DECLARATION

I, NIKETA VISHWAKARMA, student of Master of management

studies semester -3 (2018-2019) hereby declare that I have completed
the project on “COMPARATIVE ANALYSIS OF OPTIMA
RESTORE POLICY BETWEEN APOLLO MUNICH AND
STAR HEALTH INSURANCE COMPANY LTD”

The information submitted is true and original to the best of my

knowledge.

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ACKNOWLEDGEMENT

It is my proud privilege to release the feelings of gratitude to several persons

who helped me directly or indirectly to conduct this project work. I have taken
efforts in this project. However, it would not have been possible without the
kind support and help of many individuals. I would like to extend my sincere
thanks to all of them.

I express my heart full indebtedness and owe a deep sense of gratitude to my

project guide Dr. Purvi Pujari ma’am for his guidance and constant
supervision as well as for providing necessary information regarding the project
and also for his support in completing the project
I am also extremely thankful to all those people who have positively helped me
in conducting my case study.

My thanks and appreciations also go to my colleagues in developing the project

and people who have willingly helped me out with their abilities.

I would also like to express my gratitude towards my parents and friends for
their kind cooperation and encouragement which helped me in completion of
this project.

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 Certificate

NOT YET RECEIVE

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Executive summary

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3 OBJECTIVES OF STUDY

 To study the importance of Health insurance.

 To study satisfaction level of customers regarding product and premium of product.
 To know more about health insurance product offer by APOLLO MUNICH
 To study that financial benefit the person can get through health insurance coverage.

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 RESEARCH METHODOLOGY

For the purpose of analysing the data it is necessary to collect the vital
information. The data collected is primary data by the means of reports,
questionnaires.

Secondary data was collected from books and internet websites. Research
papers and companies pamphlets Brochures etc.

1.7 LIMITATION OF PROJECT: -

In undertaking the study, a number of problems were faced. Thus the study
has limitations, which are:-

(a) The information in this project is taken with the help of books and
various websites.

(b) The case study conducted is only of one insurance company and the
services and products of a single company are provided. There are
various other services provided by other company which are not
considered in the case study. The research is restricted upto the sample
size of 200 and the area is restricted to Navi Mumbai

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1.5 REVIEW OF LITERATURE

Gill & Kansra (2014) in their research paper studied trends and challenges observed that
claim paid percentage had risen than premium percentage which are biggest challenge and
they found the prospects of health insurance industry seems bright. Opportunities conclude
by them are rise in medical cost, specialized treatment become frequent due to the rise in
income pattern, low public expenditure on health and family welfare.

Aggarwal et al. (2013) studied Innovations and challenges of health insurance sector.
According to the study product development and innovation both are very important for new
customers and existing customers.

Garg (2013) emphasized that respondents are satisfied with private sector insurance
companies than the public sector. Main factor identified for satisfaction of the respondents
are claim settlement, sales force, time taken for the policy issuance, compliant handling
mechanism.

Subramanya (2014) studied the trends in health insurance in India. Increase in population,
expanding middle class, increasing awareness and lifestyle diseases, tax benefits are some of
the factors leads to increase in health insurance demand. According to the study some
challenges for survival and growth of health insurance are to provide health insurance
benefits to BPL families or they have to increase the coverage and have to provide the cost
benefits. So this sector has long way to go.

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SR.NO. PARTICULAR PAGE NO.
1 1.1INTRODUCTION TO HEALTH
INSURANCE
1.2IMPORTANCE OF HEALTH
INSURANCE
1.3BENEFIT OF HEALTH INSURANCE
1.4HOW TO SELECT RIGHT POLICY
1.5ELIGIBILITY TO BUY INSURANCE
1.6DOCUMENT REQUIRE TO BUY
HEALTH INSURANCE
1.7TYPE OF HEALTH INSURANCE
1.8SOME OF HEALTH INSURANCE
1.9TAX BENEFITS ON HEALTH
INSURANCE
2 2.1 INTRODUCTION TO COMPANY
2.2 MISSION AND VISION
2.3 WHY APOLLO
2.4 AWARDS
2.5 GROWTH RATE
2.6 ORGANISATION STRUCTURE
3 3.1 APOLLO PRODUCT
3.2 INDIVIDUAL PERSONAL
ACCIDENTALINSURANCE(IPA)
3.3 BENEFIT OF IPA
3.4 CALCULATION OF PREMIUM
3.4 OPTIMA RESTORE
3.5 BENEFIT OF OPTIMA RESTORE
3.6 CALCULATION OF OPTIMA RESTORE
4 DATA ANALYSIS & INTREPRETATION
5 FINDINGS
6 RECOMMENDATIONS
7 CONCLUSION
8 BIBLIOGRAPHY
9 ANNEXURE

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CHAPTER 1

INTRODUCTION TO INSURANCE

How many accident you need to realise that you need Health Cover? It takes just one
visit to a hospital to make us realize how vulnerable we are, every passing second. For
the rich as well as poor, male as well as female and young as well as old, being
diagnosed with an illness and having the need to be hospitalized can be a tough ordeal.
Heart problems, diabetes, stroke, renal failure, cancer – the list of lifestyle diseases just
seem to get longer and more common these days. Thankfully there are more speciality
hospitals and specialist doctors – but all that comes at a cost. The super rich can afford
such costs, but what about an average middle class person. For an illness that requires
hospitalization/ surgery, costs can easily run into five digit bills. A Health insurance
policy can cover such expenses to a large extent. Read why Health Insurance is more
important these days compared to Old days Health is a human right, which has also been
accepted in the constitution. Its accessibility and affordability has to be insured. While
the well-to-do segment of the population both in rural & urban areas have acceptability
and affordability towards medical care, at the same time cannot be said about the people
who belong to poor segment of the society. It is well known that more than 75% of the
population utilizes private sectors for medical care unfortunately medical care becoming
costlier day by day and it has become almost out of reach of the poor people. Today there
is need for injection of substantial resources in the health sectors to ensure affordability
of medical care to all. Health insurance is 9 an important option, which needs to be
considered by the policy makers and planners. As mentioned earlier, the cost of Health
Insurance depends on the sum assured , age, current health condition and your previous
medical history. Higher the sum assured, higher the premium. So what is the ideal health
insurance cover requirement? There is no standard answer or thumb rule for this. If we
agree that health insurance is important, one has to look at his/ her own lifestyle, health
condition, age/ life stage, family history of illnesses and affordability. Keep in mind that
most insurance companies limit the sum assured to a maximum of 5 lakhs. Also note that
many health insurance policies ―provide additional benefits‖ such as daily allowance,
ambulance charges, etc. for hospitalization. Not only are such ―benefits‖ superfluous,
Sundaram, Star Allied Health Insurance, HDFC standard life, Bajaj Allianz Apollo, AG
Health Insurance Company among others. India‘s fast growing demand for affordable

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health cover is attracting greater business attention, with both life and non-life insurance
companies now entering the market with innovative new protection and savings medical
insurance products. This intense competition for health insurance customers has only
intensified in recent months, with the introduction of new savingslinked and investment-
oriented health insurance schemes by some of the country‘s largest insurance groups.
India‘s insurance sector first opened up to private and international investors in 2001.
Over the past ten years coverage rates across the populous South Asian country have
doubled and the domestic insurance industry has overtaken several more developed
financial markets in the process. The overall number of insurance policies sold has
increased several times over, and combined premium income is now projected to reach
between US$350 to US$400 billion by 2020. Health insurance, in particular, has become
as one of the country‘s fastest growing insurance lines, accounting for almost a third of
new written premiums last year. Sales of medical insurance products have been driven by
three key factors: a low penetration rate of about 5 percent at present, surging treatment
costs, and a lack of other social safety options across most of India. With total
expenditure on healthcare, through both Indian government schemes and private sector
activity, expected to exceed US$200 billion by 2015, even more significant opportunities
for the country‘s health insurance sector will likely emerge. Over the next three years,
health insurance has the potential to 12 become an INR300 billion market (US$6 billion),
according to industry observers. The introduction and increased proliferation of private
sector players in India‘s health insurance sector has worked to both develop innovative
new coverage products and increase service standards for clients in the domestic market.
Of particular note has been how the entrance of several major life insurance brands,
including Life Insurance Corporation of India, Aviva Life Insurance and Max Life
Insurance, has affected the market recently. These life insurers offer largely savings-
based health plans that provide lump sum compensation to clients in case of a critical
illness or other malady specifically defined by a specific policy. These long-term
products have tenures that can last up to 20 years. When the policy expires, customers
are entitled to receive the fund value. Normally this is not a cashless process Speaking at
the first meeting of the India Health Insurance Forum in Hyderabad last Thursday, IRDA
chairman J Harinarayan said the industry must now work to improve communication
with its customers, particularly with regard to health insurance policy documentation, as
a third of all consumer complaints this year have been directed towards health insurers.
According to IRDA data, of the 92,898 complaints levied at the non-life sector so far in

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2012, 38,891, or 37.5 percent have been focused on health insurance issues. ―If one-
third of complaints are from the health side, I will conclude that the nature of
communication on health insurance policies and the understanding of the policy by the
consumer are areas of concern. Probably, the lack of clarity is reflected in the increasing
number of complaints,‖ IRDA chairman J Harinarayan said, adding that ―good
communication is the responsibility of the insurance company and not of the policy
holder. An insurance policy, as a contingent contract, has to be specific and
unambiguous.‖ With a reach of just about 2% of the country‘s 1.2 billion population,
India offers a huge potential in health insurance market. There are over 30 health
insurance products in the category offered by both life and non-life insurers. While ICICI
Lombard, Bajaj Allianz and Reliance General are some of the prominent general insurers
in the health insurance space, Apollo DKV, Star Health & Allied Insurance are the
standalone players. Health insurance‘s annual premium collections are over Rs 6,000
crores. Despite the high growth, 15 the business is a huge challenge for insurers because
of the high losses over soaring medical expenses A survey showed massive
dissatisfaction with the healthcare system in India. The interesting find about health
insurance in India was how people perceived health insurance in India. It is seen as an
instrument to protect savings. It is not aimed at protecting the asset that is health. This is
probably common to developing markets, where people tend to place wealth ahead of
health. On a macro level, very few households in India have contingency plans to meet
their health expenses. Health risks in India are perceived differently than the western
population. Prior planning in health issues is yet to be a major priority The industry is
also becoming tech-savvy with facilities to buy certain types of insurance products online
and payment of premium through Internet. The insurance penetration level in India is
very low when compared with the global average. This has brought about a plethora of
distribution channels such as agents, brokers, bancassurance (bank insurance model)
avenues, soliciting insurance through Internet or direct mailing. Many banks, financial
institutions and insurance intermediaries saw a huge opportunity in marketing insurance
products. Insurance brokers play a vital role in bringing together insurance companies
and the insured, and their role assumes importance when a claim arises. Research
includes awareness of health insurance , preference of health insurance consumption
pattern ,new services offered by insurance sectors, claim settlement procedure, and major
issues of health insurance. Health insurance policy does not always cover every possible
health problem someone might encounter in the future. There are certain terms and

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 conditions 16 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 . 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.
Quality healthcare and Apollo have become synonymous in the Indian
subcontinent, a fact reiterated by global healthcare experts and international
accreditation bodies. Committed to bring world class health care within the reach of
every individual, Apollo Hospitals Group has joined hands with Munich Health, a
world leader in the field of health insurance.

Importance of Health Insurance

Buying a health insurance policy for yourself and your family is important because medical
care is expensive, especially in the private sector. Hospitalisation can burn a hole in your
pocket and derail your finances. It will become even tough, if the person who brings in the
money, is now in a hospital bed. All this can be avoided by just paying a small annual
premium which would lessen your stress in case of medical emergencies.
A good health insurance policy would usually cover expenses made towards doctor
consultation fees, costs towards medical tests, ambulance charges, hospitalization costs and
even post-hospitalization recovery costs to a certain extent.

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Benefits of having a Health insurance Policy
1. Cashless Treatment: If you are insured, you can get cashless treatments as your insurance
company would work in collaboration with various hospital networks.
2. Pre and post hospitalization cost coverage: Insurance policy also covers pre and post
hospitalization charges up to the period of 60 days, depending on the insurance plans
purchased.
3. Transportation Charges: Insurance policy also covers the amount paid to ambulance
towards the transportation of insured.
4. No Claim Bonus (NCB): This is the bonus element which is paid to the insured if the
insured does not file a claim for any treatment in the previous year.
5. Medical Checkup: Insurance policy also provide options for health checkups. Free health
checkup is also provided by some insurers based on your previous NCBs.
6. Room Rent: Insurance policy also covers room expenses depending on the premium being
paid by the insured.
7. Tax Benefit: Premium paid on Health insurance is tax deductible under section 80D of the
Income Tax Act

How to Select the Right Insurance Policy

It’s difficult to select the best insurance policies as all insurance company provides a similar
type of insurance plan. Hence some of the important points that any Person should look
before purchasing any plans are:
1. Sum Assured
2. Minimum Entry Age and renewability clause
3. Room Rent Capping
4. Inclusion and Exclusion
5. No Claim Bonus
6. Other Benefits

Eligibility Criteria
In India, people under 45 years of age are not required to undergo a mandatory health
checkup when obtaining a health insurance policy. They are, however, required to disclose
any pre-existing conditions such as diabetes or hypertension. It is, therefore usually advised
that one should get a health insurance when young so that the premium would be less.

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Documents Required when buying a Health Insurance Policy
There are few documents that you need to provide such as:
1. Age proof – Any one of Birth Certificate, 10th or 12th mark sheet, Driving License,
Passport, Voter ID, etc.
2.Identity proof – Driving License, Passport, Voter ID, PAN Card, Aadhar Card, which
proves one’s citizenship.
3. Address proof – Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport,
should clearly mention the permanent address.
4.Some plans require a medical check-up (usually for elder people above the age of 45
years)
5. Passport Size Photo

Types of Health Insurance

1. Individual Health Insurance: This policy covers the health expenses and hospitalization
expenses of individual who has taken the policy. Premium under this policy is determined as
per the age of insured.
2. Family Health Insurance Plan: Under this policy, an individual can include all the family
members against multiple diseases under a single cover. Family health plan offers a fixed
sum assured for the family members, which can be availed by all members of the family or
by any one individual in the family.
3. Senior Citizen Health insurance Plan: This policy is designed for the senior citizens or
individuals over 60 years of age offering protection from health issues during old age.
4. Surgery and Critical Illness Insurance Plan: This plan is suitable for the insured that
requires treatment against critical illness, such as kidney failure, paralysis, cancer, heart
attack etc. As the medical expenses of these treatments are very high, the premium applicable
to these types of policies is also high.
5. Maternity Health Insurance Plan: This policy covers costs, including pre and postnatal
care, child delivery expenses of newborn babies. This policy is also covered for the newborn
up to a certain period of time as mentioned in the plan. Ambulance costs are also covered.
6. Personal Accident Plan: This policy covers hospitalization expenses in the event of an
accident. Premium amount is depending upon the amount of cover taken.
7. Unit Linked Health Plan: These plans offer a unique combination of insurance and
savings both at the same time. This policy helps in building a corpus which can be used to
meet those expenditures which are not covered by the insurance policy.

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8. Some of the Health Insurance Policies in India
1. Max Bupa Health Insurance
2. HDFC Ergo Health Insurance
3. Bharti Axa Health Insurance
4. SBI Health Insurance
5. L&T Health Insurance
6. Bajaj Allianz Health Insurance
7. Apollo Munich Health Insurance
8. National Health Insurance

9. Tax Benefits on Health Insurance

The amount you pay towards health insurance premium claimed as a tax-saving deduction
under Section 80D. You can claim ₹25,000 annually for a health insurance policy for
yourself. If you also pay the premium for a health insurance policy for your parents, you can
claim up to ₹30,000 for the same as well.
Earning money is not at all useful if you don’t have a life. Think about yourself and your
family and the importance of life. You know the importance and benefits of having a Health
Insurance Policy. Start one, if you haven’t already

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 CHAPTER 2
2.1 INTRODUCTION TO COMPANY
Apollo Munich Health is a joint venture between Asia’s largest integrated
healthcare provider, The Apollo Hospitals Group, and Germany based Munich Re’s
newest business segment, Munich Health. The joint venture is poised to make good
the conviction of both the partners that Indian health insurance market is on the brink
of explosive growth.
The company was incorporated in August, 2007. It is a specialized health
insurance company in India that has expertise in both health and insurance and is able
to leverage this understanding for the benefit of its customers.
“Munich Health is in fact the new brand under which Munich Re is now
offering its healthcare-sector services to clients and partners throughout the world.
Munich Re is thus bringing together under one banner its global insurance and
reinsurance know-how in health”.

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 Apollo Munich Health Insurance Company Limited was previously known as Apollo
DKV Insurance Company Limited. The company started as a joint venture between Apollo
Group of Hospitals and DKV AG, Europe's largest private health insurer (Deutsche
Krankenversicherung AG) on the 8th of August, 2007. Apollo DKV started on a journey to
re-define the health insurance sector in India. The stake holding of the two companies were in
the ratio of 74:26 (Apollo Group of Hospitals—DKV AG).

Apollo Munich Health Insurance is a joint venture between Apollo Hospitals Group
and Munich Health, Munich Re’s newest business segment. The Apollo Hospitals Group is
Asia’s largest integrated healthcare provider while Munich Health draws on Munich Re’s
insurance and reinsurance competence with presence in more than 40 countries. This
parentage ensures that we are in a good position to understand the health care financing
requirements of this country and replicate the success of health care financing through
insurance, as seen in other countries, with the support of Munich Health.

Thus, Apollo Munich proudly says ‘We Know Healthcare. We Know Insurance.’
Apollo Munich Health Insurance company offers comprehensive health insurance plans for
individuals and their families, as well as for corporate houses. Apart from individual personal
accident plans and travel insurance for individuals and families and senior citizens, it is
positioned as a straight-forward, user-friendly and hassle-free health insurance Company that
strive to consistently tackle concerns faced by people when it comes to healthcare and health
insurance.

Vision
To be a trusted leader in the health insurance sector by providing innovative solution to the
citizens of India.

Mission
“Our mission is to bring Healthcare of International Standards within the reach of every
individual. We are Committed to the achievement and maintenance of excellence in
education, research and healthcae for the benefit of humanity.”

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WHY APOLLO MUNICH

A few of the benefits offered along with Easy Health Standard variant is as follows:-
• Inpatient treatment expenses
• Pre- and post-hospitalization expenses
• 140 Day-care procedures
• Domiciliary treatment
• Daily cash for choosing shared accommodation
• Expenses for organ donor
• Emergency Ambulance
• Health check-up
• No co payment
• No capping in SME treatment
• No capping in room rent
• Restoration benefit
• 50% SI bonus
• Stay active benefits Up to 8% discount on renewal
• Marriage expenses for Children

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• Loan Secure
• Home Maker Care Allowance
• Pet Care
• Broken Bones
• Burns 30%

Comparison of Apollo Munich with other health Insurance

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 AWARDS

Year-2016

Award-Health Insurance of the year

Organization-Medics & Amul

For-For our performance, growth and excellence in Indian

Insurance Industry and to raise the benchmark year on year
for industry participants

Year -2016

Award- Best Health Insurance product

Organization- FICCI

For-For Dengue Care

Year-2017

Award- General Company of the year

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Year- 2017

Award-Golden Peacock Award for Risk Management

Organization- Golden Peacock awards

For- Conferred for our robust risk management

practice and steadfast focus on identifying and
averting any risk that can impact our business and
stakeholders.

Year-2018

Award- Outlook Money: Gold Award- Health

Insurance provider of the year 2018

Organization- Outlook Money

For- Best Insurance Provider in the private sector

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APOLLO MUNICH HEALTH INSURANCE

Growth rate of AMHI

GWP (Rs. Crore)

2000

1800 1730

1600

1400
1300

1200
1107

1000
861

800
693
620
600
476

400
284

200
115
49
0
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

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2.2 ORGANIZATION CHART

Assistant
Agency
Manager

Associate
Agency
Manager

Agency
Manager

Senior Agency
Manager

Assistant
Chief Agency
Branch
Manager
Manager

Branch
Manager

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 CHAPTER 3
3.1 APOLLO PRODUCT

IPA

Individual Personal Accidental Insurance

At Apollo Munich we want you to go out (carefully) and take life as it comes. Live like
you’ve always lived. Fearless. Carefree. Enjoying life in moments. Keep finding little joys in
those traffic jams, make your me-time a bit more adventurous, go an extra-mile in your daily
routine. That’s why Apollo Munich’s Individual Personal Accident Plan is designed to take
care of the uncertain surprises that life brings, and help you get your life back, right on track.

We have 3 plan options for you. Select the one that fits your need.

A. Essential
• Plan with all the essential features like death and disability coverage
• Sum Insured options from 20L to 1cr
• Coverage for accidental hospitalization along with Restore benefit
• Protects your financial liability with loan secure benefit
• Takes care of your accidental OPD expenses
• Supports your income when down with injuries

B. Advanced
• Comprehensive plan with a total of 24 benefits
• Sum insured options from 1cr to 2.5cr
• Lump sum amount in case of accidental death and disability
• Coverage for accidental hospitalization along with Restore benefit
• Protects your financial liability with loan secure benefit
• Takes care of your accidental OPD expenses
• Supports your income when down with injuries
• Coverage from accidents due to adventure sports
• Lump sum payment for burns and fractures
• Covers air ambulance cost

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C. Elite
• Comprehensive plan with a total of 30 benefits
• Sum insured options from 2.5cr to 10cr
• Lump sum amount in case of accidental death and disability
• Coverage for accidental hospitalization along with Restore benefit
• Protects your financial liability with loan secure benefit
• Takes care of your accidental OPD expenses
• Supports your income when down with injuries
• Coverage from accidents due to adventure sports
• Lump sum payment for burns and fractures
• Covers air ambulance cost
• Financial support for elderly parents, kids, spouse and even pets
• Take care of lost income while in coma
• Covers cost of head/ spinal X-rays, CT/MRI scans etc.

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Individual Personal Accident plan comes with multiple benefits to financially cover you and
your family from life’s unexpected events.

Hospitalisation treatment with Restore benefit Loan secure

Adventure sports Elderly care

Child education Burns

Pet care

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 VARIANTS
Benefits Essential Advanced Elite
1 Accidental Death (AD) 20 L to 1 cr. 1 cr. To 2.5 cr. 2.5 cr. to 10 cr.
2 Transportation of Mortal Remains Up to25,000 Up to 50,000 Up to 1L
3 Cremation Ceremony Up to 25,000 Up to 50,000 Up to 1L
4 Permanent Total Disablement Up to Up to Up to Accidental
(PTD) Accidental Accidental Death SI
Death SI Death SI
5 Permanent Partial Disablement Up to Up to Up to Accidental
(PPD) Accidental Accidental Death SI
Death SI Death SI
6 Emergency Road Ambulance Up to 5000 Up to 10,000 Up to 20,000
Charges
7 Education Fund 50,000 1L 2L
8 Purchase of Blood Up to 10,000 Up to 10,000 Up to 10,000
9 Cost of Prosthetics Up to 20,000 Up to 50,000 Up to 1L
10 Accidental Out-patient Expenses Up to 5000 Up to 5,000 Up to 10,000
11 Accident Hospital Cash 1000 for 15 3000/days for 15 5000/day for 15
Days days days
12 Family Transportation Up to 50,000 Up to 1L
13 Modificationof Residence/Vehicle Up to 2.5 L Up to 5L
14 Broken Bones 50,000 1L
15 Burns 15L 25L
16 Adventure Sports AD sum insured AD sum insured
17 Head and Spinal Injury Up to 20,000 Up to 50,000
18 Emergency Air Ambulance Up to 2,00,000 Up to 3L
Charges
19 Education Fund on Disability of 2L 3L
Dependent Child
20 Pet Care 2500/days for 15 2500/days for 15
days days
21 Homemaker Care Allowance 25,000 50,000

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22 Transportation of Imported Up to 20,000
Medicine
23 Multiple Member Disability 120% of PTD SI
24 Coma Up to 50L
25 Carrier 1L
26 Marriage Expenses for Children 10L
27 Elderly care 3L
OPTIONAL BENEFITS
1 Total Temporary Disablement 0 to 5L 0 to 25L 0 to 50L
(TTD)
2 Accidental In-patient 1L 3L 5L
Hospitalisation with Restore
Benefit
3 Loan Secure Outstanding Outstanding Outstanding loan
loan amount loan amount amount

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Benefits of IPA

1. Accidental Death – Payment of sum insured in case of death of insured person due to an
accident.

2. Accident Hospital Cash – Lump sum payment for each day of accidental hospitalization.

3. Accident In-patient Hospitalisation with Restore Benefit

3.1. Accident In-patient Hospitalisation - Reimbursement of medical expenses incurred on

accidental hospitalization of insured person. Expenses for 30 days of pre-hospitalization, 60
days of post hospitalization and day-care procedures are also covered.

3.2. Restore Benefit - Instant addition of 100% accident in-patient hospitalization sum
insured upon partial/ complete utilization of your accident in-patient hospitalization sum
insured during the policy tenure.

4. Accident Out-patient Expenses – Reimbursement of out-patient medical expenses

incurred following an accident. Out-patient expenses include, diagnostic tests, vaccinations,
pharmacy, consultations with a medical practitioner, plaster cast, crutches, minor OT charges.
A deductible of Rs 500 shall apply to each and every claim.

5. Adventure Sports – Payment of sum insured in case of death or permanent total disability
of insured member while he/she was engaged in adventure sports in a non-professional
capacity and under the supervision of trained professional.

6. Broken Bones – Lump sum payment of pre-defined percentage of sum insured basis the
severity of fracture caused due to an accident.

7. Burns – Lump sum payment of pre-defined percentage of sum insured basis severity and
degree of burns due to an accident.

8. Cremation Ceremony – Lump sum payment for performing the cremation ceremony

9. Coma – Lump sum payment basis the number of weeks for which insured person is in
state of coma due to an accident.

10. Carrier – Payment of sum insured in case of death or permanent total disability of
insured person. Insured person should have been traveling as a fare paying passenger in a
carrier at the time of accident.

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11. Cost of Prosthetics – Reimbursement of cost of medically necessary prosthetic devices,
orthopedic braces and durable medical equipment. This is payable in case of permanent total
disability of insured member.

12. Elderly Care – Lump sum payment to support elderly parent(s) in case of death or
permanent total disability of insured member.

13. Education Fund on Disability of Dependent Child – Payment of sum insured for the
education of insured child in a special school or institution following permanent total/ partial
disability due to an accident.

14. Emergency Road Ambulance Charges – Reimbursement of expenses incurred on an

ambulance used to transfer the insured person to a hospital following an accident.

15. Emergency Air Ambulance Charges – Reimbursement of expenses incurred on an air

ambulance used to transfer insured person within India.

16. Education Fund – Lump sum payment of sum insured towards education of dependent
children in case of accidental death or permanent total disability of insured member.

17. Family Transportation – Reimbursement of expenses incurred in transporting one

immediate family member to the hospital where the insured person is admitted following an
accident.

18. Homemaker Care Allowance – Lump sum payment of sum insured in case of non-
earning spouse’s hospitalization for more than 7 continuous days due to an accident.

19. Head and Spinal Injury – Reimbursement of expenses incurred on diagnostic tests (e.g.
X-ray, MRI, CT scan, ultrasound) of head/ spine conducted within 3 months of an accident.

20. Loan Secure – Payment of outstanding principal loan amount in case of death or
permanent total disability of insured member. Outstanding principle loan amount would not
include any arrears or penalties levied by the bank or financial institution.

21. Marriage Expenses for Children – Payment of sum Insured as marriage expenses for
unmarried dependent child of the insured person, provided that our maximum liability under
this benefit for all dependent children, irrespective of the number of dependent children shall
be limited to the Marriage Expenses Sum Insured. This is payable only in case of death or
permanent total disability of the insured member.

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22. Modification of Residence/Vehicle – Reimbursement of expenses incurred to modify the
insured person’s residential accommodation or vehicle in case of his/her permanent total
disability.

23. Multiple Member Disability – Payment of 20% extra PTD amount in case two or more
insured persons get permanent disablement in same accident.

24. Permanent Total Disablement (PTD) – Lump sum payment of pre-defined percentage
of sum insured basis the severity and disability caused by the accident.

25. Permanent Partial Disablement (PPD) – Lump sum payment of pre-defined percentage
of sum insured basis the severity and disability caused by the accident.

26. Pet Care – Payment of fixed daily amount to take care of pet in case the insured person is
hospitalized.

27. Purchase of Blood – Reimbursement of expenses incurred in purchasing blood through a

hospital or lawful blood bank for insured person following an accident.

28. Transportation of Mortal Remains – Reimbursement of expenses incurred on

transporting the mortal remains of the insured person from the place of the accident/ hospital
to residence/ burial ground.

29. Temporary Total Disablement (TTD) – Payment to compensate for the loss of income
in case the insured person is not able to work due to an accident.

30. Transportation of Imported Medicine – Reimbursement of expenses incurred on

freight charges for importing medicines to India, provided that such medicines are not
available in India.

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IPA PREMIUM CHART

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  Calculation of IPA premium
1. A person who is a skilled labour. He want to take a policy for 3 years, sum assured
amount is 2 crore and he want to take 1 crore loan security. And 20 lakhs TTD benefit
and 2 lakhs patient hospitalization benefit.
Calculate premium.
Solution :-
a. The person is skilled labour therfore occupation 2.
b. 3 years plan
c. 2 crore policy, Advance plan
d. Base 564.5*200= 112900
e. TTD 20*174.3= 3486
f. Loan secured 198.5*100=29850

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IPA LAST 5 MONTH GRAPH

14000
13100

12000 11500

10000
10000

8500

8000
7000

6000

4000

2000

0
Jan-19 Feb-19 Mar-19 Apr-19 May-19

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 OPTIMA RESTORE

In- Patient Indemnity health Insurance Policy

Types of Plan
 Individual Health Insurance
 Family Floater Health Insurance

Eligibility

Self, Spouse, Dependent Parents, Dependent Parent in Law

Individual Plan:

 Maximum 6 members can be insured under one individual plan.

 Maximum 4 adults can be insured under one individual plan.
 Family Discount of 10% if 2 or more members are covered under the same
individual policy

Family Floater Plan:

 Maximum 6 members can be covered under one policy with permissible combination
being 1A+1C, 1A+2C, 1A+3C, 2A, 2A+1C, 2A+2C, 2A+3C

3,00,000

50,00,000 5,00,000

Sum
25,00,000
Insured 10,00,000

20,00,000 15,00,000

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Premium payment

Easy Health provides an option to buy a plan for 2 years with a discount of 7.5% applied on
the combined premiums of the 1st& 2nd year.

Benefits of Optima Restore:-

 No sub limits:- total expenses covered by company – 100%

 No Co- Payment.
 No Room Rent Restriction.
 Restore Benefits.
 No Claim Bonus Increase by 50% up to 100%
 Pre-Hospitalization 60 days and Post Hospitalization 180 days.
 Emergency Ambulance Expenses Rs. 2000/-
 Stay active benefits Up to 8% discount on renewal.
 Expenses for Organ Donor 100%
 Deduction under – 80 D
 No medical till 65 years age.
 Cashless benefits Available more than 4500+ hospitals.
 Lifelong renewal.
 All day care Treatment Cover.
 E- Opinion with respect of critical illness.
 Portability Benefits Available (Continuity Benefits)
 Health checkup benefits available.
SI 3 lakhs 5 lakhs 10 lakhs 15 lakhs 20 lakhs N
Block of 2 Above
yrs
Floater/Individual NA 2500/1500 5000/2000 8000/4000 10000/5000

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 Terms and Condition: -

 Accident covers from 1st day.

 All illness covered after 30 days of waiting period.
 3 yrs waiting period for any pre existing illness.
 For more details please refer policy wording. *
 2 year of waiting period on Special illness.

Sinusitis, Rhinitis, Tonsillitis. Cholecystitis, Cholelithiasis, pancreatitis

Benign ENT Disorders & Surgeries i.e. Tonsillectomy, Fissure/ Fistula in Anus, Hemorrhoids, Pilonidal
Adenoidectomy, Mastoidectomy, Tympanoplasty etc. Sinus Cholecystectomy, Surgery of Hernia.
Nasal Concha Resection, Nasal Polypectomy Perineal & Perianal Abscesses, Rectal prolapse.
Surgery of Nasal Septum Deviation, Ulcer & erosion of stomach & Duodenum. Gastro
Surgery for turbinate Hypertrophy Esophageal Reflux Disorder (GERD)
Dilatation & Curettage (D&C) All forms of Cirrhosis (Excluding due to Alcohol)
All internal benign tumors, cysts, polyps of any kind Calculus Diseases of Gall Bladder & Urogenital
including benign breast lumps System E.g. Kidney Stone, Urinary Bladder Stone.
Fibromyoma, Adenomyosis, Endometriosis, Prolapse of Benign Hyperplasia of Prostate, Surgery on
Uterus. Hysterectomy. Prostate. Surgery for Hydrocele/ Rectocele.
Polycystic Ovarian Diseases Cataract, Retinal Detachment, Glaucoma.
Arthritis if non infective, Gout & Rheumatism Surgery of Varicose Veins & Varicose Ulcers.
Osteoarthritis and Osteoporosis Surgery for Prolapsed inter Vertebral Disc.
Ligament, tendon and Meniscal Tear. Surgery for Joint Replacement.

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38 | P a g e
 Calculation of Optima restore premium.
1. A man age is 45 and he wants to take a policy for family. Bellow is a details.
Mother age is 46, 1st child age is 26 and 2nd child age is 23 .
Sum assured amount is 20 lakhs. Find premium.
Solution:-
1st child age is 26. Below the 25 he is minor. Therfore he will have to take
individual plan for him/her.
And other family members take under age group of 46-50 in 2A+1C in
sum assured of 20 lakhs.
2A+1C = 42,030
1 child = 15,488
57,518
They have to pay Rs57,518 premium annually.

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OPTIMA RESTORE 5 MONTH GRAPH

Series 1
12000

10700

10000
9400

8000
8000 7500

6000
5000

4000

2000

0
Jan-19 Feb-19 Mar-19 Apr-19 May-19

Series 1

40 | P a g e
CHAPTER :4

DATA ANALYSIS & INTERPRETATION

1. Gender

Analysis: - From the above result researcher come to know that out of 100%, 58%
respondent are male and 42% are female. Which is 58% and 42% are respectively.

2. Age

Analysis &Interpretation: - From the above study researcher find that 62% respondent are
between 18 to 30 age group, 22% respondents are between 31 to 40 age group and 8%
respondents are between 41 to50, 51 to 60 age group and no response in age group of 61 to
65.

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3. Qualification

Analysis & Interpretation: - From the above graph researcher find that most of the
respondents are Post Graduate that is 46%, 36% respondents education qualification is
Graduation and 8 % respondents education qualification is SSC passed, 10% respondents
education qualification is HSC qualified.

4. Health Insurance

Analysis & Interpretation:- From the above graph researcher find that out of 100%
more than half that is 76% respondents are having a Health Insurance and 24%
respondents are not having Health Insurance.

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 5. Income

Analysis & Interpretation: -From the above graph it is seen that 32% respondents
income is 2.5 Lakhs & below, most of the respondents are having income in between 2.5
lakhs to 5 Lakhs and in between 5 to 10 Lakhs income having respondents are 24%, and
2% respondents are having income 10 Lakhs and above 10 Lakhs.

6. Company

Analysis & Interpretation: - From the above research graph researcher find that high
number of respondents are insured with Apollo Munich Health Insurance that is 56% and in
other companies 36% respondents are insured with them, and in star health insurance2% and
Cigna Health Insurance 1% and Max Bupa Health Insurance 1% respondents are insured.

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7. Type of Insurance plan

Analysis & Interpretation: -In above graph it is seen that 58% policyholder were having
individual insurance plan. 24% policyholder having a family floater insurance plan and
18% policyholders are having both individual and family floater insurance plan. In the
graph, most of policy having a individual insurance plan.

8. Product Benefit

Analysis & Interpretation: - The information in the above graph reveals that 42%
policyholder are taking benefit on Optima (Health Insurance). And 24% policyholder
taking benefit on IPA (Accidental Insurance), 16% policyholder are taking both product
benefits and 18% policyholders are taking other type of product benefit.

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 9. Satisfaction of respondent about product benefit

Analysis & Interpretation: -In the above graph it is shows that most of policyholders are
satisfied with the product benefit what the get that is 82% and 18% policyholder are not
satisfied with the product benefit.

10. Satisfaction of respondent about product premium

Analysis & Interpretation: - From the above graph researcher analysis that 74%
policyholders are satisfied with their premium on the health insurance. And 26%
policyholders are not satisfied with their product premium.

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11.Mode of payment of premium

Analysis & Interpretation: -In the above graph it is explain that the 36% policyholders
are saying that best mode of payment of premium is Annually payment and after that 8%
policyholders are saying half yearly payment of premium is a best mode of a payment.
And 8% policyholders are saying quarterly payment of premium is a best mode of
payment and 36% policyholders are saying monthly payment of premium is best mode of
payment.

12.Capacity of premium payment annually of respondent

Analysis & Interpretation: -The information in the above graph reveals that 74%
policyholders have a capacity to pay premium annually Rs 12000. And 12%
policyholders have a capacity to pay premium annually Rs25000, 8% policyholders have
a capacity to pay premium annually Rs50000 and 6% policyholders have a capacity to

46 | P a g e
pay premium annually Rs 1 Lakh, andnone of policyholder have a capacity to pay
premium annually more or above 1 Lakh Rupees.

13.Premium payment

Analysis & Interpretation: - In the above graph it is shows that 46% policyholders
paying at a time premium more than 1 year and 54% policyholders are not paying at a
time premium more than 1 year.

14.Benefit on instant payment to respondent

Analysis & Interpretation: -In the above graph it is shows that 64% policyholders are
getting benefit on instant payment of premium and 36% policyholders are not getting
benefit on instant payment of premium.

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15.More benefit

Analysis & Interpretation:-Above graph is indicates that 42% policyholders are

satisfied with benefits which they get. They are not like to add more benefits in the
policy. And 58% policyholders would like to add more benefits in policy.

16.Tax benefit on health insurance Premium

Analysis & Interpretation: -In the above graph it is shows that 62% policyholders are
taking tax benefit on health insurance premium. And 38% policyholders are not taking tax
benefit on health insurance premium.

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17.Rank to company on benefits, premium rates

Analysis & Interpretation: - In the above graph it is shows that 22% of policyholders
are given 1 position to their company for giving benefits on premium rates. 16% of
policyholders are given 2 position to their company for giving benefits on premium
rates.32% of policyholders are given 3 position to their company for giving benefits on
premium rates. 16% of policyholders are given 4 position to their company for giving
benefits on premium rates. 14% of policyholders are given 5 position to their company
for giving benefits on premium rates.

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 18.Recommending company to friends and relatives

Analysis & Interpretation: -The information in the above graph reveals that 66%
respondents are recommend their company to friends and relatives. And 34% respondents are
not recommending their company to friends and relatives.

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3.3 FINDINGS

 More numbers of people have Health Insurance.

 Majority of the respondents have individual type of insurance plan.
 More number of people are satisfied with product benefit.
 Majority of respondents are taking benefit on payment of premium.
 Large numbers of respondents want to add more benefits in their policy.
 More numbers of respondents are not able to pay more premium more than 1 year.

51 | P a g e
3.4RECOMMENDATION
 Adding more benefits in policy like lab testing, dental care etc.
 In health insurance there is a not monthly payment of premium but according to
respondents, monthly payment is a best payment of premium. They easily able to pay
monthly premium.
 Company should have to give more than 1 year payment of premium facility to the
policyholder.
 Premium of products should not be too high.

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3.5 CONCLUSION
Insurance is a superiors tool to other form of savings as it providing protection to the
life.Health insurance is protecting against economic loss of in the event of serious
accidents or illness.

In 80s most the hospitals in Indian government owned and treatment was free of cost.

The private medical care the need for health insurance was felt and various insurance
companies introduced Mediclaim insurance as a product. According to recent news
report health insurance continues fastest growing segment with annual growth rate of
25% health insurance premium has also increase to Rs. 13345 crores in 2011-2012.

Apollo Munich growth is increase yearly. In 2016-17 it was 1300 crore and in 2017-
18 it was 1730 crore. Now Apollo Munich will be mergedwith HDFC ERGO General
Insurance.

During the course of my internship with Apollo Munich Health Insurance, I got a
opportunity to learn something new about health insurance and accidental insurance.
This also provide me with the exposure to be able to understand insurance industry
better and various benefits attached to it.

53 | P a g e
3.6REFERENCE

1. Harinder Singh gill and Pooja kansra-“Prospective growth of health insurance in

India: Trends and challenges”, Pacific Business Review International Volume 7,
issue, July 2014.
2. Aggarwal A., Kapoor N. and Anchal G. (2013), Health Insurance: Innovation and
challenges ahead. Global journal of management and Business studies. Vol. 3, Issue 5,
Pp. 475-780
3. Garg A. (2013), Satisfaction and Problems of Health insurance Policy holders in
India. International journal of Banking, Risk and Insurance. Vol. 1, Issue 2, Pp. 43-53.
4. Subramanya M. (2014), Emerging trends in Health Insurance in India: Opportunities
and challenges. Acme Intellects International journal of research in Management,
social sciences & technology. Vol. 2, Issue 1, Pp.

54 | P a g e
3.7BIBLIOGRAPHY
www.apollomunichinsurance.com

shodhganga.inflibnet.ac.in

moneyexcel.com

moneycontrol.com

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 Annexure

Questionnaire

Name - ____________________

Age – 18 to 30 □ 31 to 40 □ 41 to 50 □ 51 to 60 □ □
61 to 65

Gender – Male □ Female □

Qualification – SSC □ HSC □ Graduation □ Post-graduation □
1. Do you have a Health Insurance?

Yes □ No □
2. What is your income per annum?

2.5 lakhs & below □ 2.5 to 5 lakhs □

5 to 10 lakhs □ 10 lakhs and above □
3. From which company you are insured?

Cigna Health insurance □ Apollo Munich Health Insurance □

Max Bupa Health Insurance □ Star Health Insurance □
4. Are you able to smoothly pay your current health insurance policy with your current
annual income?

Yes □ No □
5. Which type of insurance plan you have?

Individual □ Family floater □

6. Which type of product benefit you take?

IPA □ Optima □ Both□ Others □

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7. Are you satisfied with your product benefit?

Yes □ No □
8. Are you satisfied with your Health Insurance premium?

Yes □ No □
If yes, then________________________________________________
If no, then_________________________________________________________

9. What should be the optimum premium according to your financial strength?

10. According to you, what is the best mode of premium payment?

Annually □ Half yearly□ Quarterly□ Monthly□

11. What is capacity of your premium payment annually?

12000 □ 25000□ 50000□ 75000□ 1 lakh□ Above 1 lakh□

12. Are you paying at a time premium more than 1 year?

Yes □ No □
If yes then how many years____________

13. Are you getting any benefit on instant payment of premium?

Yes □ No □
14. Any more benefits would you like to add in your policy?

Yes □ No □
15. Are you adequately covered?

Yes □ No□

16. Are you taking tax benefit of your health insurance premium?

Yes □ No□
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17. Which rank you give to your company for giving Benefits on premium rates?

1 □ 2□ 3□ 4□ 5□
18. Would you like to recommend this company to your friends & relatives?

Yes □ No□

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