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EXECUTIVE SUMMARY

Study Period :- 01 January to 12 march 2009.

Place of Study :- Star Health & Allied Insurance om!any

As the nation is de"elo!in# at a much hi#her s!eed than $hat $as e%!ected nearly 2 '

decades a#o( is )rin#in# in sedentary life style #i"in# rise to o)esity related disorders. So the demandfor !ro!er tertiary care hos!itals is also #oin# u!. *his )rin#s $ith them hi#h amount of out-of !oc+et

e%!enses.

In the li#ht of !resent healthcare cost it is im!ossi)le to )ear the cost out-of !oc+et(

$hich #i"es a ma,or set )ac+ in terms of financial )urden to the earnin# mem)er of the family. So

insurin# healthcare is the )est !ossi)le $ay out.

Around a decade earlier healthcare !ortfolio $as not #i"en much im!ortance. "en the

#eneral insurance com!anies thin+ it as a )leedin# !ortfolio. ut no$ !eo!le are more a$are of its

)enefits and are o!tin# for it. As the a$areness is #oin# u! mal!ractices are also #oin# u!( cases of

moral ha/ards are "ery common and hence there is as need of strict medical & non medical under$ritin#

#uidelines $hich $ill )e user friendly and com!ati)le $ith todays fast mo"in# $orld( $hich can )e

enhanced throu#h $e) ser"ices and alerts.

y !ro,ect mainly focuses on the com!arison )et$een under$ritin# #uidelines of

different !roduct lines in a !ri"ate sector only health insurance om!any3 and a !u)lic sector com!any

#eneral insurance com!any3. *heir S45* analysis !ertainin# to the restricted #eo#ra!hical area. 4ays

and means throu#h $hich the $or+flo$ can )e enhanced ta+in# the hel! of $e) ser"ices and alerts.

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FINDINGS:-

1. *here is a "ast difference in under$ritin# #uidelines of the t$o com!anies.

2. *here is much sco!e to im!ro"ise in the under$ritin# #uidelines of )oth the

com!anies ma+in# them more users friendly.

'. *he com!anies should )e more "i#ilant re#ardin# the dis)ursement of claims as

mal!ractices are "ery common in this sector.

6. ore stress should )e #i"en on e"en distri)ution of ris+ amon#st !o!ulation

)oth in rural and ur)an area )y effecti"e cam!ai#nin# and creatin# a$areness.

7. *here is "ast #a! )et$een the demand and need of the health insurance in the

society $hich should )e su!!lied effecti"ely.

8. Peo!le tend to a"ail health insurance in second half of their life. oun#er a#e

#rou! should )e encoura#ed more and more to a"ail this facility instead of a

relati"ely a#ed #rou!.

. A !ro!er health care system should )e im!lemented nation$ide )y ta+in#

e%am!les of other nations.

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TABLE OF CONTENTS

ac+#round

Introduction to Insurance

Health are Insurance Scenario

Star Health & Allied Insurance om!any

5),ecti"es of the study

ethodolo#y

;imitations of Study

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C- Questionnaire for sales managers

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INTRODUCTION TO INSURANCE

Definition:-

Insurance is defined as the e@uita)le transfer of the ris+ of a loss( from one entity to another( in

e%chan#e for a !remium( and can )e thou#ht of as a #uaranteed small loss to !re"ent a lar#e( !ossi)ly

de"astatin# loss.

Insurance a!!ears simultaneously $ith the a!!earance of human society. 4e +no$ of t$o ty!es

of economies in human societies:

Money Economie

4ith mar+ets( money( financial instruments and so on........

Non-Money O! N"t#!"$ Economie

4ithout money( mar+ets( financial instruments and so on........

*he second ty!e is a more ancient form than the first. In such an economy and community( $e

can see insurance in the form of !eo!le hel!in# each other. >or e%am!le( if a house )urns do$n( the

mem)ers of the community hel! )uild a ne$ one. Should the same thin# ha!!en to ones nei#h)or( the

other nei#h)ors must hel! 5ther$ise( nei#h)ors $ill not recei"e hel! in the future. *his ty!e of

insurance has sur"i"ed to the !resent day in some countries $here modern money economy $ith its

financial instruments is not $ides!read.

>or %am!le:- ountries in the territory of the former So"iet Bnion.

*urnin# to insurance in the modern sense i.e.( insurance in a modern money economy( in $hich

insurance is !art of the financial s!here3( early methods of transferrin# or distri)utin# ris+ $ere !racticed

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)y hinese and a)ylonian traders as lon# a#o as the 'rd and 2nd millennia ( res!ecti"ely. hinese

merchants tra"ellin# treacherous ri"er ra!ids $ould redistri)ute their $ares across many "essels to limitthe loss due to any sin#le "essels ca!si/in#. *he a)ylonians de"elo!ed a system $hich $as recorded

in the famous ode of Hammura)i( c. 170 ( and !racticed )y early editerraneansailin# merchants.

If a merchant recei"ed a loan to fund his shi!ment( he $ould !ay the lender an additional sum in

e%chan#e for the lenders #uarantee to cancel the loan should the shi!ment )e stolen.

Ac%"emeni"n mon"!c%of Iran $ere the first to insure their !eo!le and made it official )y

re#isterin# the insurin# !rocess in #o"ernmental notary offices.

*he G!ee& and Rom"nintroduced the ori#ins of health and life insurance in 800 AC $hen

they or#ani/ed #uilds called D)ene"olent societiesD $hich cared for the families and !aid funeral

e%!enses of mem)ers u!on death.

Insurance as $e +no$ it today can )e traced to the Ereat >ire of ;ondon( $hich in 1888

de"oured 1'(200 houses. In the aftermath of this disaster( ?icholas ar)on o!ened an office to insure

)uildin#s. In 18F0( he esta)lished n#lands first fire insurance com!any( D*he >ire 5ffice(D to insure

)ric+ and frame homes

In#!"nce( in la$ and economics( is a form of ris+ mana#ement !rimarily used to hed#e a#ainst

the ris+ of a contin#ent loss. An In#!e!is a com!any sellin# the insuranceG an In#!e'is the !erson or

entity )uyin# the insurance.

(!emi#m:-

*he in#!"nce !"teis a factor used to determine the amount to )e char#ed for a certain amount of

insurance co"era#e( called the )!emi#m.

In'emnity:-

*he technical definition of DindemnityD means to ma+e $hole a#ain. *here are t$o ty!es of insurance

contractsG

1. an DindemnityD !olicy and

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2. a D!ay on )ehalfD or Don )ehalf of !olicy.

*he difference is si#nificant on !a!er( )ut rarely material in !ractice. An DindemnityD !olicy $ill ne"er

!ay claims until the insured has !aid out of !oc+et to some third !arty. Bnder the same situation( a D!ay

on )ehalfD !olicy( the insurance carrier $ould !ay the claim and the insured )oth. ost modern lia)ility

insurance is $ritten on the )asis of D!ay on )ehalfD lan#ua#e.

Insurers ma+e money in t$o $ays: 13 throu#h Un'e!*!itin+( the !rocess )y $hich insurers select the

ris+s to insure and decide ho$ much in !remiums to char#e for acce!tin# those ris+s and 23 )y

in,etin+the !remiums they collect from insured !arties.

C$"im: - >inally( claims and loss handlin# is the materiali/ed utility of insuranceG it is the actual

D!roductD !aid for( thou#h one ho!es it $ill ne"er need to )e used.

ommercially insura)le ris+s ty!ically share se"en common characteristics:-

Limite' !i& of c"t"t!o)%ic"$$y $"!+e $oe.

C"$c#$"$e Lo

Affo!'"$e (!emi#m

L"!+e Lo

Acci'ent"$ Lo

Definite Lo

A $"!+e n#me! of %omo+eneo# e.)o#!e #nit

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/EALT/ CARE INSURANCE

Definition :-

*he term %e"$t% in#!"nce is #enerally used to descri)e a form of insurance that !ays for

medical e%!enses.

A health insurance !olicy is a contract )et$een an insurance com!any and an indi"idual( y

estimatin# the o"erall ris+ of healthcare e%!enses( a routine finance structure such as a monthly

!remium or annual ta%3 is de"elo!ed( ensurin# that money is a"aila)le to !ay for the healthcare )enefits

s!ecified in the insurance a#reement. *he ty!e and amount of health care costs that $ill )e co"ered )y

the health !lan are s!ecified in ad"ance( in the mem)er contract or "idence of o"era#e )oo+let.

*he conce!t of health insurance $as !ro!osed in 1896 )y Hu#h the lder ham)erlain from the

Peter ham)erlain family. Accident insurance $as first offered in the Bnited States )y the >ran+lin

Health Assurance om!any of assachusetts. *his firm( founded in 1F70( offered insurance a#ainst

in,uries arisin# from railroad and steam)oat accidents. efore the de"elo!ment of medical e%!ense

insurance( !atients $ere e%!ected to !ay all other health care costs out of their o$n !oc+ets( under $hat

is +no$n as the fee-for-ser"ice )usiness model. Curin# the middle to late 20th century( traditional

disa)ility insurance e"ol"ed into modern health insurance !ro#rams.

*oday( most com!rehensi"e !ri"ate health insurance !ro#rams co"er the cost of routine(

!re"enti"e( and emer#ency health care !rocedures( and also most !rescri!tion dru#s( )ut this is not

al$ays the case.

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*he )asic conce!t of health insurance is !o!ulation solidarity. *here are inherent ris+s in a

!o!ulation )ut the !o!ulation a)sor)s the cost of ris+s to an indi"idual )y s!readin# the im!act ofincurred costs amon#st the insured !o!ulation. Ho$e"er( if the !o!ulation is s!lit into insured and

uninsured #rou!s( or into selecti"ely #rou!s as $ith !ri"ate insurance $ith !re-insurance selection

either )y the insurance com!any or the insured3 the conce!t of !o!ulation solidarity )rea+s do$n. *he

insurance )alances costs across a lar#e( random sam!le of indi"iduals. >or instance( an insurance

com!any has a !ool of 1000 randomly selected su)scri)ers( each !ayin#

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Insurance com!anies li+e to com!are )uyin# health insurance after )ein# dia#nosed $ith a

serious medical condition li+e H to tryin# to )uy fire insurance on a )urnin# house. *hat soundsreally lo#icalK.e%ce!tK.most fire insurance !olicies are ne"er used as most houses dont )urn do$n.

"eryone has medical !ro)lems( ho$e"er( at one time or another.

*o !re"ent a !erson from )uyin# health insurance only $hen they need it( the insurance industry

uses a !rocedure called Lmedical under$ritin#. ;oosely translated into !lain n#lish( it means

Ldiscriminatin# a#ainst anyone $e feel may cost us money. And this ty!e of discrimination a#ainst

!eo!le $ith health !ro)lems is !erfectly le#al.

*he >rench model of health insurance has )een ran+ed )y the 4orld Health 5r#ani/ation as the )est in

the $orld( )ecause it !ermits a hi#h @uality of care and nearly total !atient freedom. . It $as a

com!romise )et$een Eaullist and ommunist re!resentati"es in the >rench !arliament. *he

onser"ati"e Eaullists $ere o!!osed to a state-run healthcare system( $hile the ommunists $ere

su!!orti"e of a com!lete nationali/ation of health care alon# a ritish e"era#e model. *he resultin#

!ro#ramme $as !rofession-)ased. All !eo!le $or+in# $ere re@uired to !ay a !ortion of their income to

a health insurance fund( $hich mutualised the ris+ of illness( and $hich reim)ursed medical e%!enses at

"aryin# rates. hildren and s!ouses of insured !eo!le $ere eli#i)le for )enefits( as $ell. ach fund $as

free to mana#e its o$n )ud#et and reim)urse medical e%!enses at the rate it sa$ fit.

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/EALT/ CARE INSURANCE SCENARIO IN INDIA

*he health care system in India is characteri/ed )y multi!le systems of medicine( mi%ed

o$nershi! !atterns and different +inds of deli"ery structures. Curin# the last 70 years India has

de"elo!ed a lar#e #o"ernment health infrastructure $ith more than 170 medical colle#es( 670 district

hos!itals( '000 ommunity Health enters( 20(000 Primary Health are centers and 1'0(000 Su)-

Health enters. 5n to! of this there are lar#e num)er of !ri"ate and ?E5 health facilities and

!ractitioners scatters thou#h out the country. 5"er the !ast 70 years India has made considera)le

!ro#ress in im!ro"in# its health status.

Pu)lic sector o$nershi! is di"ided )et$een central and state #o"ernments( munici!al and

Panchayat local #o"ernments. Pu)lic health facilities include teachin# hos!itals( secondary le"el

hos!itals( first-le"el referral hos!itals Hs or rural hos!itals3( dis!ensariesG !rimary health centres

PHs3( su)-centres( and health !osts. Also included are !u)lic facilities for selected occu!ational

#rou!s li+e or#ani/ed $or+ force SI3( defense( #o"ernment em!loyees EHS3( rail$ays( !ost and

tele#ra!h and mines amon# others.

*he !ri"ate sector for !rofit and not for !rofit3 is the dominant sector $ith 70 !er cent of !eo!le

see+in# indoor care and around 80 to 0 !er cent of those see+in# am)ulatory care or out!atient care3

from !ri"ate health facilities.

India s!ends a)out 8M of ECP on health e%!enditure. Pri"ate health care e%!enditure is 7M or

6.27M of ECP and most of the rest 1.7M3 is #o"ernment fundin#. At !resent( the insurance co"era#e is

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ne#li#i)le. ost of the !u)lic fundin# is for !re"enti"e( !romoti"e and !rimary care !ro#rames $hile

!ri"ate e%!enditure is lar#ely for curati"e care. 5"er the !eriod the !ri"ate health care e%!enditure has#ro$n at the rate of 12.F6M !er annum and for each one !ercent increase in !er ca!ital income the

!ri"ate health care e%!enditure has increased )y 1.6M. ?um)er of !ri"ate doctors and !ri"ate clinical

facilities are also e%!andin# e%!onentially.

1) Increasing health care costs,

2) High financial burden on poor eroding their incomes,

3) Increasing burden of new diseases and health risks and

4) Neglect of preventive and primar care and public health functions due to under

funding of the government health care!

Around 26M of all !eo!le hos!itali/ed in India in a sin#le year fall )elo$ the !o"erty line due to

hos!itali/ation (World Bank, !!"# An analysis of financin# of hos!itali/ation sho$s that lar#e

!ro!ortion of !eo!leG es!ecially those in the )ottom fourincome @uintiles )orro$ money or sell assets to

!ay for hos!itali/ation (WorldBank, !!"#

Ei"en the a)o"e scenario e%!lorin# health-financin# o!tions )ecomes critical. In li#ht of the

fiscal crisis facin# the #o"ernment at )oth central and state le"els( in the form of shrin+in# !u)lic health

)ud#ets( escalatin# health care costs cou!led $ith demand for health-care ser"ices( and lac+ of easy

access of !eo!le from the lo$-income #rou! to @uality health care( health insurance is emer#in# as an

alternati"e mechanism for financin# of health care.

Health insurance is "ery $ell esta)lished in many countries. As #lo)al insurance !remiums #re$

)y or 7M in real terms to reach N'. trillion due to im!ro"ed !rofita)ility and a )eni#n economic

en"ironment characteri/ed )y solid economic #ro$th( moderate inflation and stron# e@uity mar+ets.

Ad"anced economies account for the )ul+ of #lo)al insurance. *he to! four countries accounted for

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nearly t$o-thirds of !remiums in 2008. *he B.S. and Ja!an alone accounted for 6'M of $orld insurance(

much hi#her than their M share of the #lo)al !o!ulation. mer#in# mar+ets accounted for o"er F7M ofthe $orlds !o!ulation )ut #enerated only around 10M of !remiums. ut in India the health insurance

mar+et is "ery limited co"erin# a)out 10M of the total !o!ulation. It is a ne$ conce!t e%ce!t for the

or#ani/ed sector em!loyees. In India only a)out 2 !er cent of total health e%!enditure is funded )y

!u)licOsocial health insurance $hile 1F !er cent is funded )y #o"ernment )ud#et. In many other lo$ and

middle income countries contri)ution of social health insurance is much hi#her.

T"$e 0

(e!cent"+e of tot"$ %e"$t% e.)en'it#!e f#n'e' t%!o#+% )#$ic1oci"$

in#!"nce "n' 'i!ect +o,e!nment !e,en#e

COUNTRYSoci"$ /e"$t%

In#!"nce

Go,e!nment

B#'+et

Al#eria ' M '8M

oli"ia 20 M '' M

hina '1 M 1' M

=orea 2' M 10 M

ietnam 2 M 20 M

India 2 M 1F M

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It is estimated that the Indian health care industry is no$ $orth of

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STAR /EALT/ 2 ALLIED INSURANCE COM(ANY

Star Health and Allied Insurance o. is a ,oint "enture )et$een 5man Insurance

om!any( r. Syed ohamed Salahuddin(r. ssa A)dullah Al Ehurair(leadin# Indian industrialists and

)usiness houses. It is thier endea"or to !ro"ide dedicated( afforda)le and @uality health insurance that

!reser"es and "alues human li"es. *his com!any aim to )e the most fa"ored )rand in the health insurance

se#ment. 4e offer a $ide ran#e of health insurance ser"ices and related !roducts at afforda)le !rices. 5ur

!rime o),ecti"e is to offer ser"ices in the health se#ment that ena)le you to mana#e stressful situations.

Star Health and Allied Insurance om!any ;imited Star Health3 has a ca!ital )ase of

ood & e"era#es and

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D!3 M3 Y3 5%"n is currently the hairman of the an+in# and Ad"isory council of S an+ ;td.

M!3 D3 R3 5""!t%i&ey"n is currently a "isitin# !rofessor in many !resti#ious institutions.

M!3 V3(3 N"+"!"6"nis the %ecuti"e Cirector of *A AS5? and *A S*A< #rou! of om!anies

head@uartered in Cu)ai( BA.

M!3 Mo%"mme' /""nis a !rominent educationalist and industrialist and has $ide +no$led#e in the

STAR /EALT/ 2 ALLIED INSURANCE COM(ANY :-

$s the first stand alone health insurance company in $ndia# $t speciali%es in &ealth

$nsurance, pro'ides uality ser'ice at the best rates, and commits itself to the

ser'ice of the insured#

)ffers hassle free cashless settlement to the insured# *here is no *hird Party

Administrator in'ol'ed, +hich means better ser'ice, in shorter time and no

hassles### at all

Pro'ides a o Claim .iscount - one that has ne'er been offered before in the

country#

&as a round-the-clock /P ser'ice, +hich pro'ides counseling and ad'ice # When

necessary the insured +ill be guided to the Company0s large net+ork of doctors in

different localities#

Pro'ides periodic health check ups for the clients# &as a range of policies suited to

e'ery age group, different health aspects and concerns#

1 And last but not the least, 2*A3 &4A5*& is first and foremost, a dedicated insurer +ho

cares for your health###in e'ery +ay

E.c$#i,e Fe"t#!e :

ashless ser"ice $ithout *PA inter"ention the BSP of the om!any

Cirect tie-u! $ith hos!itals on all India )asis

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INTRODUCTION TO STUDY

*his study focus on understandin# the under$ritin# Euidelines O Procedures !racticed in t$o different

com!anies from t$o different sectors mainly focusin# on Pri"ate Sector om!any

1. Star Health & Allied Insurance om!any ;td.Pri"ate Sector om!any32. ?e$ India Assurance om!any Pu)lic Sector om!any3

*he study $ill ha"e follo$in# ty!es of insurance !olicies :-

1. ediclaim Policy2. Accidental Insurance'. 5"erseas ediclaim

OB4ECTIVES

1. *o study the under$ritin# EuidelinesO!rocedure of selected !olicies $hich are )ein# !racticed in

the insurance com!any.2. *o calculate & su##est !ossi)le $ays to decrease the turn around time in the under$ritin#

!rocedure for each !olicy.'. *o do a S45* analysis for the !ur!ose of com!arison.6. *o study the e%istin# $e) ser"ices & alerts for the !ur!ose of !olicy under$ritin# & !ost !olicy

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ser"ices.

FLO7 C/ART FOR UNDER7RITTING

T/E MEDICLAIM (OLICY

Sales ana#er OA#ent

Su)mits the Pro!osal to Bnder$riter

Underwriter checks all the Mandatory felds flled in

theProposal FormProposals below50 yrs.O age are Proceeded

or underwriting

Proposals aboe 50yrs. O age are sent or

Pre!medical

#mproperly flled ormsare sent back or

upgradation

Properly flled orms are

preceded or underwriting

$ccording to the proposal

with%without loading on premium

policy is underwritten and issued

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UNDER7RITTING

*he most com!licated as!ect of the insurance )usiness is the under$ritin# of !olicies. *here are 2

different methods of a!!lication that anyone loo+in# for !ersonal health insurance must )e a$are of.

*hese are

1. >ull edical Bnder$ritin# >B3

2. oratorium 5

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lon# you ha"e had it and $hat treatment you ha"e had or are still ha"in# for that condition. A#ain( each

health insurance com!any is different $ith different !olicies so ma+e sure you al$ays do yourhome$or+ $ith re#ards to $hat is and $hat is not included.

If you o!t for a !olicy that re@uires full medical under$ritin# then all your medical history $ill

)e a"aila)le to your insurers u! front ena)lin# them to ma+e an informed ,ud#ement )efore confirmin#

your !olicy. A moratorium !olicy is ho$e"er a little )it different as this ty!e of a!!lication !rocess does

not re@uire disclosure of medical history $hen ,oinin#. Instead any illness is assessed at the !oint of

ma+in# a claim.

4ith moratorium you do not need to fill in a health @uestionnaire. Instead( !re-e%istin#

conditions for $hich you and any de!endant included in your a!!lication3 ha"e recei"ed treatment

andOor medication( or as+ed ad"ice on( or had sym!toms of $hether or not dia#nosed3( durin# the four

years immediately )efore your !ri"ate health insurance co"er started $ill automatically )e e%cluded

from co"er.

Ho$e"er( if you do not ha"e any sym!toms( treatment( medication( or ad"ice for those !re-

e%istin# conditions( and any directly related conditions( for t$o continuous years after your !olicy starts(

then insurers may reinstate co"er for those conditions.

4hen choosin# a !ersonal health insurance !ro"ider it is "ital that you understand the

differences )et$een !olicies and $hich one is )est suited. 4ith any insurance com!any thou#h it is

al$ays )etter to )e honest from the outset to a"oid any disa!!ointment or hefty medical )ills further

do$n the line. 4ith >ull edical Bnder$ritin# the )oundaries are !erha!s clearer as e"erythin# $ill )e

documented from the outset and assessed )y your insurer )efore the !olicy is a!!ro"ed lea"in# you $ith

a clear understandin# of e%actly $hat your !ersonal health insurance co"ers you for. Bsin# a $ide

assortment of data( insurers !redict the li+elihood that a claim $ill )e made a#ainst their !olicies and

!rice !roducts accordin#ly. *o this end( insurers use actuarial science to @uantify the ris+s they are

$illin# to assume and the !remium they $ill char#e to assume them. Cata is analy/ed to fairly

accurately !ro,ect the rate of future claims )ased on a #i"en ris+. Actuarial science uses statistics and

!ro)a)ility to analy/e the ris+s associated $ith the ran#e of !erils co"ered( and these scientific !rinci!les

are used to determine an insurers o"erall e%!osure. B!on termination of a #i"en !olicy( the amount of

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!remium collected and the in"estment #ains thereon minus the amount !aid out in claims is the insurers

under$ritin# !rofit on that !olicy. 5f course( from the insurers !ers!ecti"e( some !olicies are $innersi.e.( the insurer !ays out less in claims and e%!enses than it recei"es in !remiums and in"estment

income3 and some are losers i.e.( the insurer !ays out more in claims and e%!enses than it recei"es in

!remiums and in"estment income3.

*he )usiness model can )e reduced to a sim!le e@uation:

Profit Q earned !remium R in"estment income - incurred loss - under$ritin# e%!enses.

Insurers ma+e money in t$o $ays:

*hrou#h #n'e!*!itin+( the !rocess )y $hich insurers select the ris+s to insure and decide ho$

much in !remiums to char#e for acce!tin# those ris+s.

y in,etin+the !remiums they collect from insured !arties.

Insurance com!anies also earn in"estment !rofits on Lfloat. L>loat or a"aila)le reser"e is

the amount of money( at hand at any #i"en moment( that an insurer has collected in insurance !remiums

)ut has not )een !aid out in claims. Insurers start in"estin# insurance !remiums as soon as they are

collected and continue to earn interest on them until claims are !aid out.

Some insurance industry insiders( most nota)ly Han+ Ereen)er#( do not )elie"e that it is

fore"er !ossi)le to sustain a !rofit from float $ithout an under$ritin# !rofit as $ell( )ut this o!inion isnot uni"ersally held. ?aturally( the Lfloat method is difficult to carry out in an economically de!ressed

!eriod. ear mar+ets do cause insurers to shift a$ay from in"estments and to tou#hen u! their

under$ritin# standards. So a !oor economy #enerally means hi#h insurance !remiums. *his tendency to

s$in# )et$een !rofita)le and un!rofita)le !eriods o"er time is commonly +no$n as the D#n'e!*!itin+D

or Lin#!"nce cyc$e

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MEDIAL UNDER7RITING:-

5n recei"in# an a!!lication from an indi"idual for health insurance( the insurance

com!any carefully scrutini/es the a!!licants medical history and other factors to decide $hether to offer

co"era#e or not and if yes( then on $hat rate and on $hat conditions. ach insurance com!any de"elo!s

its o$n under$ritin# #uidelines to outline the characteristics the com!any considers desira)le and those

that ma+e an a!!licant ineli#i)le for co"era#e. Health insurers a"oid indi"iduals or #rou!s that they

thin+ may )e li+ely to ma+e claims( either )ecause of !oor health or )ecause the !erson or com!any is

financially unsta)le. Insurance com!anies use the term D"',e!e e$ectionD to descri)e the tendency for

only those $ho $ill )enefit from insurance to )uy it. S!ecifically $hen tal+in# a)out health insurance(

unhealthy !eo!le are more li+ely to !urchase health insurance )ecause they antici!ate lar#e medical

)ills. 5n the other side( !eo!le $ho consider themsel"es to )e reasona)ly healthy may decide that

medical insurance is an unnecessary e%!enseG if they see the doctor once a year and it costs

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ecause of ad"erse selection( insurance com!anies em!loy me'ic"$ #n'e!*!itin+( usin# a

!atients medical history to screen out those $hose !re-e%istin# medical conditions !ose too #reat a ris+

for the ris+ !ool. efore )uyin# health insurance( a !erson ty!ically fills out a com!rehensi"e medical

history form that as+s $hether the !erson smo+es( ho$ much the !erson $ei#hs( $hether the !erson has

)een treated for any of a lon# list of diseases and so on.5ne lar#e industry sur"ey found that rou#hly 1'

!ercent of a!!licants for com!rehensi"e( indi"idually !urchased health insurance $ho $ent throu#h the

medical under$ritin# in 2006 $ere denied co"era#e. Ceclination rates increased si#nificantly $ith a#e(

risin# from 7 !ercent for indi"iduals 1F and under to ,ust under a third for indi"iduals a#ed 80 to 86.

Amon# those $ho $ere offered co"era#e( the study found that 8M recei"ed offers at standard !remium

rates( and 22M $ere offered hi#her rates.

*he !remium structure is not desi#ned for the e%tra ris+ assumed )y insurin# !ersons $ho drin+

into%icants to e%cess( $ho are "ictims of dru# ha)its( $ho are rec+less in their manner of li"in# or

choice of associates or $ho ha"e @uestiona)le re!utations. Such !ersons are not eli#i)le for health

insurance.D All com!anies sellin# indi"idual ma,or medical insurance !olicies e%amine the medical

history of e"ery a!!licant( usin# @uestions on the a!!lication( follo$-u! !hone calls( edical

Information ureau re!orts( !aramedical e%ams( and )lood and urine sam!les. edical under$ritin#

manuals are e%tensi"e and include detailed discussions of +no$n illness for each of the )odys systems

circulatory( ner"ous( re!roducti"e( etc.3

oral ha/ard occurs $hen an insurer and a consumer enter into a contract under symmetric

information( )ut one !arty ta+es action( not ta+en into account in the contract( $hich chan#es the "alue

of the insurance. A common e%am!le of moral ha/ard is third-!arty !ayment$hen the !arties in"ol"edin ma+in# a decision are not res!onsi)le for )earin# costs arisin# from the decision. An e%am!le is

$here doctors and insured !atients a#ree to e%tra tests $hich may or may not )e necessary. Coctors

)enefit )y a"oidin# !ossi)le mal!ractice suits( and !atients )enefit )y #ainin# increased certainty of

their medical condition. *he cost of these e%tra tests is )orne )y the insurance com!any( $hich may ha"e

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had little say in the decision. o-!ayments( deducti)les( and less #enerous insurance for ser"ices $ith

more elastic demand attem!t to com)at moral ha/ard( as they hold the consumer res!onsi)le.

Bnder$ritin# is a $ay of determinin# the insura)ility of the client )y re"ie$in# hisOher medical

and financial details usin# "arious ris+ classification models. *his !ractice can )e dated )ac+ to 1F00

.( $hen underta+in# ris+( or under$ritin# ris+( of shi!s $ith #oods $as done. >rom those days(

under$ritin# has e"ol"ed #reatly and is !resently cate#ori/ed into life and non-life under$ritin#( )oth

includin# financial under$ritin#. ;ife under$ritin# can )e further di"ided technically into medical and

non-medical under$ritin#.

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Here are a fe$ ti!s for !rudent medical under$ritin#:

1. Ue yo#! "n"$ytic"$ min' - A&8 9Doe it m"&e ene

Al$ays as+ yourself $hether the data #i"en ma+es sense. In most of the cases the data !resented can )e

mani!ulated or it can )e false !ositi"es. >or e%am!le( a client can ta+e a hy!o#lycemic dru# and #o for a

fastin# )lood #lucose test or the "alue of nine #i"en can )e H)A1( $hen a H)A1c test $as to )e!erformed.

;3 Re"' et*een t%e $ine

Analy/e $hat is not #i"en in the data !ro"ided or find the !otential ris+s the medical re!orts !oint to.

>or e%am!le( a 66-year-old female under#oin# tooth e%traction $as also as+ed to under#o an

electrocardio#ram and fastin# )lood su#ar test. *his data created a dou)t and $hen further in"esti#ated

re"ealed dia)etes mellitus.

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>3 Ue )!o"i$ity )!inci)$e

Bse !ro)a)ility !rinci!les to e"aluate the chances of death or susce!ti)ility to critical illnesses co"ered

)y the health insurance !roduct !ro!osed $ithin that s!an of the co"era#e )y the com!any.

?3 Do not t%in& $on+ te!m

A medical under$riter should not thin+ from a lon#-term !oint of "ie$.

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5ey Fin'in+ in St"! /e"$t% 2 A$$ie' In#!"nce Com)"ny

Lt'

It is the first stand alone health insurance com!any in India. It s!eciali/es in Health Insurance(

!ro"ides @uality ser"ice at the )est rates( and commits itself to the ser"ice of the insured.*he om!any

is led )y a #rou! of leadin# industrialists and )usiness houses in the su)continent.

5man Insurance om!any is one of the leadin# Insurance om!anies in the iddle ast. r.

ssa A)dullah Al Ehurair hails from the !rominent Al Ehurair family in the B.A.. 4ith a net $orth of

BSC '. )illion( the family has )een ran+ed as one of the $orlds richest )y >or)es ma#a/ine...

*he com!any has its /e"' Officein hennai( Co!)o!"te Officein um)ai & Re+ion"$ Office

in Pune from last three years. ;oo+in# at the !otential of "idar)ha re#ion the com!any started its )ranch

office in na#!ur in octo)er 200F.

*he or#anisational structure for this )ranch is as follo$s:

PolicyBnder$riter

ranch ana#er

&alesManagers

'ariable &ales

Managers

$disors$disor

Medical

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*he com!any has "ery stron# financial )ac+u! & "ery #ood leadershi! $hich t$o are the most

im!ortant factors for any com!any to )ecome successful. *he com!any has recorded itself as the fastest

#ro$in# com!any $ith 600M of #ro$th rate.

;oo+in# at the indian scenario of Health insurance( $hich remained hi#hly underde"elo!ed and

a less si#nificant se#ment of the !roduct !ortfolios of the nationali/ed insurance com!anies in India(*here $as need of such ty!e of com!any dealin# only in health insurance. *herefore there is

o"er$helmin# res!onse from the consumers. 5nly in na#!ur from last ' 6 months o"er 600 !olicies

are sold $hich comes around 6 7 !olicies !er day.

Here comes the role of an under$riter as Health sector !olicy formulation( assessment and

im!lementation is an e%tremely com!le% tas+ es!ecially in a chan#in# e!idemiolo#ical( institutional(

technolo#ical( and !olitical scenario. >urther( #i"en the institutional com!le%ity of our health sector

!ro#rammes and the !luralistic character of health care !ro"iders.

*hou#h !olicy under$ritin# is done in the )ranch office for those not re@uirin# medical

e%amination as they are )elo$ 70 years of a#e( those !ro!osers $ho are a)o"e 70 years of a#e( their

medical under$ritin# is done at re#ional office !une.

*he $or+ load here is thou#h not much as the com!any is in its cradle !hase still the under$riter

confirms the !olicy under$ritin# in minimum time $hich "aries from half hour to 6 hours for !olicies

not re@uirin# medical under$ritin#( & those re@uirin# medical under$ritin# may "ary from 26 hours to

17 days. *he ma,or factor here of concern is delay from the !ro!oser in su)mittin# medical documents.

If time !hase is considered from the su)mission of medical re!orts to the issuin# of !olicy it comes to

around 12 hours to 6F hours.

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UNDER7RITTING GUIDELINES FOR VARIOUS

(RODUCTS

03 Me'i-C$"ic In'i,i'#"$

;3 F"mi$y /e"$t% O)tim"

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03 MEDI-CLASSIC INDIVIDUAL :-

edi lassic Insurance from Star Health is a !olicy that aims to !ro"ide reim)ursement of

hos!italisation e%!enses incurred as a result of illnessOdiseaseOsic+ness andOor accidental in,uries.

Any !ersons a#ed )et$een 7 months and F0 years( residin# in India(can ta+e this insurance.

Premium

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'00000 ''00 '870 810 F200 12827 1'916 1F669

'70000 '70 6170 60F 10198 166'6 17986 21'61

600000 6200 6700 F00 11671 18262 1F017 262'8

700000 6900 7600 1000 1'97F 19F79 2211' '002'

Hos!ital ash:Pro"ides for !ayment of amily !ac+a#e !lan and !ro"ides for your ne$-)orn from

)irth u! to the e%!iry of the !olicy !eriod. *he sum insured is restricted to 10M of the sum

insured in res!ect of the mother. Premium 10M of !olicy !remium.

Hos!italisation o"er : In-!atient hos!italisation e%!enses for a minimum of 26 hours.Includes

room rent and )oardin# 2M of sum insured(su),ect to a ma%imum of

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Pre-hos!italisation medical e%!enses u!to '0 days !rior to date of admission.

Post-hos!itali/ation - a lum!sum calculated at M of the hos!italisatione%cludin# room

char#es3su),ect to a ma%imum of

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>irstear%clusions:eni#n Prostate Hy!ertro!hy(Hernia(Hydrocele(>istula in anus(Piles(Sinusitis

and related disorders(on#enital internal diseaseOdefect(remo"al of #allstones and renal stone

?aturo!athy treatment

%!enses $hich are !urely dia#nostic in nature $ith no !ositi"e e%istence of any disease

*reatment of o#ential e%ternal diseaseOdefectsOanomalies

%!enses $hich are mainly cosmetic in nature

;3 FAMILY /EALT/ O(TIMA :-

>amily Health 5!tima from Star Health is a health insurance !lan that #i"es !rotection for the

entire family on the !ayment of a sin#le !remium under a sin#le sum insured. *he sum insured

floats amon# the family mem)ers insured. Its ,ust one more $ay to ti#hten the family )onds.

Any !erson a#ed )et$een 7 months and 80 years residin# in India can ta+e this insurance

A: Adult : hildren u!to 27 yrs. ?A: ?ot A"aila)le

S#m In#!e' : R3 088

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> Mont% - => Y! =? Y!- >> Y! >? Y!- ? Y!

2A 187 ?A ?A

1A R 1 1717 ?A ?A

1A R 2 1860 ?A ?A

1A R ' 1F7 ?A ?A

2A R 1 1F90 ?A ?A

2A R 2 2027 ?A ?A

2A R ' 2187 ?A ?A

S#m In#!e' : R3 ;88

> Mont% - Y!

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2A R ' '827 6080 897 F20

S#m In#!e' : R3 Mont% - Y!

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2A R ' 8027 8760 127F7 17F17

S#m In#!e' : R3 >88

> Mont% - Y!

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ost of medicines and dru#s

mer#ency am)ulance char#es for trans!ortin# the insured !atient to the hos!ital u!to a sum of

irst *$o ears %clusions:ataract(Hysterectomy for enorrha#ia or

>i)romyoma(

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accident3(Prole!ses of inter"erte)ral discother than caused )y accident3("aricose "eins and

"aricose ulcers

>irst ear %clusions:eni#n Prostate Hy!ertro!hy(Hernia(Hydrocele(>istula in

anus(Piles(Sinusitis and related disorders(con#enital internal diseaseOdefects( remo"al of

#allstones and renal stone

?aturo!athy treatment


%!enses incurred for non-allo!athic treatment

*reatment of e%ternal on#ential diseaseOdefectsOanomalies

%!enses $hich are mainly cosmetic in nature

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>or !eo!le a#ed )et$een 80 and 89 years

Euaranteed rene$als )eyond 89 years

?o !re-insurance medical test re@uired

*reatment at net$or+ hos!itals only

All !re-e%istin# diseases are co"ered from first year(e%ce!t those for $hich treatment or ad"ice

$as recommended )y or recei"ed durin# the immediately !recedin# 12 months from the date of

!ro!osal

Cisease for $hich treatment or ad"ice $as recommended )y or recei"ed durin# the immediately

!recedin# 12 months from the date of !ro!osal $ill )e co"ered from second year on$ards

Ce!e!o V"c#$"!

Acci'ent 1 C"!'io

V"#$"! Die"e

100000 7000

200000 170000

Ren"$

Com)$ic"tion

100000 7000

200000 170000

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A$$ Ot%e! m"6o!

S#!+e!ie

100000 80000

200000 120000

Policy Premium Includin# ser"ice ta%

Hos!itali/ation o"er: In-!atient hos!itali/ation e%!enses for a minimum of 26 hours.Includes

room rent and )oardin# 1M of sum

IB e%!enses !er day 2M of sum insured

?ursin# e%!enses

Sur#eons fees(consultants fees(Anesthetists and s!ecialists fees(!er illness 27M of sum

insured

ost of )lood(o%y#en(!acema+er

ost of dru#s and dia#nostic tests 70M of sum insured !er hos!itali/ation

*reatment for ardio"ascular Ciseases O ere)ro"ascular AccidentOancer and )rea+a#e of

ones : u!to

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Post-hos!itali/ation - a lum!sum calculated at M of the hos!itali/ation e%!ensese%cludin#

room char#es3(su),ect to a ma%imum of

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%!enses for treatments that are mainly cosemtic in nature

70M co-!ayment a!!lica)le for !re-e%istin# diseases conditions

'0M co-!aument a!!lica)le for all other claims.

03 ACCIDENT CARE :-

An accident can !ut anyones future at ris+. 4hile an accident can )e sudden( #uardin# a#ainst

them can )e a conscious deli)erate decision. S*A< Health Accident are Insurance !ro"ides

com!ensation in the e"ent of death( !ermanent disa)ility and in,uries suffered due to accidents

Accidental death

Permanent disa)ility total or !artial follo$in# an accident

*em!orary total disa)lement the Insured Person is eli#i)le for a $ee+ly )enefit at 1M of

a!ital Sum Insured follo$in# an accident3 su),ect to ma%imum of

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Co,e!"+e 1 Ri& G!o#) G!o#) I G!o#) II G!o#) III

*a)le I 0.67 !er mille 0.80 !er mille 0.F0 !er mille

*a)le II 0.F0 !er mille 1.'0 !er mille 1.7 !er mille

*a)le III 1.27 !er mille 1.7 !er mille 2.00 !er mille

Fo! G!o#) :-

G!o#) SieH of 'ico#nt on (!emi#m

e.c$#'in+ "''-on co,e! 2 e!,ice t".

2 - 100 Persons 7M

101 - 1000 10M

1001 - 7000 12.7M

7001 - 10000 17M

U 10000 20M

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Policy can )e e%tended to co"er edical %!enses on !ayment of Additional Premium

>or !ur!ose of ratin#( !ersons !ro!osed for insurance are classified under three ris+ #rou!s

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;3 O,e!e" /e"$t% In#!"nce :- Star Corporate travel Protect

Star Family Travel Protect

Star Student Travel Protect

Star individual Travel Protect

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St"! Co!)o!"te t!",e$ (!otect:-

Elo)ali/ation and )usiness e%!ansion ha"e increased the need for tra"elin# )et$een countries.

Peo!le $ho tra"el also hold !ositions of hi#h res!onsi)ility in their or#ani/ations. 4hile all ris+s

cannot )e a"oided( S*A< Health !rotects cor!orate e%ecuti"es durin# their tra"el )y co"erin#

them a#ainst most ris+s arisin# out of tra"el so they can focus on the ,o) at hand and accom!lish

their o),ecti"es.

Fe"t#!e

mer#ency medical e%!enses $hilst you tra"elOstay a)road

mer#ency medical trans!ortation to India

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Any tra"el e%!enses incurred in sendin# a su)stitute em!loyee follo$in# the co"ered

sic+nessOaccidental in,uries of the insured em!loyee

E$i+ii$ity

All or!orate %ecuti"es residin# in India a#ed )et$een 1F and 0 years tra"elin# a)road on

)usiness !ur!oses can ta+e this insurance

I it nece"!y to #n'e!+o me'ic"$ tet

Eenerally not re@uired. Ho$e"er any !ro!osal $ith ad"erse medical history( irres!ecti"e of the

a#e should )e accom!anied )y an E( >astin# and Post!randial lood Su#ar( Brine Stri! *est

and holesterol Profile re!orts duly certified )y a cardiolo#ist.

($"n "n' T!i) o)tion

*he insurance is a"aila)le for *ra"el $orld$ide includin# BSA and A?ACA( for sum insured

limits of BSC 1(00(000( BSC 2(70(000 and BSC 7(00(000.

STAR STUDENT TRAVEL (ROTECT :-

Students tra"elin# a)road are already on their o$n and need hel! if they are e"er laid lo$ )y an illness.

S*A< Health has a s!ecially desi#ned Student *ra"el Protect Insurance that !rotects them durin# a

crucial !hase )ecause medical treatment a)road can )e !rohi)iti"ely e%!ensi"e in most cases.

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Me'ic"$ Benefit

mer#ency medical e%!enses

mer#ency trans!ortation )ac+ to India

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*hese days a lot more families "acation a)road. 4hile this is the !erfect o!!ortunity for en,oyment(

there is a clear need to !rotect the family from ris+s that may )e merely incon"enience( li+e the loss of a!ass!ort or somethin# more serious li+e a mem)er of the family fallin# ill and needin# hos!itali/ation.

*o )e !re!ared for any crisis S*A< Health offers financial !rotection under >amily *ra"el Protect

Insurance Policy

E$i+ii$ity

All Indian ?ationals and their families - a#ed )et$een 8 months and 80 years( tra"elin# a)road

on holiday can a"ail this insurance >amily consists of insured !erson( s!ouse and t$o de!endent children hildren )elo$ 1F years3

Additional children can )e co"ered on !ayment of e%tra !remium at 27M additional !remium !er

child u! to a ma%imum of t$o additional children

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C$"im (!oce'#!e

#norm the #) number or easy reerenceon toll ree number

#n case o emergency hospitali*ation+inormation to be gien within ,- hours ater

#n non!network hospitals+ payment must be

made upront and then reimbursement will beeected on the submission o documents .

#n case o planned hospitali*ation+ it shouldbe inormed ,- hours prior to admission into

$ter checking o the ull documents / feldisit report the claim settlement department

settles the claim.

he Medical O(cer will personally isit the

hospital or oerlooking / taking proper ollow

up o the claim / flls the feld isit report

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*he ma,or time is ta+en )y the !olicies re@uirin# medical under$ritin# i.e. !ro!osers

a)o"e 70 yrs. 5f a#e. As it re@uires !rom!t action from the !ro!oser side after #i"in#

ad"anced recei!t.

5ther$ise !olicies not re@uirin# medical under$ritin# are #ettin# under$ritten e"en in

1:00 1:'0 hrs.

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SOME SUGGESTIONS FOR CONSIDERATIONS:-

Still ri#orous mar+etin# acti"ities can )e underta+en for #ra)in# attention of the mar+et.

As the $or+ load #oes u! unedr$rittin# !rocedures should )e more cautiously done for not

acce!tin# dou)tful cases so the re!udiation rate of the claims can also )e reduced there)y

reducin# disa!!ointment for the !olicy holders.

edical under$riter can )e a!!ointed after the $or+load e%ceeds limit of around 12 -17 cases

!er day reduce the turn around time re@uired for !olicy issuin#.

?on-net$or+ hos!itals should )e em!anelled as soon as !ossi)le after confirmin# their #enuiness

to reduce incidences of moral ha/ards.

*he com!any totally de!ends on $e) ser"ices for their under$ritin#( there should )e some

)ac+u! if the system fails to continue the $or+.

4e) ser"ices and alerts can )e more ri#orously used for !ost !olicy ser"ices )y #i"in# additional

features as follo$s :-

*o #ather and enlist the data )ase of all !olicy holders.

*hose ha"in# mo).no. can )e !ro"ided $ith either $ee+ly O e"ery fortni#ht.

Health ti!s( Health Alerts for social out)rea+s.

Alerts a)out ne$ health care schemes and )enefits.

5ne can ma+e !eo!le a$are a)out e%tra )enefits li+e ta% e%em!tions etc.

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S7OT - An"$yi

STRENGT/S 7EA5NESSES

Stand alone health insurance com!any in

the field. %!erience( e%!ertise and su!!ort of

i# financial #rou!.

;atest *echnolo#y and Infrastructure to

su!!ort & fasten the ser"ices.

All the ran#e of health !roducts under one

roof.

ashless ser"ice $ithout *PA inter"ention

i.e. in-house claim settlement.

26 hours Eeneral Practitioners ad"ice and

medical counselin#

26% in-house all enter

*oll free tele!hone assistance

om!lete +no$led#e )ac+ed $e)site to offer

medical information( includin# health

ti!s.

;ar#e ran#e of !remiums throu#h different

!roducts for e"ery class of !eo!le.

Cirect discount on !remium for no claim

)enefit

4elcome discount for the !ro!osers shiftin#

from other com!any $ith all the

continuation )enefits.

Inno"ati"e !roducts e"en for chronic non-

cura)le diseases li+e dia)etes( AICS etc.

B!comin# !ri"ate health com!anies

offerin# health insurance.

4ell esta)lished !u)lic sector

com!anies.

;ac+ esta)lished infrastructure at

)ranch offices.

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A"aila)ility of tailor made !olicies.

O((ORTUNITIES T/REATS

A)ility of local !eo!le to !ay for #ood

ser"ices.

?on-a"aila)ility of any ma,or health

insurance ser"ice !ro"ider.

4illin#ness of or!orates to ha"e a tie-u!

$ith the com!any.

;ar#e sector of the !o!ulation not co"ered

under health insurance & e"en is una$are of

the )enefits.

Increasin# !o!ulation #oin# a)road and

hence a"ailin# 5"erseas !olicies.

Inceasin# num)er of road side accidents &

increased cost of healthcare facilities

.

sta)lished #eneral insurance

com!anies ha"in# )rand name.

>rom the mal!ractices )ein# re#ularly

done in this form of insurance !ractices.

Bn$illin#ness of !eo!le to )uy health

insurance thin+in# of $asta#e of money.

ore no. 5f !ro!osals from senior a#e

#rou!.$ho are in real need of health care

e%!enses.

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=ey >indin#s durin# study in

?e$ India Assurance om!any

sta)lished )y Sir Cora) *ata in 1919( ?e$ India is the first fully Indian o$ned insurance

com!any in India.

4ith a $ide ran#e of !olicies ?e$ India has )ecome one of the lar#est non-life insurance

com!anies( not only in India( )ut also in the Afro-Asian re#ion.

?e$ India $as a !ioneer amon# the Indian om!anies on "arious fronts( ri#ht from insurin#

the first domestic airlines in 1968 to satellite insurance in 19F0. *he latest addition to the list of firsts

is the insurance of the I?SA*-2.

5ur ission:-

*o de"elo! #eneral insurance )usiness in the )est interest of the community.

*o !ro"ide financial security to indi"iduals( trade( commerce and all other se#ments of the

society )y offerin# insurance !roducts and ser"ices of hi#h @uality at afforda)le cost

5ur alues :-

Hi#hest !riority to customer needs.

Hi#h standards of !u)lic conduct.

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*rans!arency in o!erations.

*he com!any has many )ranch offices in ?a#!ur for different re#ions of ?a#!ur. *he focus

of the com!any is more on "ehicle( fire etc. ty!e of insurances. Health insurance thou#h

ha"in# all ty!e of !ortfolios under the um)rella of the com!any is still a less concerned issue

for them.

*here is common under$riter for all ty!e of insurance !olicies. edical under$ritin# is done

on ad"ice of the authori/ed dia#nostic centers in the city. *hey dont ha"e in-house claim

settlement de!artment. 5n their )ehalf third !arty administrators do the ,o) for them for

$hich they #et 8M of the !remium amount.

*he team of their sales mana#ers are also ne#lectin# health care !ortfolio.

5ther !ri"ate insurance com!anies are !ro"idin# them $ith more )enefits and much more

u!#raded ser"ices.

*here is much sco!e for either im!ro"in# or im!lementin# the under$ritin# #uidelines.

*here is much difference in !remium char#ed for the said co"era#e in !ri"ate com!anies and

?e$ India Assurance om!any.

5ther )enefits li+e no claim )enefit( cumulati"e )onus( continuation )enefits should )e more

em!hasi/ed on $hile e%!lainin# to the !ro!oser.

*he com!any has di"ided $hole India in three /ones accordin# to the health costs of those

!articular areas for reim)ursements.

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mediclaim policy 6-

*his insurance is a"aila)le to !ersons )et$een the a#e of 1F years to 80 years. hildren )et$een

the a#e of ' months to 1F years can )e co"ered !ro"ided !arents are co"ered simultaneously. *he

!ersons )eyond 80 years can continue their insurance !ro"ided they are insured under ediclaim

!olicy $ith our om!any $ithout any )rea+.

*he !olicy co"ers hos!italisation e%!enses for the treatment of illnessOin,ury !ro"ided

hos!italisation is more than 26 hours. Pre-hos!italisation e%!enses for '0 days and !ost

hos!italisation e%!enses for 80 days are also !aya)le.

Cay-care treatment - *he edical e%!ense to$ards s!ecific technolo#ically ad"anced day-care

treatments O sur#eries $here 26 hour hos!italisation is not re@uired.

Am)ulance har#es for shiftin# the insured from residence to hos!ital are co"ered u! to the

limits s!ecified in the !olicy.

Ayur"edic O Homeo!athic and Bnani system of medicine are co"ered to the e%tent of 27M of

Sum Insured !ro"ided the treatment is ta+en in the Eo"ernment Hos!ital.

Pre-e%istin# diseases are co"ered only after 6 continuous and claim free rene$als $ith our

om!any.

Pre-e%istin# conditions li+e Hy!ertension( Cia)etes( and their com!lications are co"ered after

t$o years of continuous insurance on !ayment of additional !remium.

"#clusions$%

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1. Ciseases contracted $ithin '0 days of insurance

2. Cental treatment e%ce!t arisin# out of accident.

'. Ce)ility and Eeneral

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>ollo$in# is the chart for their mediclaim !olicy :-

S#m

in#!e'

y!3

O,e! >

y!3 To

y!3

O,e!

y!3

To =

y!3

O,e!

= y!3

To =>

y!3

O,e!

=>y!3

To >

y!

O,e!

>y!3

To >>

y!

O,e!

>>y!3

To ?

y!

O,e!

?y!3

To ?>

y!

O,e!

?>y!3

To @

y!

0 1'17 1270 16F0 1F70 2700 2F10 '280 '870 6110

0;> 1897 1817 1F80 22F0 2990 '7'0 6010 6710 7080

0> 2017 1920 2210 217 '0 6260 6F60 7670 8080

0@> 2'07 2197 27'0 '100 6'60 6FF0 7880 8'80 090

; 2797 260 2F67 '690 6910 7880 8620 '10 F210

;;> 2F70 217 '1'0 'F'0 7660 820 110 F280 91F0

;> '107 2977 '607 617 7980 8FF0 F10 900 10120

;@> ''80 '200 '8F7 6720 86F0 690 F700 9F60 10920

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6087 'F0 6680 760 970 9210 106F0 120'0 1'660

= 6710 6297 6970 800 F910 10'60 11F0 1'7'0 170'0

=> 6980 627 760 8'7 9F80 11680 1'00 17060 1890

> 7610 7170 79'7 27 10F20 127F0 16'70 18720 1F680

2pecial 7eatures 6-

1. Ciscount in !remium for family co"er

2. ;oyalty Ciscount

'. Eood Health Ciscount

6. umulati"e onus

7. ost of Health hec+ u!

8. Income *a% enefit under Section F0C of I* Act.

laims are administered throu#h *hird Party Administrators *PA3 $hose contact !articulars

a!!ear on the !olicy document. Insured can o!t for cashless or reim)ursement facility for their

claims. *he !ro!oser has the o!tion to a"ail *PA ser"ices( $hich is cashless or direct ser"ice )y

Policy issuin# 5ffice( $hich is on reim)ursement )asis.

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(e!on"$ Acci'ent (o$icy:-

*his !olicy offers com!ensation in case of death or )odily in,ury to the insured !erson( directlyand solely as a result of an accident( )y e%ternal( "isi)le and "iolent means.

*he !olicy o!erates $orld$ide and is a 26 hours co"er.

Cifferent co"era#es are a"aila)le ran#in# from a restricted co"er of Ceath only( to a

com!rehensi"e co"er co"erin# death( !ermanent disa)lements and tem!orary total disa)lements.

>amily Pac+a#e co"er is a"aila)le to Indi"iduals under Personal Accident Policy $here)y the

!ro!oser( s!ouse and de!endent children can )e co"ered under a sin#le !olicy $ith a 10M

discount in !remium.

Erou! !ersonal accident !olicies are also a"aila)le for s!ecified #rou!s $ith a discount in

!remium de!endin# u!on the si/e of the #rou!.

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*his !olicy is )asically desi#ned to offer some sort of com!ensation to the insured !erson $ho

suffers )odily in,ury solely as a result of an accident $hich is e%ternal( "iolent and "isi)le. Hence

death or in,ury due to any illness or disease is not co"ered )y the !olicy.

*he follo$in# ty!es of co"era#es are offered under a Personal Accident !olicy:-

T"$e D

1. Ceath co"er $herein 100M of the ca!ital sum insured is !aya)le.

T"$e C

1. o"era#e under *a)le C

2. ;oss of t$o lim)s O )oth eyes O one lim) and one eye $herein 100M of the ca!ital sum insured is

!aya)le.

'. ;oss of one lim) or one eye $herein 70M of the ca!ital sum insured is !aya)le.

6. Permanent *otal Cisa)lement other than a)o"e e.#. !aralysis due to an accident( $herein 100M

of the ca!ital sum insured is !aya)le.

T"$e B

1. o"era#e under *a)le

2. Permanent Partial Cisa)lement i.e. $here a !art of the )ody )ecomes !ermanently disa)led due

to an accident( e.#. total and irre"oca)le loss of use of a fin#er due to an accident. In such cases(

a !ercenta#e of the ca!ital sum insured as s!ecified in the !olicy is !aid.

T"$e A

1. o"era#e under *a)le

2. *em!orary *otal Cisa)lement i.e. $here the insured !erson )ecomes tem!orarily disa)led from

underta+in# any $or+ as a result of an accident for e.#. fracture of le#s. In such cases( a $ee+ly

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!ayment of 1M of the ca!ital sum insured su),ect to a ma%imum limit( is !aid for the num)er of

$ee+s or !art thereof ma%imum 100 $ee+s3( durin# $hich the insured !erson is totally disa)led.

*he insured can claim only under any one of these sections as a result of any one accident.

*he !olicy also co"ers e%!enses incurred for carria#e of dead )ody from !lace of accident to the

residence su),ect to a limit of 2M of the ca!ital sum insured or amily Pac+a#e Policy( an education fund is !aya)le

for a ma%imum of 2 de!endent school #oin# children( in case of death or !ermanent total

disa)lement of the insured !erson.

*he com!any issue se"eral ty!es of !ersonal accident !olicies such as :-

Indi"idual Personal Accident !olicy.

Erou! Personal Accident !olicy.

Passen#er >li#ht ou!on - o"erin# !ersonal accident ris+ $hilst tra"elin# as a !assen#er on a

scheduled fli#ht.

Eramin Personal Accident Policy - for !ersons residin# in rural areas $here )enefits as !er *a)le

mentioned a)o"e are co"ered for a ca!ital sum insured of

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ha#yashree hild 4elfare Policy - for #irl child in the a#e #rou! of 0 to 1F years. $hose

!arents a#e does not e%ceed 80yrs. In case of death of either or )oth !arents due to an accident( asum of or non $or+in#

s!ouse( the sum insured is restricted to 70M of the sum insured of earnin# s!ouse su),ect to a

ma%imum of

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In case of in,ury claim :-

1. ?otify the !olicy issuin# office immediately.

2. Su)mit Police re!ort if any.

'. Su)mit claim form alon#$ith medical certificate certifyin# the disa)lement.

6. In case medical e%!enses e%tension has )een ta+en( then the !rescri!tion alon#$ith )ills are to )e

su)mitted.

)'erseas 8ediclaim Policy

/i+%$i+%t :-

Premium !aya)le in

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Policy a"aila)le for fre@uent cor!orate tra"elers

edical e%!enses incurred )y the insured !ersons( outside India as a direct result of )odily

in,uries caused or sic+ness or disease contracted are co"ered.

i#ht Plans a"aila)le under the !olicy:

(LAN A-0>or tra"el to countries e%cludin# BSA & anada for )usiness and holiday limited to

BSC 70(000.

(LAN-A-;Same as A-13 a)o"e e%ce!t that )enefits stand increased to BSC 270000.

(LAN B-0>or tra"el $orld$ide includin# BSA & anada for )usiness and holiday limited to

BSC 1(00(000.

(LAN B-;Same as -13 a)o"e e%ce!t that )enefits stand increased to BSC 7(00(000.

(LAN C>or tra"el to countries e%cludin# BSA & anada for em!loyment and studies limited

to BSC 170(000.

(LAN D>or tra"el $orld$ide includin# BSA & anada for em!loyment and studies limited to

BSC 170(000.

(LAN E-0>or tra"el $orld$ide includin# BSA & anada for cor!orate fre@uent tra"elers

limited to BSC 1(00(000.

(LAN-E-;Same as -13 a)o"e e%ce!t that )enefits stand increased to BSC 7(00(000.

>* o"er is a"aila)le for %ecuti"es 5f or!orate clients and Partners of re#istered firms

annually su),ect to the duration of any one tri! not e%ceedin# 80 days.

ACCI*I5?A; Add-on )enefits:-esides the a)o"e additional add-on )enefits are a"aila)le

under usiness & Holiday and >* co"er%ce!t Plan and Plan C3

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>irst BSC 100 of all claims are to )e )orne )y the tra"eller.

Please refer to Policy for further details.

S7OT - An"$yi

STRENGT/S 7EA5NESSES

5ne of the )i##est #eneral insurance

com!any

;atest *echnolo#y and Infrastructure to

su!!ort & fasten the ser"ices.

26 hours Eeneral Practitioners ad"ice

and medical counselin#

*oll free tele!hone assistance

om!lete +no$led#e )ac+ed $e)site to

offer medical information( includin#

health ti!s..

ffecti"e Pan India Presence.

first fully Indian o$ned insurance

com!any in India.

Already esta)lished )rand name.

;ar#e amount of s+illed and

e%!erienced man!o$er.

ery stron# financial )ac+ u!.

All the ran#e of #eneral insurance

!roducts under one roof.

ashless ser"ice $ith *PA inter"ention

hence loose !ersonal touch $ith the

consumer.

;ac+ of @ualitati"e and result oriented

leadershi! in health insurance.

Bnder-utilisation of all the reources li+e

man!o$er( technolo#y(

infrastructure etc.

Bna"aila)ility of ri#orous trainin#

sessions for +no$led#e u!#radation.

Bna"aila)ility of cross chec+in#

mechanism for claim settlement.

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O((ORTUNITIES T/REATS

A)ility of local !eo!le to !ay for #ood

ser"ices.

4illin#ness of or!orates to ha"e a tie-

u! $ith the com!any.

;ar#e sector of the !o!ulation not

co"ered under health insurance & e"en is

una$are of the )enefits.

Increasin# !o!ulation #oin# a)road and

hence a"ailin# 5"erseas !olicies.

an !ro"ide all sort of #eneral insurance

!ortfoiio under one roof as a

com!rehensi"e ser"ice !ro"ider..

>rom the mal!ractices )ein# re#ularly

done in this form of insurance !ractices.

Bn$illin#ness of !eo!le to )uy health

insurance thin+in# of $asta#e of

money.

ore no. 5f !ro!osals from senior a#e

#rou!.$ho are in real need of health

care e%!enses.

>raud claims #ettin# a!!ro"ed.

>rom fastly #ro$in# !ri"ate sector

com!anies !ro"idin# #ood ser"ices.

.

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'nne#ure 1

(uistionnaire for &ales anagers

?ame :- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

o 4hy you chose to )e a Stars Sales ana#erW

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV


o Ho$ do you a!!roach a !ros!ecti"e consumer W for e%.

Pre"ious contacts or relati"es

Cirectly to un+no$n !erson

Any other Please s!ecify3

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

o 4hich !olicy you stress more on & for ho$ much of co"era#eW


o 4hat do you mean )y )!e-e.itin+ 'ie"e!lease defineW


o 4hat is the )!oce'#!e fo! c$"im!lease #i"e detailsW


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o 4hat are our to$$ f!e no3>or our re#ion W


o 4hat are the J#e!iecustomer raises $hile you e%!lain them the !ro!osalsW



o 4hat is the m".im#m $imitof time fo! !ene*"$of the !olicy W


o In totality ho$ many forms of !olicies S*A< ha"e in its !ortfolioW




o 4hat do you e%!lain to customer $hile e%!lainin# the !olicies li+e PC( e%clusions(

)enefits( rene$als etc.W





Please e%ce!t my sincere than+s for co-o!eratin# me in my !ro,ect $or+.

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JUISTIONNAIRE FOR (OLICY /OLDERS

1. >rom $here you #ot the information a)out Star Health & Allied Insurance com!anyW

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

2. Ho$ you find !ost !olicy ser"ices of the com!anyW


'. Ha"e you e"er claimed for your healthcare ser"icesW


6. If yes ho$ $as the e%!erienceW


7. Are you satisfied )y the !remium amount this com!any char#e forW



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