An Assignment On Practical Application with reference to Strategic Management Study of

Health Insurance Plans

Faculty Guide Prof. Kalpesh Ganotra

Submitted by:CHETAN ANSODARYA (5) PATEL VARUN Section :- Finance B MBA Semester III (6)

Parul Institute of Management & Research Parul Group of Institute Affiliated to Gujarat Technological University

Health Insurance Plans

Easy Health Insurance Plans are designed in a way to suit your need and fit your pocket. They will not only guard you against the spiraling medical costs but will also guide you on the path of wellness, providing you a double protection of prevention and cover. The Easy Health Insurance Plans are available for Individuals (Easy Health Individual Health Insurance Plan) and Families' (Easy Health Family Health Insurance Plan). These Plans manage you and your families health-related needs right from consultation and hospitalisation to the post-hospitalisation. These policies are available on a cashless basis in over 4000 network hospitals thus managing your expenses and providing hassle-free transactions. To provide you with Best Health Insurance coverage and to let you decide the right policy that suits your needs, we have made three variants available, which give you a choice and freedom to decide your premium. The Easy Health Insurance policies are power-packed with unique features like cash credited on daily basis on choosing shared accommodation, daily cash for accompanying an insured child, maternity expenses, health check-up, spectacles, contact lenses, etc. and out-patient dental treatment. When a person is young, he is optimistic about his health and not very concerned about major risks to his being hale and hearty. But this tends to change as the years go by. That change in mindset and awareness leads most people to think about getting a health insurance for those unforeseen illnesses and disruptions in the healthy functioning of their body. When prepared for purchasing a health insurance, it is always advisable to take a comprehensive health insurance as it completely takes care of sudden hospitalisation which can be traumatising for everyone.

There are just a few factors that should be considered when insuring yourself or your family members. The most important is to not listen to unsolicited advice. This is generally the case when people try to know about the health plans taken by relatives, neighbours and friends and assume that they can emulate somebodys choice when they wish to buy insurance for themselves. For getting the right insurance, it is crucial to know what you are looking for. You should be well informed, aware of all your requirements including your budget. It makes a big difference if you are aware of what is covered and what is not when looking to buy an insurance policy. The minimum entry age for the complete health insurance policy is 6 years. It is advantageous to get a policy while you are at the peak of your health as you do not have to undertake a medical test to get an insurance cover under the age of 45 years. Such minor details help you make the right decision when you buy health insurance. It is possible to customise the health insurance policy as per every individuals requirement. In case of hospitalization, a policy covers the expenses for the room, doctors fees or a surgeons along with the medical bills, to a large extent. More often, the policy also takes care of all the medical expenses 30 days prior and 60 days after hospitalisation. Being paranoid and stressed is a likely reaction to sudden hospitalisation due to unforeseen events. This is when a health insurance will come to your rescue. With a network of over 4000 hospitals, the policy holder can even get cashless claim which allows the family to focus on the health of the hospitalised family member. These pointers can help you determine just what you will need when you look to buy insurance to be prepared for unanticipated medical bills.

Salient Features of the Policy

1.1 The Group UNIVERSAL HEALTH INSURANCE POLICY will be available to groups consisting of more than 100 families. Each Insured should cover all eligible members (insured persons) under one group policy only. In other words different categories of eligible members shall not be allowed to be covered under different group policies. It is not permissible to issue any unnamed group policy. 1.2 The Group Policy will be issued in the name of the Group/Association/Institution (called insured) with a schedule of names of the members including his/her eligible family members (called Insured persons) forming part of the policy. 1.3 The Policy covers reimbursement of Hospitalisation expenses for illness/diseases contracted or injury sustained by the Insured Person. In the event of any claim becoming admissible under policy, the company through TPA will pay to the Hospital/ Nursing Home or Insured Person the amount of such expenses subject to limits as would fall under different heads mentioned below, as are reasonably and necessarily incurred in respect thereof anywhere in India by or on behalf of such Insured Person but not exceeding Sum Insured (all claims in aggregate) for that person as stated in the Schedule in any one period of insurance.

Section - I: Hospitalisation Expenses

Hospitalisation Benefits A. a. Room, Boarding expenses as provided by the Hospital/Nursing Home b. If admitted in IC Unit B. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs. Limits a. Upto to 0.5% of Sum Insured per day b. Upto 1% of Sum Insured per day Upto Rs.15% of Sum Insured per illness/ Injury Upto 15% of Sum Insured per illness/Injury

Payment of Premium
1. Individual Person Rs.365/- per annum 2. Family (not exceeding five members) consisting of Insured,Spouse and first 3 dependant children Rs.548/- per annum. 3. Family not exceeding 7 members consisting of Insured, Spouse, first 3 dependant children and dependant parents Rs.730/- per annum. Note : No Refund of premium will be allowed for deletion of Insured Person in the event of Insured Person having made/recovered a claim under the Policy. The Policy may be renewed be mutual consent. The Company shall not however be bound to give notice that it is due for renewal and the Company may at any time cancel this policy by sending the Insured 30 (thirty) days notice by Registered Letter at Insured's last known address and in such event the Company shall refund to the Insured a prorata premium for unexpired period of Insurance The Company shall however, remain liable for any claim which arise prior to the date of cancellation The Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company's Short period rate only (table given here below) provided no claim has occurred up to the date of cancellation.
Rate of premium to be charged 1/4 of the annual rate

Period of risk Up to 1 month

Up to 3 months 1/2 of the annual rate Up to 6 months 3/4 of the annual rate Exceeding 6 months Full annual rate

Health insurance coverage

Hospital insurance In this plan offers specific benefit for daily hospital room and board and common hospital services and supplies during stay in hospital Surgical expenses insurance Surgical expenses insurance pays part or full amount of the surgeons fees for operation. A policy of this kind usually list a number of specific operation and the maximum fee allowed for each. The higher the maximum fee allowed in the policy. The higher the premium charged. `Physician expanses insurance:Physician expanses insurance helps to pay for physicians care that does not involve surgery. Its coverage may include visit to the doctors office, X-rays, and lab tests. Dental Insurance:It is insurance designed to pay a portion of the cost associated with dental care. They have a wide range of coverage options which may include free preventative services such as cleaning. There is no industry standard annual maximum limitation, deductable, or co-pay. Long term care insurance An insurance product sold in the united state and united kingdom helps to provide for the cost of long term care beyond a predetermined period. It covers care generally not covered health insurance, Medicare or Medicaid.

Health insurance in India and its importance

Health is wealth. If you are not in the best of health, you will find it hard to do or enjoy anything else. An unhealthy person cannot achieve much because dealing with his sickness dominates his thoughts, whereas a person with a sound health will be motivated and will be able to achieve anything. With increasing awareness on health amongst the younger generation, India is gradually becoming health conscious. This is because youngsters have new ambitions, big dreams and high goals and they have the motivation and drive to make them all come true. Their lives are fast paced and because of this fact there is an absolute need for health care so that they are able to overcome all the obstacles that might come their way. For this reason, Indians have realized the importance of health insurance India. Owing to this realisation. the medical insurance sector is one of the fastest growing segments in India today. A lot of factors have contributed to this change with the most important being the change in people's mindset about mediclaim insurance. Earlier, it was thought that mediclaim insurance policies are only for older people. In addition to this, another misconception was that insurance companies are not reliable and that they have hidden clauses that the health insurance companies use to trick you in the name of health care. Despite such obstacles, the mediclaim companies have seen growth and earned people's trust. Furthermore by providing the best medical insurance policies, they have also reached a point where even the Indian government acknowledges the benefits of getting a mediclaim policy. Here are a few reasons why companies providing insurance for medical care have been so successful
1.

Security for you and your family: Health insurance policies are plans that are designed to be used when you have any health related problem. A health care insurance policy can be thought of as a contingency plan made to make things easier for you when the going gets tough. A policy not only protects you, but your whole family. The best health insurance companies offer "family floater" plans. A "family floater" plan can cover two adults and two children and comes out to be more efficient than four individual policies for each family member. Usual benefits included are coverage of medical

expenses due to hospitalisation, 30 days prior to hospitalisation, 60 days post hospitalisation etc. Furthermore, best health insurance policies should include other bonus features such as "cashless hospitalisation", free health check-ups, inclusion of pre-existing diseases etc.

2. Monetary support: Along with the support of medical care that a policy provides, it is also important to note financial benefits that it gives. The monetary advantage of having a mediclaim policy is so great that it can make a huge difference in the financial status of a family. You save in two different ways with a medical insurance policy. Firstly, you save on the cost of treatment, which can include the cost of hospitalisation, pre and post hospitalisation care, cost of expensive diagnostics etc. Secondly, the Indian government gives heavy tax benefits in the form of deductions and exemptions from the total taxable income to anyone paying premium towards a mediclaim insurance policy. If you have two mediclaim policies, one for your family and another for your parents, then you can get a sizeable tax deduction from your total taxable income.

3.

Best care: You and your family deserve the best. The best medical insurance companies are here to give you the finest medical care, should you need it. This is possible because the best health insurance companies are tied up with top notch health care providers around the country. All these doctors, hospital and clinics are at your disposal, if the need arises for them. Medical insurance companies providing the best health insurance policies have widespread and strong networks of hospitals on their panels where you can receive specialised and timely medical care with a smile.

4.

Support for emergencies: Of all the things that people worry might happen in the future, the ones that bother them the most are the ones they cannot predict. These are the emergency situations that are the hardest to control because you do not know when, where and to whom it might happen. The mediclaim insurance companies have come up with plans on how to tackle emergencies and make it easier for you, and has also come up with the clause of "cashless hospitalisation". This feature allows you to get hospitalised without the hassle of cash. This is a especially designed feature

for emergencies where it is quite impractical to expect a patient to withdraw cash from a bank before heading to the hospital to get admitted. All you have to do is check whether the hospital you are headed to is on the panel of the medical insurance company or not, pick up your health card and get admitted.

5. Peace of mind: Stress is the number one enemy of health. Stress makes your immune system weak and makes you vulnerable to all kinds of health trouble. With all these benefits of a health insurance policy in your pocket, you can be sure that you can handle anything that life has to offer. You can relax and breathe easy. No more will you have to fret about medical bills or worry about your and your family's future health.

Major provision in a health insurance policy

Renewal or continuance provisions Optionally renewable Conditionally renewable Guaranteed renewable Non-cancelable and guaranteed renewable Entire contract Grace period Claims Physical exam and autopsy Legal action Change of beneficiary