“RELICARE CRITICAL ILLNESS POLICY”

PRESENTED BY - GROUP 2

Richa Gupta

Ravindra Sharma

Prateek Paliwal

Huma Siddiquee

Abhishek Gupta

Namita Pandey

Viral Makhwana

Manish Shukla

Bhavesh Chaddidar

Ranveer Singh Baghel

Dipika Malpani

MBA-HHC, SIHS, Pune

Relicare - Critical care illness policy

Provides protection from the life threatening illness, which can hamper your routine life style. With a critical illness cover you can secure yourself from such contingencies. This is a benefit which pays the SI a lump sum amount once you are diagnosed with one of the listed critical illnesses-

First Heart attack

Cancer

Multiple sclerosis

Paralysis

CABG

Major organ Transplant

Primary pulmonary Arterial Hypertension

Stroke

Kidney failure

Aorta Graft surgery

Integrated

Need for policy India is home to over 60 million coronary heart patients.

India's economic loss due to heart related disease could be $236 billion till 2015.

At any given time there will be 3 million cancer patients in India.

India has the highest incidence of heart related diseases in the world and the number of those affected is likely to double in the coming years .

Over the last three decades, cases of coronary artery disease in India have risen threefold.

An estimated 12 out of 100 people living in cities; and seven out of 100 in rural India suffer from heart disease.

(Source: World Health Organization )

Acc. To Enas A Enas, Director, CADI (Coronary Artery Disease among Asian Indians) Research Foundation, California -

"If no initiative is taken to check the disease, the most predictable and also preventable among all chronic diseases, India will have 65 million patients with heart disease by 2015, compared to 16 million in the US.

The rate of heart attacks among Indians younger than 45 years of age in the last three years was five times higher than in other populations.

"If urgent preventive steps are not taken, heart attack deaths in India are likely to double by 2015," he said.

A WHO report also stated that deaths due to cardiovascular diseases account for 29% of all deaths.

Some more Vital Stats

60% patients in India get acute coronary syndrome, compared to 40% in the developed world.

75% patients bear hospital costs out of their own pocket. Insurance etc take care of only a tenth of the population.

AMI mortality rates have been detected to be around 166/100000 for men and women respectively.

The Indian scene revealed that the prevalence of cardiovascular diseases in 2005 was 3422/100000 with the mortality figure due to cardiovascular diseases being 188/100000 in 2005.

Estimated mortality from Coronary Heart Disease (CHD)

Year Deaths in age groups (yrs) 4% Deaths in age groups (yrs) 6%

Total deaths

20-29 30-39 40-49 50-59 60-69

2000 180,448 219,571 244,778 352,758 302,503 1,300,057

2005 246,016 290,149 333,361 462,978 385,940 1,718,444

2010 332,687 363,820 438,981 602,438 512,452 2,250,378

2015 419,680 498,062 572,402 780,488 675,638 2,956,288

AMI Myocardial infarction (MI or AMI) commonly know as Heart

attack, is the rapid development of myocardial necrosis caused by a critical imbalance between oxygen supply and demand of the myocardium. This usually results from plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium.

Diagnosis:

1) ECG

2) Cardiac markers – creatine kinase- MB, and troponin I or T.

3) Angiography – coronary catheterization

 

Treatment Options

Treatment Option Approximate cost of Treatment

Thrombolytic therapy

Lower end thrombolytics

~ Rs. 15 000 - 25,000

Higher end thrombolytics

~ Rs. 60,000 - 85,000

Percutaneous Coronary Intervention (PCI)

~ Rs. 2 – 4 lakhs

CABG ~ Rs. 1.5 Lakhs

Angioplasty (with or without Stenting)

~ Varies with the no. and length of damaged artery

Newer therapies: Stem cell (Under studies)

Depends on the case

Existing product Company/ Key features

Bajaj Allianz Reliance General

Tata AIG ICICI Lombard

HDFC Standard life insurance

Product name Critical illness Reliance Critical Illness

Criti-care Critical care insurance

HDFC Critical Care Plan

Coverage (Rs.) 5 Lakhs 5 Lakhs 5 Lakhs 3, 6 or 12 lakhs 3 to 5 Lakhs

Premium (cost of coverage in Rs.)

1500 1510 3909 Not discreted No data provided.

Special features

Cover 10 critical illnesses & Donor expenses covered

Provide Coverage for 10 Critical Illness. Surgeries

Covers 12 critical illnesses & Second Opinion Benefit

Also provides cover against 9 Critical illness & accidental death and permanent total disablement

Covers as many as 10 critical illnesses ,Provides valuable protection on survival post diagnosis

Medical test Not specified After 45yrs No No No

Eligibility conditions

Indian Nationals only, Children >3 Yrs and Adult <65 yrs

Any individual between age group of 20 and 50 yrs. The max entry and exit age 50 and 55 yrs

No data provided by the provider

Age grp 20 – 45 yrs

Age group 18-65 years. The max. entry and exit is 60 years.

IRDA GUIDELINES

Regulation 5 sub regulation 2 & 3 of IRDA (Assets, Liabilities and Solvency margin of Insurers) Regulations 2000 requires Mortality rates/ Morbidity Rates to be used, shall be by reference to a published table, unless the insurer has constructed a separate table based on his own experience and such table to be made available to the insurance industry by the Actuarial Society of India (ASI), with the concurrence of the Authority.

ASI after the process of examination by a committee of actuaries has suggested CIBT 93 to be used as the Standard reference Critical Illness rates table to be used under sub regulation 3 of regulation 5 of IRDA (Assets, Liabilities and Solvency margin of Insurers) Regulations 2000 for pricing and valuing the liabilities of Critical Illness Standalone products or Critical Illness Riders-Accelerated or Lump Sum.

IRDA gave its concurrence to the same which has been communicated to all Life Insurers by ASI.

According to IRDA the following documents are required in case of a Critical Illness Claim:  

1) Claimant’s statement  

2) Attending Physician’s statement   3) Original policy document  

4) Medical records like investigation report, admission records, treatment records  

5) Discharge summary duly attested by the Issuing authority or notarized copy

According to New IRDA Guidelines for Health Insurance Companies :

 -A health insurance company cannot refuse to renew policy, except in cases of fraud, which means a wrongful claim has been made to dupe the insurance company.

-Just because you have been hospitalized for an illness, and when you go back for renewal the Insuring company cannot force you to move to another plan. They will have to renew the one you already have.

Marketability Check Marketability can be check by identifying the strength or distinctive features

of the policy. By measuring the external environmental factor like competitor’s marketing strategy, awareness about the policy, penetration in the market etc..

It is also checked by the geographical features of the area like for critical illness policy we have to check the No. of patients in that particular area, The possibility of the potential patients, No. of specialty hospital for this disease in the area.

The economical condition have to be taken in to consideration for the marketability of the policy.

Effective sales and marketing strategy is also a vital for the marketability check.

Contd… Countable no. of existing policies are available in the market

which cover this major life threatening disease

Despite of people belonging to medium or high economical strata, majority don’t have critical health policies.

A market survey done in State of Maharashtra( no of cardiologist n= 92) and Gujarat (n= 80) resulted in conclusion that 72% of patients with AMI could not avail the costlier and effective treatment just because of non coverage under critical health insurance schemes.

Survey findings shows that approx 52% of the population are unaware of such kind of Critical care policies. And only 3% of the individual are covered with these policies.

also the survey resulted in preference of such kind of insurance policies by cardiologists and the General public.

Contd…

Now with the people getting more verse with the recent advances in healthcare and also getting acquainted with the various payment options for the treatment (with help of insurance coverage).

So in all the product covering such kind of disease do certainly have a place to exist in the market for longer time.

There seems to be more demand for such kind of health coverage.

So its time to hit the paddle as fast as possible to attain a star position in the market.

“RELICARE CRITICAL HEALTH POLICY”

 

 

 

Features

Starting date: Nov 1, 2009

Objective: To provide cover on diagnosis and treatment of any of the 10 major medical illnesses and procedures. The first of its kind, it offers a lump sum benefit on diagnosis of the listed critical illness.

Critical Illness Cover The Critical Care Insurance shall cover, subsequent to

120 days from the policy start date, the following major medical illnesses and procedures:

1. Cancer2. Coronary Artery Bypass Graft Surgery3. Myocardial Infarction (Heart Attack)4. Kidney Failure (End Stage Renal Failure)5. Major Organ Transplant6. Stroke7. Paralysis8. Heart Valve Replacement Surgery9. Multiple Sclerosis

10.Aorta graft surgery

On diagnosis of any of the above illnesses, the insured is entitled to the lump sum benefit of the entire Sum Insured opted for.

Main features

1. Individual contract

2. Pure risk product

3. Multiple options insurance plan

4. One year contract with possible extended terms

5. Premium is payable yearly

6. The critical illness cover can be enhanced by adding the optional additional benefits: accidental death.

7. All optional benefits must be selected at the outset of the plan itself.

8. Once such a claim has been met, no further claim can me made under this benefit

Unique Features

1. Lump sum Benefit on Diagnosis: Pays a lump sum benefit up to Rs. 15,00,000 if diagnosed to be suffering from a Critical Illness covered under the plan and if it is the first incidence.

2. Second Opinion Benefit: Relicare provides for taking another opinion on the first diagnosis of the Critical Illness. The second opinion agency transfers the medical reports and diagnosis to a expert panel for review and independent opinion on diagnosis and line of treatment. This facility is absolutely free of cost to the customer and is applicable on the covered Critical Illnesses.

Eligibility conditions

Covers people between the ages of 18 – 65 years

Maximum age for entry for the policy is 60 years

The insured can be either you or your spouse

Age is calculated as on the date the policy is issued (i.e. age completed as on his last birthday)

Exclusions 

Critical illness that could have been made under any earlier policy.

Any condition directly or indirectly related caused or associated with HIV/AIDS

Pregnancy and childbirth complications.

Occupational diseases

War, invasion terrorism

Natural peril

Radioactive contamination

Self-injury

Use of intoxicating drugs/alcohol

Does not cover any other illnesses

Premium

Premium rates vary depending on the age of the policyholder, the term of the policy and the sum insured.

Premium mentioned is Annual (in Rs) & inclusive of applicable Service Tax. The premium paid (up to Rs 10,000) is exempt from Income Tax under Sec 80 D of Income Tax act. This Policy does not cover any Pre-Existing Medical Conditions.

Premium rates

Coverage Limit (Rs)

250000 350000 500000 750000 1000000 1500000

Age In yrs            

18-24 962 1347 1925 2887 3850 5775

25-29 1365 1911 2731 4095 5460 8191

30-34 1955 2736 3909 5864 7817 11726

35-39 3330 4661 6659 9988 13317 19976

40-44 6089 8525 12178 18267 24356 36534

45-49 10607 14849 21214 31820 42427 63640

50-54 16695 23374 33392 50087 66783 100175

55-59 25339 35474 50676 76015 101353 152029

60-64 38597 54035 77193 115790 154386 231579

Policy Coverage

ReliCare offers you a choice of coverage on both the sum insured and the tenure of the policy. You can choose the sum insured of Rs 2.5, 3.5, 5, 7.5, 10, 15 Lacs over a period of 1, 3 or 5 years. The premium would be calculated accordingly.

Key Benefits Comprehensive Cover - Lump sum benefit on diagnosis of

any of 10 Critical Illnesses Cover.

Avail tax benefit under section 80D of Income Tax Act.

No health check-up required.

No 30 day survival period, benefit paid immediately on diagnosis

In case of death of the policyholder, the insured sum is paid to the nominee

In case of death due to an accident, an additional amount equal to the basic sum insured is paid to the nominee

MARKETING

MARKETING

REGULATIONS Regulatory authority viz; IRDA appointed by parliament, has issued

mandatory provisions for regulating markets forces. Every company must follow while appointing agents, payment of compensation, pricing and launching of the product promotion champagne and observance of code of ethics under advertisements.

MARKETING

Product launch and commercialization steps:

· Finalize the product, including component parts;

· Develop a promotional strategy;

· Determine the competitive positioning and distribution channels;

· Establish staff training courses and incentive schemes; and

· Shore up technological and communication systems.

Criteria for developing a market strategy

4 P`sProduct Price Place Promotion

4 C`sCustomer need and wantsCost to customerConvenienceCommunication

Marketing health insurance:

Various ways of marketing Hire a telemarketer

Ads in local publications.

Networking clubs.

Post card mailers.

Web marketing.

fliers and banners

Free health checks

TV commercials

Customer relationship managementFollowing points will be followed to ensure an effective CRM:

•For effective CRM, one should pay attention to existing and potential health insurance policy holders. It’s important to listen to what people who actually matter have to say.

•A health insurance company will charge the same rates for any one policy from all clients.

• When a insurance claim is filed, especially for a large amount, the company will help the policyholder with the necessary paperwork. Company will avoid bureaucracy and instead, facilitate the speedy dispensing of claims. There are companies who avoid doing this in order to frustrate beneficiaries who eventually forsake their claim. Although this generates a short term profit for the company; but it hurts the reputation of the company in the long run .

•One common problem that insured people face is that insurance companies do not inform clients regarding a hike in premium rates. All these information will be provided to the policy holders.

EVALUATION

The product is evaluated under the following point and features:

The regulatory requirements and guidelines issued by the IRDA are followed.

The customer is properly guided about the terms and conditions of the policy.

To increase the acceptance in the market it is being aggressively promoted.

Costing of the policy. It is compatible with the risk level acceptable to the organization. Whether the policy is accepted by the people or not. The information which are included in a policy is convey properly.Whether we are able to achieve the predetermine target.What people want from the policy?

Evaluation Cont.

SWOT Analysis:

We can also evaluate the policy with the help of the SWOT Analysis in which we measure the distinctive features of the policy, which make the policy different from the others like the premium is very low, the policy cover the more people as compare to other policy.

We should identify the weakness or the features which act as the hurdle in making the policy feasible or accepted by the people.

The feature in which by modifying them we make the policy more feasible or more viable for the people. We should identify the opportunities measure of the policy.

We also evaluate the by various other measure like,

Rate of return on the policy.The cost incurred in the sales, marketing and other administrative work.The No. of policy sold or accepted by the people. The rate at which the policy is being accepted. The contribution of the policy in the total revenue of the company. Development of the policy in the market. Advertisement convey the information regarding policy in a proper manner. Any dissatisfaction or complaint about the policy in the people.

These are the some of the features on the basis of which we can evaluate the policy.

Policy Review

A policy review involves an analysis of benefit and costs.a policy review ensures that:

The right coverage is in place for financial objectives and obligations.

Ownership is structured in your and your beneficiaries' best interests.

Beneficiary designations are up-to-date.

The policy is cost-effective.

It is amazing how many businesses do not understand the policies they have in place and what risks are covered under them. This not only leads to valid claims not being made but also can have more serious consequences. If an event occurs so it is necessary for us to timely review the policy.

Review Dates

Particulars Date

Submission of Proposal to the Regulatory body

25th Sep

Approval by regulatory authorities

1st of Oct.(Expected)

Completion of formulated product

20th Oct.

Launching of Product 1st of Nov.

Post marketing Surveillance 6 month later after the launch

Financial and performance review

6-12 months after the introductions and there after regularly every after 6 months.

Financial Review ROI= Revenue/ Profits

- E.g 100 crore is invested in project, cost of capital- 10% than we need to generate ROI more than 10%.

Cash flow: It is cash in hand which helps in future expansion. Cash (rather than book profits) is what is most important to the management and shareholders that have a claim on the organization.

How to compute cash flow….

Cash Flow (CF) = EBIT (1- t) - ∆WC - ∆PPE

EBIT = Earnings Before Interest and Taxes

t = Tax rate

∆WC = change in working capital = ∆current assets - ∆current liabilities

∆PPE = change in property, plant, and equipment = capital expenditures – depreciation

Performance Evaluation

Common indicators of company performance are available

Statistical analysis of performance

Ratio analysis

Trends over time

Compare to industry average

The higher the liquidity ratio, the more liquid the company

Liquidity Ratio = Invested Assets / Loss Reserves and Unearned Premium Reserves

Performance Evaluation

Underwriting gains and losses or underwriting profitability measured by the net underwriting margin

Profits include investment income, underwriting profits and realized capital gains

Ratios can be calculated to focus on various sources of profits

Net Underwriting=

Premium Income - Policy Expenses

Total AssetsMargin

Success requires making the right choices

Time is real value and critical make sure all your assets are

safe.

Real Time

Thank you