provide you with healthcare at the

specified cost. These costs include medical exams, drugs and treatments referred to as

"covered services" in your insurance policy.

As with any type of insurance, there are exclusions and limitations. To know what these are,

you have to read your policy to find out what is covered and what is not. If you elect to have

a medical procedure done that is not covered by your insurance, you will have to pay for that

service out of pocket. The range of coverage for expenses varies depending on the type of

plan, as will the restrictions. You can purchase the insurance directly from the insurance

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company through an agent or through an independent broker but most people get their

insurance coverage through employer-sponsored programs.

Additional Costs

Aside from premiums, there are other costs associated with your health insurance coverage.

Let's explore what these are and how you would calculate them.

Premiums: This is the amount that you pay for coverage.

Deductible: The amount that you pay out of pocket. Like any other type of insurance,

the deductible can range in amount depending on how much you would like to pay out of

pocket. Generally, the higher the deductible, the lower the premiums.

Co-insurance: The percentage of covered expenses paid by the medical plan. The co-

insurance amount is per family per calendar year. For example, in a co-insurance

arrangement, there can be an 80/20 split between the insured and the insurance carrier in

which the insured pays 20% of the cost of care up to the deductible, but below the out-of-

pocket limit set forth by the policy. This is typically associated with coverage provided by a

PPO.

Co-payment: Sometimes referred to "co-pay", this is a set cap amount that you will pay each

time you receive medical services. This is typically associated with coverage through an

HMO (which will also be discussed a little later). For example, every time you visit your

doctor, you may have to pay $20 as a co-payment. These payments usually do not contribute

toward out-of-pocket policy maximums. The co-payment and the coinsurance are not one in

the same.

Stop-Loss Limit: The cumulative dollar amount of covered expenses in excess of the

deductible after which the coinsurance payment stops and the insurer pays 100% of covered

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expenses. The purpose of to the stop-loss limit is to limit the out-of-pocket costs for the

insured individual. The "out-of-pocket max" is the maximum out-of-pocket expense you will

incur before your insurance carrier pays 100% of covered services. At this point, all you will

have to pay is your premiums.

What's important to remember for out-of-pocket expenses is that not all expenses go toward

meeting the out-of-pocket max. Co-payments and premiums do not apply to the out-of-pocket

expense maximum. Your deductible and coinsurance do apply toward this amount. It's worth

noting that this may not be a standard feature with every policy.

CONCEPT OF CUSTOMER SATISFACTION

Customer satisfaction is a measure of how products and services supplied by a company meet

or surpass customer expectation. In a competitive marketplace where businesses compete for

customers, customer satisfaction is seen as a key differentiator and increasingly has become a

key element of business strategy. The concept of consumer satisfaction occupies a central

position in marketing thought and practice. Satisfaction is a major outcome of marketing

activity and serves to link processes culminating in purchase and consumption with post

purchase phenomena such as attitude change, repeat purchase, and brand loyalty. Reichheld

and Sasser (1990) found that when a company retains just 5 percent more of its customers,

profits increase by 25 percent to 125 percent (Bowen and Chen, 2001). The centrality of the

concept is reflected by its inclusion in the marketing concept that profits are generated

through the satisfaction of consumer needs and wants. The need to translate the philosophical

statement of the marketing concept into pragmatic operational guidelines has directed

attention to the development and measurement of consumer satisfaction. In the early 1970s,

consumer satisfaction began to emerge as a legitimate field of inquiry. Satisfaction is a major

outcome of marketing activity and serves to link processes culminating in purchase and

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consumption with post purchase phenomena such as attitude change, repeat purchase, and

brand loyalty. It can broadly be characterised as a post purchase evaluation of product quality

given pre purchase expectations (Kotler, 2003).

To encourage actions, which will lead to an optimal level of satisfaction, it is necessary to

understand the link between the antecedents of satisfaction and satisfaction's behavioral and

economic consequences. The vast majority of studies hold that satisfaction is related to the

size and direction of the disconfirmation experience, where disconfirmation is related to the

person's initial expectations. More specifically, an individual's expectations are: confirmed

when a product performs as expected; negatively disconfirmed when the product performs

more poorly than expected; and positively disconfirmed when the product performs better

than expected. Dissatisfaction results when a customer's expectations are negatively

disconfirmed. The full disconfirmation paradigm encompasses four constructs: expectations,

performance, disconfirmation, and satisfaction. First, buyers form expectations of the specific

product or service prior to purchase. Second, consumption reveals a perceived quality level,

which is influenced by expectations if the difference between actual quality and expectations

is perceived as being small. Hence, perceived quality may increase or decrease directly with

expectations as indicated by the arrow drawn from expectations to perceived quality in Figure

l. Third, perceived quality may either confirm or disconfirm pre purchase expectations. The

determination of the extent to which perceived quality expectations are disconfirmed is

depicted by arrows drawn from expectations and perceived quality to disconfirmation.

Fourth, as shown by the arrows in, satisfaction is positively affected by expectations and the

perceived level of disconfirmation. Expectations provide a baseline or anchor for level of

satisfaction. If disconfirmation is perceived to have occurred, then customer satisfaction

increases or decreases from this baseline level. Expectations are expected to have a direct

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positive effect on perceived quality. However, expectations affect satisfaction only via

perceived quality and disconfirmation.

CONCEPT OF CUSTOMER SATISFACTION IN HEALTH INSURANCE

Insurance is not a commodity. It is a promise to perform in future in return for a present

monetary consideration. Such a promise is made in an environment when the customer is

absolutely not sure whether the promise will be fulfilled if and when the need arises. But

then, if and when the need comes, it is already late for him to evaluate the customer service

standards in the insurer. Yet another unique feature of the industry is the peculiar rules of the

game such as uberrimae fidei (utmost good faith), indemnity etc, which underwriters are

more aware of than the customers. Insurance being an intangible product, the 'technical

quality of the service' depends upon its reliability.

Over the last few years, developments in the insurance sector have resulted in a paradigm

shift in the way the business is conducted. In a free market scenario, the customer has a

choice from whom to buy. He exercises this choice based on perceptions formed through his

experiences. Customer servicing today has become the focal point of insurance companies. It

is an area where the new companies are clearly ramping up by bringing in their best practices

and operational efficiencies by appropriate use of technology. There is a greater sensitivity in

dealing with the customers. However, a lot needs to be done. Insurers need to fast gear up to

the situation and the real response and turn-around time in delivery of services needs to be

reduced in specific areas like delivery of first policy receipt, policy documents, premium

notice, maturity payments, death claims etc.

There is absolutely no exaggeration in mentioning that the amount of customer grievances in

the insurance domain has gone up steeply. Grievances arise where there is a certain level of

expectation by a customer and the reality does not match up to it. This could be in terms of

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response time or quantum or the lack of response itself. It is time that insurers took stock of

the situation and wherever there is need for plugging the loopholes, attend to that without any

further loss of time. Instead of looking for reasons to explain the emergence of customer

related problems, it would be more desirable to ensure that there is a fall in their number.

Redressal of customers' grievances is just a reactive way of insurers providing the minimum

expected customer service. The need of the hour is a more proactive approach aimed at

seeking what additional elements would delight the customer more and more.

The shots for market changes would be called by the consumers and no longer by the

insurers. Competition has enabled more choices of services and products to consumers; and

excellence in perceived service by insurers is seen as a differentiator, instead of price; as the

real value of the product. Customers want the best of all the worlds; price reductions, wider

product coverage and excellent claims settlement. Once that is available, customers would

ask, what next? That is the trend seen in all other sectors. Price reduction is a one-time

exercise. After collecting a large number of customers, how does one retain them? The

obvious question to ask is: how many customers are happy? How would insurers deal with

the changing loyalties of consumers, who only think of their interests to the exclusion of

those of the insurers, annually seeking more value to be delivered at lower costs? Sentiment

to crush competition at any cost should not be the sole marketing guide; but excellence in

execution of assurances given to consumers and internal cost cutting should be the goals to

pursue for insurers to become more competitive. Insurers should know that in a competitive

scenario, there would be only one winner to emerge out of the market scene. And that is the

'customer'--the powerful change agent of the market that would call the shots to shape the

future of the insurance market.

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 CHAPTER 2

HEALTH INSURANCE IN INDIA

Health insurance can be defined as insurance against the future medical expenditure of a

person. This means that when someone takes a health insurance plan he or she expects a

certain amount of medical expense to be there in future and that individual is paying for that

in the present in the form of premium. The main aim of a health insurance plan is to make

sure that people have enough money to take care of their emergency medical requirements

when they get old.

However, a health insurance policy does not always cover every possible health problem

someone might encounter in the future. There are certain terms and conditions agreed to by

the insured (person who is taking the plan), and the insurer (entity that is providing the plan)

and the entire procedure happens according to what has been agreed to in the contract.

Appropriate time to take health insurance:

According to experts the best time to avail a health insurance plan is when the insured is still

in a good physical condition. The normal logic among young people is that since they are

rarely afflicted by physical ailments they do not need such a plan.

In reality people can fall prey to a disease or other physical problem at any time - nobody can

be absolutely sure of a life fully free of such issues. Normally as someone gets older the

problems increase and the possibilities of some major disease are always there.

A problem with trying to get a medical insurance during old age is that since there are more

chances of a medical condition the premium is often high or the insurer is not ready to cover

the individual in question.

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 TYPES OF HEALTH INSURANCE

In India there are two major types of health insurance plans - critical illness insurance and

medical insurance.

Medical insurance: this form of insurance provides hospitalization cover and pays back

medical costs that have been there for paying for diseases or surgery when the insured was

admitted in a healthcare facility.

Following are the various forms of medical insurance:

Individual medical insurance

Overseas medical insurance
Group medical insurance

There are certain health policies which pay back the actual expenses of hospitalization for all

diseases - these programs are primarily offered by non-life insurance providers and are

normally referred to as Mediclaim policies. The other health insurance policies are available

from both non-life and life insurers.

The accidental insurance policies insure a person against the risk of any form of accident.

There are certain health insurance providers such as Apollo Munich who provide medical

accident insurance facilities as well. Besides, there are several other insurance providers that

have accidental insurance policies:

Royal Sundaram
HDFC Ergo
ICICI Lombard

Critical illness insurance: this type of health insurance provides cover against the threat of

major ailments. With this program, the insured can be sure that he or she will be receiving a

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pre-determined amount in case the individual is diagnosed with a critical illness that is part of

the initial agreement.

With these plans, the payment is done within a few days of the diagnosis and once the

payment is done the policy is no longer in operation. Under normal circumstances these plans

cover the following:

Aorta graft surgery

Significant organ transplant
Cancer
Multiple sclerosis
Coronary artery bypass surgery
Paralysis
First heart attack
Primary pulmonary arterial hypertension
Kidney failure
Stroke

Ways to file health insurance claims

The following documents are needed in order to register the claims for a health insurance

policy:

Properly filled and signed claim form

Reports and receipts of diagnostic tests accompanied by doctor's notes
Discharge certificate of the hospital
Receipts and bills from consultants, anaesthetists, or specialists with diagnosis

certificate
Illness related documents right from the day it was detected - this includes

consultations with the physician and the insured's medical history and reports
Surgeon or doctor's certificate that states the complete recovery of the insured
Bills, cash memos, and receipts from the healthcare facility - this needs to be backed

up with proper prescriptions

Providing previous policies' details to the third party administrator - accidents are

regarded as exceptions

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If the hospitalization is planned the following procedures need to be followed:

Getting in touch with the 3rd party administrator for the particular policy and providing them

the information about hospitalization Making sure that the healthcare facility is in the

network - even if the hospital or nursing home is not in the network the money will be

provided Verification of coverage terms Contacting the TPA (third party administrator)

regarding the availability of cash less facility.

If the hospitalization is not planned the processes mentioned below have to be adhered

to:

The TPA has to be informed as early as possible and the claim form has to be

collected and filled up properly.

The claim form along with necessary documents has to be submitted within 7 days of

the insured's recovery.

Procure all the treatment related documents from the hospital once treatment is

completed.
Bills have to be paid by the insured initially - the insurance company will only

reimburse them.
The policy document has to be read properly to understand which expenses are

included.

There is a possibility that the claimant may be rejected if the disease is not covered by the

plan. In such circumstances the claimant needs to send a letter to the organization within 15

days to file a complaint.

If the payment is incomplete the claimant needs to contact the TPA and find out the reasons

for the same. In majority of such cases it has been seen that if additional papers are provided

the remainder of the claim is settled.

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 HEALTH INSURANCE GUIDELINES & REGULATIONS

Health insurance business in India has, traditionally, been regulated by the framework

governing general insurance business as issued by the Insurance Regulatory and

Development Authority of India (IRDAI) from time to time. However, due to a series of

developments, a need was felt for creating a specific framework for the development and

operation of health insurance products. In 2013, the IRDAI issued the IRDA (Health

Insurance) Regulations 2013 (Health Regulations 2013) along with the Guidelines on

Standardization in Health Insurance of 20th February 2013 (Standardization Guidelines 2013)

which set out the procedures and requirements for filing health insurance products and certain

follow through operational requirements.

Recently, following a number of representations made by various stakeholders (including

Insurers) on a multitude of issues as well as to update the existing framework, the IRDAI, by

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way of a notification of 18th July 2016, issued the IRDAI (Health Insurance) Regulations

2016 (Health Regulations 2016) replacing the Health Regulations 2013. The IRDAI also

replaced the Standardization Guidelines 2013 with the Guidelines on Standardization in

Health Insurance of 29th July 2016 (Standardization Guidelines 2016) and the Guidelines on

Product Filing in Health Insurance Business of 29th July 2016 (Product Filing Guidelines).

Some of the key features of the Health Regulations 2016 include the following:

Pilot Products: The Health Regulations 2016 have introduced the concept of "Pilot

Products" aimed at encouraging innovation in the design of products for covering

risks that have not been offered before. Pilot Products may be offered by General

Insurers and Health Insurers for a policy tenure of one year, but not exceeding five

years. Further, the sales and publicity material of such products are required to

provide certain specific disclosures as set out under the Health Regulations 2016.

Wellness and Preventive Aspects of Health Insurance Policies: The Health

Regulations 2016 have introduced norms aimed at encouraging the inclusion of

"Wellness and Preventive" aspects as part of the product design. Insurers may now

promote wellness amongst health insurance policyholders by offering them health

specific services which are to be provided only by their network providers, such as,

outpatient consultations or treatment, pharmaceuticals, and health check-ups.

Moreover, Insurers are prohibited from offering discounts on products of third parties

either as part of the policy or otherwise.

Restrictions on Life Insurers offering Health Insurance Policies: Life Insurers are

prohibited from offering indemnity based health insurance products either as an

individual or a group policies. Consequently, all such existing indemnity based

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 products offered by Life Insurers are now required to be withdrawn in accordance

with the prescribed procedure.

Group Health Insurance Policies: Per the Health Regulations 2016, Insurers can

offer group health insurance products for a term of one year except credit linked

products where the term can be extended up to the loan period which shall not be

more than five years. Moreover, these regulations mandate that the minimum size of

the group shall be 7.

Key features of the Standardization Guidelines 2016

The Standardization Guidelines 2016 set out the revised set of standard definitions of

terminology and standard nomenclature and procedure for critical illnesses which are

required to be used in health insurance policies. These guidelines also prescribe the standards

and benchmarks required to be met by network providers or hospitals. In addition, the

Standardization Guidelines 2016 also set out the various health insurance returns required to

be submitted by Insurers in a periodic manner.

Key features of the Product Filing Guidelines

The Product Filing Guidelines set out the procedure and the requisite forms for filing

various types of health insurance products, such as, new health insurance products,

Pilot Products, Health Package Products and Non-Life Package Products under the

File & Use Procedure. The provision for submitting a lawyer's certificate while filing

such products with the IRDAI has now been omitted.

The Product Filing Guidelines also mandate setting up of a "Product Management

Committee" (PMC) by General Insurers and Health Insurers. The PMC is, among

other functions, required to carry out a due diligence process and record its

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 concurrence on various product related risks for all product filings under File & Use

before any application for a product is sent to the IRDAI for approval.

A significant change brought about by the Product Filing Guidelines is the

introduction of the Use & File procedure for group health insurance products. Per this

procedure, a group product may be launched without the prior approval of the IRDAI

subject to the following stipulations:

o The product must be approved by the PMC;

o The Insurer shall obtain a Unique Identification Number for every insurance

product from the IRDAI by duly informing them of the name of the product

proposed to be launched; and

o The product shall be filed with the IRDAI within seven days from the date of

approval by the PMC in the prescribed form.

Life Insurers are not permitted to file group health insurance products under the Use

& File Procedure and are required to follow the procedure of File & Use as prescribed

under the Product Filing Guidelines for these products.

In addition, the Product Filing Guidelines provide detailed guidance on Wellness

Features and Benefits that an Insurer may offer in a health insurance product. The

Product Filing Guidelines also provide an extensive procedure for the withdrawal of

products.

The revised regulatory framework governing health insurance products seeks to bring greater

accountability internally within Insurers to the extent that the PMC of an Insurer is required

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to ensure that the products proposed to be launched in the market are in compliance with

applicable laws and regulations. Further, there is an apparent encouragement to bring

innovation in the product design and promote wellness through allowing pilot products and

wellness features as part of health insurance products.

The content of this article is intended to provide a general guide to the subject matter.

Specialist advice should be sought about your specific circumstances.

BENEFITS OF HEALTH INSURANCE POLICY

The major advantages of a health insurance policy may be enumerated as below:

Assists in securing the future through premiums

Payment for medical and hospitalization bills
Saves lot of future financial losses due to costly medical and post treatment expenses
Custodial and disability bills
Heightened sense of security
Tax benefits as per Indian Income Tax Act's Section 80D
Greater financial security
These policies can even be availed after crossing 60 years

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 HOW TO CHOOSE A HEALTH INSURANCE POLICY

There are different ways to judge the viability of an insurance policy but the most basic

ones may be mentioned below:

Comparison of features and prices before availing a policy is essential. Aggregator

sites can be used for this purpose.

In case of brokers it is advisable to get their license numbers and verify the details

from the IRDA website. Since the brokers operate independently they will offer the

best advice instead of preferring a particular company as is done by the agents.

In case of families it is better to avail a family floater policy, which is less costly and

provides better coverage for every family member. It also enables a family member to

use any part of the policy - this facility comes in handy as the instances of an entire

family falling sick are rare.

It is better to provide complete and true information in the declaration form. This will

ensure proper payment of claims thorough comparison of policy terms - brokers

normally provide the best suggestions in this regard.

It is better to eat healthy and work out consistently. Smoking and drinking should be

avoided totally as well. These will make sure that the premium comes down in time.
It is better to avoid a policy that has cashless arrangements with a nearby hospital or

nursing home. It is advisable to go for a policy that provides adequate fulfilment of

requirements.
If an insured has a disease already it is better to take utmost care and not think about

the insurance while deciding on lifestyle and habits. This will be beneficial in the long

term.
Do detailed research on the hospitals covered by a particular plan and determine their

respective areas of specialty. This will help in taking quick decisions at times of

emergency.

PARAMETERS OF A GOOD MEDICAL INSURANCE POLICY

A health insurance policy should have the following criteria to be regarded as a viable option:

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 Should pay for fees of hospital rooms, surgeons, and doctors.
Should provide basic protection.
Should pay for medicines, medical tests, and relevant expenses.
There should be extra options that can be availed later on as per the needs of the

insured.
The specific health plans should include crucial ailments like kidney failure and heart

attack or cancer and diabetes.

The critical illness plans should provide tax benefits.

Health Insurance Premium

Following are the factors that are considered significant in determining a health

insurance policy's premium:

Age - the older the insured, the higher the premium.

Policy terms - if the term period is higher the premium will come down.
Earlier medical history - if the insured does not have a disease already premium will

be lower.
Claim free years - the more claim free years a person has the lower the premium will

be.
Work atmosphere of insured - pilots and miners need to pay more than teachers or

clerks. The logic is that in occupations perceived as more hazardous there are greater

chances that the insured will encounter health problems.

Coinsurance: As per this arrangement, a certain percentage of insurance will be paid by the

company. This has a direct effect on the premium.

Copay: This benefit is provided in case of individual health insurance plans. Hereby,

insurance providers share the medical expenses like fees for doctor and medicine charges.

Company Top Policies

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Star Health and Allied Insurance Company Limited Senior Citizen Red Carpet
Star Family Health Optima

Bajaj Allianz General Insurance Health Guard

Max Bupa Health Insurance Heart Beat Gold
Heart Beat Platinum
Heart Beat Silver

Oriental Insurance Happy Family Floater

Apollo Munich Easy Health Gold
Easy Health Exclusive
Easy Health Standard
Easy Health Premium

United India Insurance Family Medicare

Reliance Health Insurance Health Wise Family Floater
New India Assurance Mediclaim Policy
ICICI Lombard Health Advantage
National Assurance Varishta Mediclaim

Insurance Companies in India:

Aviva Life Insurance Agriculture Insurance Company of India Ltd

Bajaj Allianz Life Insurance
Birla Sun Life Insurance
HDFC Standard Life Insurance
ING Vysya Life Insurance
Life Insurance Corporation of India
Max Life Insurance Company
MetLife Insurance Company
Reliance Life Insurance
Sahara India Life Insurance
SBI Life Insurance
Tata AIG Insurance Company Limited
Om Kotak Mahindra Insurance Company
Amsure Insurance
ANZ Insurance
Cholamandalam General Insurance
Employees State Insurance Corporation
ICICI Lombard General Insurance
IFFCO-Tokio General Insurance
National Insurance Company Ltd
Oriental Insurance Company Ltd
Peerless Smart Financial Solution
Royal Sundaram Alliance Insurance India
Tata AIG Insurance Company Ltd
Export Credit Guarantee Corporation of India Ltd

CHAPTER 3

REVIEW OF LITERATURE

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The review of the literature is divided under two heads i.e. Insurance and customer

satisfaction.

INSURANCE:

The insurance and the economic growth of the country mutually influence each other. As the

economy grows, the standard of living of people improves and demand for insurance

products emerges. A well-developed insurance market promotes economic growth by

encouraging risk taking.

1) Pfeffer (1965) in this study makes an effort to measure the profit potential of the new

life insurance companies. The five types of strategies available to new companies are:

grandfather strategy; hit and run; captive; brokerage; and traditional strategy. Although

the evaluation of profit potential in case of new companies is practically impossible due

to various reasons such as paucity of useful published data about the actual

performance, it is concluded that out of many entrants, only a few are capable of doing

business in the long run.

2) Peterson et al (1972) study the effect of marketing innovations in life insurance sector.

The results show that flow of innovation is a two-step flow i.e. it flows from innovator

firms to large firms in the industry and then to others. The relative advantage of

innovating firms is short lived when the offering in unprotectable. Therefore future

research on diffusion of competitive innovation among sellers must consider industry

characteristics such as "ability to protect innovations."

3) Meidan (1982) presents different marketing strategies for insurers, suggesting that the

selection of an appropriate strategy should be based on the internal conditions and

external forces facing the firm. The two broad categories of insurance marketing

strategies exist: growth strategies; and competitive marketing strategies. Due attention

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 should be given to the marketing organisational structure and its departmental

responsibilities.

4) Rajesham and Rajender (2006) also discuss the changing scenario of the Indian

insurance sector. They point out the challenges in the present scenario as increasing

India's share in the global insurance market, having qualified, skilled actuaries,

penetration in rural markets, developing customised policy for clients etc.

5) Selecting the type of life insurance policy is a very complex decision. In this paper,

Rajagopalan (2006) does a comparative evaluation of the traditional insurance policies

available in the Indian market from a consumer perspective. He suggests that, it is

better for an individual to buy the cheapest term insurance for the required amount of

death protection and term. In case of endowment policy, instead of buying non-

participating endowment policy, it is better to invest the extra premium in a PPF accoun

CUSTOMER SATISFACTION:

1) Customer satisfaction is an evaluation of difference between prior expectations about

product and its actual performance. Customer satisfaction is how customers react

towards the state of satisfaction, and how customers judge the satisfaction level (Hanif,

Hafez & Riaz, 2010).

2) Customer satisfaction is the perceived feeling of a customer for which he or she has set

standards if his expectations match with the standard he is satisfied (Eggert & Ulaga,

2002).

3) There is a significant effect of customer satisfaction on the performance of business and

through customer satisfaction returns of shareholders can be increased and value of any

business can be maximized (Osullivan, Mccalling, 2010).

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 4) Customer satisfaction with offices is resolved by specialized execution, as well as by a

many-sided set of trade procedures, for example, compelling correspondence and

administration of desires. (Campbell&Finch, 2004).

5) Customer satisfaction with offices is resolved not just by specialized execution;

additionally by a multifaceted set of trade methodologies, for example, powerful

correspondence and administration of desires. (Campbell&Finch, 2004).

CHAPTER 4

RESEARCH METHODOLOGY

OBJECTIVES OF THE STUDY

To identify the insurance needs of the Indian population with respect to their emotional, physical and

financial conditions.
Comparative study of various health insurance players in the market.
To study the satisfaction level of customers in health insurance.

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 STATEMENT OF PROBLEM
The study is confined with health insurance in terms of customer satisfaction. The

study has been undertaken on the basis of sample survey.

HYPOTHESIS
Alternative Hypothesis: Customer satisfaction in health insurance is dependent on

age, health and income of the individual.

Null Hypothesis: Customer satisfaction in health insurance is not dependent on age,

health and income of the individual.

LIMITATIONS OF STUDY
I have observed the following limitations in the course of my study:
The areas which were selected were limited only to Mumbai (India) i.e., the

findings are regional.

The study is conducted of academic nature
The sample size collected is 30 individuals.
This project is done with the help of primary as well as secondary data with limited

period of time.

CHAPTER 5

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 DATA ANALYSIS

1) Do you have any health insurance policy?

Parameters No. of count Percent

Yes 19 63%
No 11 27%
Total 30 100%
Analysis:-

63% Respondents having Health Insurance policy. 27% Respondents dont have

Health Insurance policy. Because lack of awareness about Health Insurance.

2) If yes which companies do you avail?

Parameters No. of count Percent

ICICI Lombard 10 34%
Bajaj Alliance 6 20%
Star Allied 4 13%
New India Assurance 4 13%
Others 6 20%
Total 30 100%

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 Insurance Company

ICICI Lombard
Bajaj Alliance
Star Allied
New India Assurance
Others

Analysis:-

Indias largest Pvt. Sectors Bank, which is also in Health insurance, ICICI Lombard is one

of the best health insurance company. The company offer attractive products as per

expectations of the customers .Although the premium amount is high but customers still opt

this companies Insurance product. It has created as his own brand image. only because of

quality services.

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3) How did you get this policy?

Parameters No. of count Percent

Employer Provides 5 17%
Own Purchase 17 56%
Family Provides 8 27%
Total 30 100%

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 Source of policy

Employer Provides
Own Purchase
Family Provides

Analysis:

The Analysis shows that 56% respondents purchased own Health Insurance .Single premium

provide lots of extra lifetime facility, as compare to family floater plan customer will get

maximum sum assured. Very few companies are provide health insurance for their employee.

4) At what age did you avail this policy?

Parameters No. of count Percent

Before 18 yrs 9 30%
18-30 yrs 11 37%
31-50 yrs 7 23%
After 50 yrs 3 10%
Total 30 100%

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 Age

Before 18 yrs
18-30 yrs
31-50yrs
After 50yrs

Analysis:

As the data says 37% people gets insured after 18 mostly after getting employed, and also

30% people gets health insured before 18 since premium will be less. After the age of 50

there are very less people who does health insurance.

5) How much premium do you pay annually?

Parameters No. of count Percent

1000-5000 9 30%
5001-10000 11 37%
10001-15000 7 23%
Above 15000 3 10%
Total 30 100%

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 Annual Premium

1000-5000
5001-10000
10001-15000
Above 15000

Analysis:

Most of the respondents having insurance policy between the range of 1000-15000 ,Insurance

companies offered insurance policy as per the age of the customer but one most important

thing researcher found that as the premium amount is increase automatically customer will

get better coverage and benefit but some middleclass and lower-class customers not able to

pay more amount for premium.

6) Why did you purchase this health insurance plan?

Parameters No. of count Percent

Health expense recover 13 44%
Tax benefits 7 23%
Recover future uncertainty 10 33%
Total 30 100%

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 Reason for purchase

Health expense recover

Tax benefits
Recover future uncertainty

Analysis:

The main concern of any insurer by purchasing any Health Insurance is to cover their Health

expenses ,the number of diseases increases day by day and peoples are paying high amount

for that so to recover that expense people preferred Health Insurance. and most of the

customers purchase health plan for the tax benefit and recover the future uncertainty.

7) How Well Do You Think, You Are Covered By Your Current Health Insurance Policy?

Parameters No. of count Percent

Definitely well-covered
Probably well-covered
Not well-covered
Probably not well-covered
Total
9 30%
8 26%
8 27%
5 17%
30 100%

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 Coverage under health insurance policy

Probably well-covered
Not well-covered
Probably not well-covered

Analysis:

27% respondents says that their health insurance plan not well covered and probably not well

covered the percentage is quite high. people should understand their health insurance plans

before buying to avoid these confusions.

8) Are you clear with the Terms of policy provided by your agent?

Parameters No. of count Percent

Yes 11 37%
No 6 20%
Maybe 13 43%
Total 30 100%

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 Clarity with terms of policy

Yes
No
Maybe

Analysis:

Almost 43% individuals are not clear about their policy terms. Before getting a policy a

person should always know its terms and Agent should also clarify the terms clearly.

9) At what point do you find difficulty in the policy?

Parameters No. of count Percent

After sale service 8 27%
Incomplete assistance by agent 5 17%
Non issuance of policy renewal notice 10 33%
Others 7 23%
Total 30 100%

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 Point of difficulty

After sale service

Incomplete assistance by
agent
Non issuance of policy
renewal notice
Others

Analysis:

During the survey the mostly finded redressal is about policy renewal and after sale service,

so the insurance companies Gould always concentrate on this part to satisfy the customers

and provide better service.

10) What are the reasons you dont have any health insurance?

Parameters No. of count Percent

Its too expensive 8 27%
Insurance is not important, no 2 6%

reason to get it
I Do Not Have Trust On 5 17%

Insurance Companies
Employer Sponsored Cover Is 9 30%

Sufficient For Me
All of them 6 20%

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 Total 30 100%

Reasons for not having health insurance

Its too expensive

Insurance is not important,
no reason to get it
I Do Not Have Trust On
Insurance Companies
Employer Sponsored
Cover Is Sufficient For Me
All of them

Analysis:

Respondents think health insurance is too expensive high premium and other problems have

resulted in a very complicated and perhaps unsustainable health insurance system.

Respondents says that the concept of insurance is very hard and confusing to understand

because of that insurance agents mislead people and not provide them actual hidden charges.

And nowadays many companies provide health coverage to their employees.

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 CHAPTER 6

FINDINGS, SUGGESTIONS & CONCLUSION

FINDINGS & SUGGESTIONS

Today everyone believes investment in Health Insurance it is vital for the future.
Despite the high growth, the business is a huge challenge for insurers because of the

high losses over soaring medical expenses.

Most of the time Policy Holders have inadequate knowledge on illness covered in

their polices, exclusion of illness in the policy, cashless Reimbursement and list of

empanelled hospitals.

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 Majority of the customers complaining that there has been always delay in claim

settlement and other after sale service.

The insurance companies need to concentrate more on their after sale service and also

should provide an professional well knowledgeable person as a agent to make people

know about their policy and also to satisfy the customers.

CONCLUSION

This paper makes an attempt to understand the satisfaction of individuals in their

Health insurance plan. The result of this study shows that the annual premium is the

most important factor that influences the decision or choice of health Insurance plan.

This means that households having higher income have higher probability of buying
healthcare plan. Thus, less income groups may not opt for health insurance plan. Thus

there is a need to develop more products that cater to need of larger and all levels of

income groups.
The Customers want their Agents to be efficient and perform up to the expectation of

the policyholders and insurers. Even though the insurers are providing need based

plans but more should be done to meet the needs arising out of changing lifestyles of

people. Insurance companies also need to maintain a good after Sale Service to

maintain the goodwill of the company as well as for customer satisfaction.

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 WEBLIOGRAPHY

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serialsjournals.com/serialjournalmanager/pdf/1446547872.pdf

http://economictimes.indiatimes.com/

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