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

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

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

Content
• Introduction
• Company Profile
• Scope, objectives & Limitation of
study
• Research Methodology
• Data Sources
• Sampling Design
• Data Collection
• Data Representation
• Data Analysis
• Findings
• Conclusion
• Suggestions
• Reference

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

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

Contd…
 According to the government’s Insurance Information
Bureau, India’s health insurance market is growing fast. In
2010, private insurance companies had 6.8 million policies
covering nearly 55 million Indians (or 4.6 percent of the
population).
 The Indian government also provides subsidized health
coverage to 25.3 million poor families.

Health Insurance Product
 Family medicare
 Senior citizen
 Topup
 Super topup
 Gold
 Platinum

Company Profile
 Type - Public
 Industry - Insurance
 Founded - 1938
 Headquarter Chennai
 Employee 17,361
 Key people Mr. Milind Kharat (CMD)

Contd…
 United India Insurance Company Limited (UIIC) ( A Govt. Of
India Undertaking) is the one among the 4 public General
Insurance Companies of India and a leading General Insurance
player. With the net worth of Rs 4,587 crores as on September 30,
2011.
 United India Insurance Company Limited was incorporated as a
Company on 18 February 1938.
 12 Indian Insurance Companies, 4 Cooperative Insurance
Societies and Indian operations of 5 Foreign Insurers, besides
General Insurance operations of southern region of Life Insurance
Corporation of India were merged with United India Insurance
Company Limited.

Ratings
United India Insurance Co. Ltd. has been awarded 'iAAA` rating
for its claims paying ability by ICRA (Investment Information
and Credit Rating Agency) for the third successive year.

Vision
 The most preferred insurer in India with global footprint &
recognition.
 Trusted brand admired by all stakeholders.
 The best-in-class customer service provider leveraging
technology & multiple channels.
 The provider of a broad range of innovative products to
meet the needs of all customer segments.
 Great place to work with highly motivated and empowered
employees.
 Recognized for its contribution to the society.

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

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

Scope, Objectives & Limitations
of the Study

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

OBJECTIVE
The main objectives of the study are:-
To find awareness level of health insurance for Moradabad
(UP) location.
To estimate the percentage of population having health
insurance product.
To study claim settlement process in the health Insurance
policy.
To determine the satisfaction level of the customer regarding
Claim settlement.

Limitations
There were certain limitations in undertaking this research work.
As it is understood that the limitations are a part of the project,
they have been overshadowed by the benefits of the study.
The survey conducted may not be considered as
comprehensive as only limited respondents could be contacted
because of the time constraint.
Objectives, the purposes of the study and the questions had to
be explained to the respondents and in this context their
responses may be biased.

Contd…
 Some of the respondents were reluctant to give their
responses.
 Only limited sample size had been considered for the study
and therefore, the conclusions drawn based on this may not
be a reflection of the entire population.

Claim settlement process in the
Health Insurance policy
The United India Insurance Company Limited provides
tow types of health claim:-
 Cashless and
 Reimbursement

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

Process of Cashless Claim
 Search the networked hospital, as cashless is available only for
networked hospitals.
 For planned hospitalisations, intimations to be sent to the TPAs in
advance with Name and address of the hospital.
 In case of an emergency hospitalisation, intimation to be sent to the
TPA immediately on admission.
 On admission, a Pre-Authorisation Request for cashless is to be sent
to the TPA by the hospital.
 On discharge from Hospital, pay (if any) the difference of amount
disallowed under the policy or limited by the sum insured.
 All documents in original to be submitted within 7 days to TPA,
after completion of Post Hospitalisation treatment.

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

Process of Reimbursement Claim
 Written intimation about hospitalisation to be sent to TPA
immediately, and within 24 hours of hospitalisation in the case of
emergency hospitalisation.
 Before leaving the hospital, Discharge Summary, Copy of
investigation report and other relevant documents may be obtained
from the hospital authorities. All the documents in original to be
submitted to TPA / Office within 7 days from date of discharge.
 Documents include claim form issued by insurer, discharge
summary of hospital, doctor's certificates and prescriptions, final
hospital bills, laboratory and other investigation reports and bills,
pharmacy bills and all related documents.
 All documents in original to be submitted within 7 days after
completion of Post Hospitalisation treatment.

RESEARCH METHODOLOGY:-
• RESEARCH DESIGN:- Descriptive Research
• SAMPLING DESIGN:- Non Probability sampling in
particular convenient sampling techniques is used.
• Sample size:-The sample size of the survey is 80.
• Population:-
Our target population belongs to Moradabad (UP). It
covers all the groups of the society such as income,
occupation, and age.

Methods/ tools of analysis:-
Tools used for analysis are:-
Charts & Diagrams
Simple Percentage
Simple Correlation
Chi Square Test

• Data Sources
The main source of information for this study is based on the data
collection. Data collected are both primary and secondary in
nature.
• Primary Data
Primary data have been directly collected from insured by survey
method through structured questionnaire.
• Secondary Data
The secondary data was collected from various websites, books,
magazines, journals and daily newspapers published and
unpublished literature from the company, IRDA & III.

ANALYSIS & INTERPRETATION

0
20
40
60
Below 20 yr.
21 - 40 Yrs.
41 - 60 Yrs.
Above60 Yrs.
12
40
21
7
1. Age of the respondents
Inference:
From the above graph It is shown that maximum number of respondent 40 ( i.e
50%) is coming under age group of 26 - 45 years and minimum number of
respondents 7 (i.e 8.7%) above age group of 60 years.
A Below 25 year 12 15%
B 26 – 45 year 40 50%
C 46 – 60 year 21 26.3%
D Above 60 year 7 8.7%
Total 80 100%

10
12
Graduation
Post graduation
22.5%
23.8
41.2%
2. Educational Qualification of Respondents
Inference:
From the above table and graph we can conclude that the maximum number of
respondents are graduates with a percentage of 41.2 and minimum are SSC with
percentage of 12.5.
A SSC 10 12.5%
B HSSC 19 23.8%
C Graduate 33 41.2%
D Post graduate or Above 18 22.5%
Total 80 100%

3. Occupation of Respondents
Inference:
Here we can find out that more number of respondents are corporate employee
(42.5%) and less no of respondents among our target population is Others (8.8%) .
A Government
Employee
22 27.5%
B Corporate
Employee
34 42.5%
C Self Employee 17 21.2
D Others 7 8.8%
Total 80 100%

4. Aware about Health Insurance Plan available in the
market
Inference:
From the above graph it is evident most of the respondent (87.5%) are
aware about the Health insurance plan.
87.5%
12.5%
YES
NO
Yes 70 87.5%
No 10 22.5%
Total 80 100%

5. Having Health Insurance Policy
Inference:
From the above graph It is shown that most of the respondents (77.5%) have
health insurance policy i.e. 62.
22.5%
77.5%
YES
NO
YesT 62 77.5%
No
18 22.5%
Total 80 100

6. Annual premium of the policy.
Inference:
Table shows that most of the respondents are handling policies with a maximum premium
of 5 to 10 thousand annually (45.2%) , and respondents with minimum premium <5
thousand per annum (14.5%).
A Below 5000 9 14.5%
B 5001 – 10,000 28 45.2%
C 10,001 – 25000 15 24.2%
D Above 25,000 10 16.1%
Total 62 100%

7. Coverage Sum Insured in Lakhs
Inference:
Among our respondents we can conclude that 32.25% have sum assured 5-10 lakhs and
respondents who have sum assured above ten lakhs are 14.5%.
A Below 1 Lakh 17 27.41%
B 1 - 5 Lakhs 20 32.25%
C 5 - 10 Lakhs 16 25.8%
D Above 10 Lakhs 9 14.5%
Total 62 100%
17
20 16

8. Satisfaction levels of the customers towards claim
settlement
Inference:
Table shows here that 43.3% of respondents are satisfied with claim settlement towards
their health insurance policy and some 8.7 % of respondent are neither satisfied nor
dissatisfied with this process.
Satisfaction level No of Respondents Percentage
Highly Satisfied 15 24.2%
Satisfied 25 40.3%
Neutral 5 8.1%
Dissatisfied 11 17.7%
Highly Dissatisfied 6 9.7%
Total 62 100%
0
20
40 Highly Satisfied
Satisfied
Neutral
Dissatisfied
Highly Dissatisfied

Coefficient of Correlation

Correlation technique to find the correlation
between Annual Premium and Sum Insured.
H0: There is no significant relationship between Annual premium and Sum Insured.
H1: There is a significant relationship between Annual premium and Sum Insured.

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

Correlation technique to find the correlation
between duration of the policy and selection of
United India Co.
H0: There is no significant relationship between duration of the policy and selection of United
India Co.
H1: There is significant relationship between duration of the policy and selection of United
India Co.

Contd…
From the above table correlation result shows that duration of the policy
and selection of United India Co are negatively correlated with each other.
Since the correlation value is less than 0.5, the correlation is not significant
Inference : There is no significant relationship between duration of the
policy and selection of United India Co.

CHI-SQUARE TEST

Chi-Square Test for comparing the occupation and
satisfaction level of claim settlement.
Occupation and satisfaction level Crosstabulation
Count
Satisfaction Level
TotalHighly
Satisfied
Satisfied Neutral Dissatisfied
Highly
Dissatisfied
Occupation
Govt.
Employee
3 5 1 4 2 15
Corporate
Employee
6 14 2 5 2 29
Self
Employee
4 5 1 2 1 13
Others 1 2 1 0 1 5
Total 14 25 5 11 6 62

Contd…
H0: There is no significant relation between occupation and satisfaction level of
claim settlement of the respondents.
H1: There is a significant relation between occupation and satisfaction claim
settlement of of the respondents.
20

Since the P value 0.927 is greater than 0.05, the null hypothesis (H0) is
accepted.
Inference : There is no significant relation between occupation
and satisfaction level of the respondents.
Chi-Square Tests
Value df
Asymp. Sig. (2-
sided)
Pearson Chi-
Square
5.783
a
12 .927
Likelihood
Ratio
6.216 12 .905
Linear-by-
Linear
Association
.058 1 .809
N of Valid
Cases
62
a. 15 cells (75.0%) have expected count less than 5. The
minimum expected count is .40.

Chi-Square Test for comparing the Annual
Premium and surveyor reach.
Annual Premium * How soon reach the surveyor Crosstabulation
Count
Surveyor Reach
TotalWithin 3
Hrs.
3 - 8 Hrs.
8 - 24
Hrs.
Above 24
hrs.
Annual
Premium
Below 5000 1 2 3 3 9
5000 - 10,000 6 8 7 7 28
10,000 - 25,000 6 5 4 0 15
Above 25,000 3 2 4 1 10
Total 16 17 18 11 62

H0: There is no significant relation between Annual Premium and surveyor
reach.
H1: There is a significant relation between Annual Premium and surveyor
reach.
Chi-Square Tests
Value df
Asymp. Sig. (2-
sided)
Pearson Chi-Square 8.416
a
9 .493
Likelihood Ratio 10.813 9 .289
Linear-by-Linear
Association
3.307 1 .069
N of Valid Cases 62
minimum expected count is 1.60.

Since the P value 0.493 is greater than 0.05, the null hypothesis H0 is
accepted.
Inference:
Hence, There is no significant relation between the annual
premium and surveyor reach.

Chi-Square Test for comparing the time period of claim
settlement and satisfaction level of the respondent.
Claim being settled * Satisfaction level towards claim settlement
Crosstabulation
Count
Satisfaction level
Total
Highly
Satisfie
d
Satisfied Neutral
Dissatisfie
d
Highly
Dissatisfie
d
Time
period of
Claim
Within 7
Days
5 4 2 2 2 15
7 - 15 Days 7 9 3 4 2 25
15 - 30 Days 3 10 0 2 0 15
Above 30
Days 0 2 0 3 2 7
Total 15 25 5 11 6 62

H0: There is no significant relation between time period of claim and
satisfaction level of respondents.
H1: There is a significant relation between time period of claim and
satisfaction level of respondents.
Chi-Square Tests
Value df
Asymp. Sig. (2-
sided)
Pearson Chi-
Square
16.046
a
12 .189
Likelihood Ratio 18.863 12 .092
Linear-by-Linear
Association
.008 1 .927
N of Valid Cases 62
minimum expected count is .56.

Since the P value 0.189 is greater than 0.05, the null hypothesis H0 is accepted.
Inference:
There is no significant relation between time period of claim and satisfaction
level of respondents.

Findings
1. It is concluded that most of the respondents are aware about the health
insurance plans.
2. It is founded that almost all the respondents are satisfied towards claim
settlement.
3. The major findings of the study is that the maximum number of
respondents are Graduates while the minimum number of respondents
are SSC.
4. It is observed that most of the respondents are handling policies with a
maximum premium of Rs. 5001- 10,000.
5. It observed most of the respondents have health insurance policy.
6. Among our respondents we can conclude that most of them have sum
assured 5-10 lakhs and less number of respondents have sum assured
above 10 lakhs.

Contd…
7. There is a significant relationship between annual premium and sum
insured.
8. There is no significant relationship between duration of the policy
and selection of United India Co.
9. There is no significant relation between occupation and
satisfaction level of the respondents.
10. 10. There is no significant relation between the annual premium and
surveyor reach.
11. There is no significant relation between time period of claim and
satisfaction level.

Conclusion:-
 The study has been able to accomplish its objectives, by thoroughly
analyzing and identifying the awareness of the customers of United
India Insurance Company Limited strengths and weaknesses of health
policy among the clients of United India Insurance company and to
identify claim settlement process of health policies.
 The outcome of the study has proved that the performance of the
company is outstanding in making awareness about health insurance
plan in the non-life insurance segment and that the company has a
higher reputation among customers and company have great awareness
among respondents. We can also conclude that respondents of the study
are satisfied with Company products and services.

Contd…
 It is also concluded that the company could initiate various steps based
on the suggestions. The company by adopting some of the
recommendations, if not all, can further improve its performance and
occupy a leading position among other competitors in the non-life
insurance market in future years.

Suggestions
 The company should conduct an effective research for making more and
more awareness about its products among potential customers by means
of advertisements and efficient insurance agents, which in turn will help
in increasing its customers.
 Company may motivate all the agents and intermediaries to suggest the
policy according to individual requirement.
 Company has to do new process and strategies to create a product with
less expensive and which gives more coverage.

Managerial Implications:
 The outcome of the present research is useful for the decision makers in
the company to understand the satisfaction level and accordingly they
can formulate their strategies for promoting their business.
 This research results will enable the marketing personal to explore the
ways to satisfy the existing customers and consequently, to attract new
customers with the motive of financial inclusion.
 Further, the research outcome will be very useful to the general
insurance business involved in them to know the existing customers and
new customers expecting from the company.

Reference
 BOOKS:
IC-27 (Health insurance), Insurance Institute of India: Mumbai.
Kothari. C.R. Research Methodology, New Age International Publishers, New
Delhi 2004
 WEBSITES:
www.uiic.co.in
www.irdaindia.org
www.economywatch.com/insurance/general-insurance
 MAGAZINES AND JOURNALS
Outlook Money.
IRDA Journal.
Insurance watch
Insurance world

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

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