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CHAPTER I
INTRODUCTION
The insurance industry in India has come to a full circle from being
an open competitive market to nationalization and back to liberalized
market again. The opening up of Indian Insurance Industry as a part of
economics return happened to October 24, 2000. Due to this, a drastic
change has happened in the insurance service of India in the last 7 years.
These has been aimed at increasing the efficiency by expanding the role
of private sector, which brought about the inflow of investment and
technology. Even though the public sector insurance companies
contributed much in providing awareness about insurance and expanding
the insurance market. It was recognized that their reach was still limited.
This attracted many players to the field of insurance. They entered the
market with wide variety of products and services. The opening has paved
way for innovative products and services. This opening has paved the way
for innovative products new distribution channels etc along with ample
job opportunities. Mean time it calls for certain problems also. The doubts
raised by many are: whether it will lead to destruction of public
corporations. In the light of the above said circumstances the present
study is considered to be very relevant.


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STATEMENT OF PROBLEM
The insurance industry in India is now having both public and
private players. They offers life and general insurances. Star Health
Insurance is a big health insurance company in India.
The problem to be reviewed in the study is whether the customers
are aware of various mediclaim insurance products offered by Strar Health
Insurance.


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OBJECTIVES OF THE STUDY
1. To know the awareness of customers with regard to various Health
insurance products.
2. To assess the customer satisfaction regarding the settlement of medical
claims
3. To know the level of customer satisfaction with Star Health Insurance.
4. To analyze the problems and prospectus of Health insurance policies.


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METHODOLOGY
Present study is designed as a descriptive on survey method. Both
primary and secondary data were collected.
Primary Data
Primary data means first hand information collected from the
customers directly. Primary data required for study are collected from the
beneficiaries of Star Health Insurance in Wayanad district with the help of
a standard questionnaire.
Secondary Data
Secondary data means data collected from secondary source. These
are second hand information. Secondary data for this study are collected
from books, newspaper, journals, magazines and websites.


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LIMITATIONS OF THE STUDY
The study is limited to Wayanad district only and hence findings
cannot be generalized. Some of the respondents may have given based
opinions.


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CHAPTER II
AN OVERVIEW OF INSURANCE SECTORS

Life is full of risks. Being a social animal and risk averse, man
always tries to reduce risk. An age old method of sharing of risk through
economic corporation led to the development of the concept of insurance.
Insurance may be described as a social device to reduce or eliminate
risk of loss to life and property. Insurance is a scheme of economic
corporation by which members of the community share the unavoidable
risk. The risk which can be insured against include fire, the perils of sea,
death, accidents and burglary. The members of the community subscribe to
a common pool or fund which is collected by the insurer to indemnify the
losses arising out of risks. Insurance cannot prevent the occurrence of risk
but it provides for the losses of risk. It is a scheme which covers large risks
by paying small amount of capital. Insurance is also a means of savings
and investment.
Definition
Insurance can be defined as a legal contract between two parties
where by one party called insurer undertakes to pay a fixed amount of
money on the happening of a particular event, which may be certain or

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uncertain. The other party called insured pays in a fixed sum known as
premium. The insurer and the insured are also known as Assurer or
underwriter and Assured respectively. The document which embodies the
contract is called the policy.
An insurance contract is based on some basic principles of insurance
1. Principle of atmost good faith
2. Principle of indemnity
3. Doctrine of subrogation
4. Principle of insurable interest
Principles of Insurance
The principles of insurance can be grouped into two knids.
1. Primary Principles
The following principles are applicable to any type of insurance.
(a) Principles of Cooperation
The insurer collects premium from the insured in a pool and
pays their claims out of the pool. The insurance company is an
association of persons which pays the claims out of its pooled
money.


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(b) Principles of Probability
The occurrence of risk in each type of insurance is estimated
through the theory of probability for which the insurer follows the
theory of large numbers.
2. Legal principles
The regular fundamental principles are common to all types of
insurance contracts the exception of the principle of indemnity which is
not applicable to personal insurance contracts.
(a) Principle of utmost good faith
Insurance contracts are based upon the mutual trust and
confidence between the insurer and the insured. It means that the
parties to the contract must make a full disclosure of all the material
fact and information relations to the contract.
(b) Principle of insurable interest
Insurable interest means proprietary or monetary interest or
legal right to insure.
(c) Principle of indemnity
It is the controlling principles in insurance contract. Indemnity
simply means making up the loss. Literally it means security against
damage or loss or compensation for loss.


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(d) Principle of subrogation
Subrogation is a corollary of or supplement to the principle of
indemnity. Subrogation means inheriting the rights available to an
individual.
(e) Principle of causa proxima
The maxim causa proxima non remota spectabure means
that proximate (nearest) causa and not the remote one is to be taken
notice of at the time of determining the liability of the insurer.
(f) Principle of contribution
Contribution is also a corollary of the principle of indemnity.
The doctrine of contribution applies when there is more than one
policy covering the same subject matter against the same peril for
the same period and for the same insured. Principle contribution is
not applicable to personal insurances.
History of Insurance
The concept of insurance is believed to have emerged almost 4500
years ago in the ancient land of Babylonia where traders used to bear risk
of caravan by giving loans which were later repaid with interest when the
goods arrived when the goods arrived safely. In order to protect against the
risk of loss of goods in transit, piracy and natural calamities like storm and

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so on. Medieval Guides Grade Association formed a common pool of
funds which was used as support in times of sickness and death and
sometimes even offered as ransom for members held captive by pirates.
The first insurance contract was entered into by European Maritime
Nations in 1347 to accept marine insurance as a practice.
The concept of insurance as we known today took shape in 1688 at a
place called Lioyds. Coffee House in London where risk bearers used to
meet to transact business. This Coffee House became so popular that
Lioyds became the one of the first modern insurance companies by the end
of the eighteenth century.
Marine Insurance Companies came into existence by the end of the
eighteenth century. These companies where empowered to write fire and
life insurance as well as marine. The great fire of Landon in 1966 caused
huge loss of property and life. With a view to provide fire insurance
facilities Dr. Nicholas Barbon setup in 1967 the first fire insurance
company known as the Fire office. The infamous Newyork fire and the
great Chicago fire in 1835 and 1871 respectively created awareness and
need for insurance.



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Regulatory Body
The Insurance Regulatory and Development Authority (IRDA) were
constituted as an autonomous body to regulate and develop the business of
insurance and re-insurance in India. The authority was constituted on April
19 2000 vide government of Indias notification No. 277.
The Insurance Regulatory and Development Act 1999 was enacted
by parliament in the 15
th
year of the Republic of India for the establishment
of an Authority to protect the interest of holders of insurance policy, to
regulate, promote and ensure orderly growth of the insurance industry and
for matters connected therewith or incidental thereto and further to amend
the Insurance Act 1938, the Life Insurance Corporation Act 1956, and the
General Insurance Business (Nationalization) Act 1972. The act was
approved in the Parliament in December 1999 and the insurance sector was
thrown open for private licensees on August 5, 2000. IRDA was
constituted in terms of the Insurance Regulatory and Development
Authority Act 1999, as the regulator of Indian insurance industry.
IRDA was setup in 1996 but it was formally constituted as a regular
of the insurance industry in April 2000. The regulator was initially known
as the Insurance Regulatory Authority but was subsequently rechristened
as IRDA as it was provided that it has a broader role to perform in the

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Indian Insurance Market. It had not only to frame and issue statutory and
regulatory stipulations; guidelines; and clarifications but it has also to
perform a development and promotional role. The development and
promotional role of the regulator include facilitating the growth of the
market by attracting large number of players, integrating of the insurance
market with the domestic financial service market; and synchronizing the
Indian Insurance market with that of global insurance. Thus the objective
of IRDA are two fold: Policy holder protection and healthy growing of the
insurance market.
IRDA has a chairman and four part whole-time members. IRDA has
constituted the insurance adversary committee and in consultation with this
committee has bought out seventeen regulations. A leading consumer
activist has also been inducted into the insurance adversary committee. In
addition, representatives of consumers, industry, insurance agents,
womens organizations and other interest groups are a part of this
committee. It has formed a consumer advisory committee and a surveyor
and less assessors committee. It has a panel of eligible chartered
accountants to carryout investigation inspection and so on.
IRDA has till not issued seventeen regulations in the area of
registration on insurers, their conduct of business, solvency margins,

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conduct of reinsurance business. Licensing and code of conduct
intermediaries. It follows the practice of prior consultation and discussion
with various interest groups better issuing regulations and guidelines.
1. In India the life insurance was started on 1870.
2. Indias first insurance institution was Bombay Mutual Life
Insurance Society.
3. The founder of Bombay Mutual fund was the assistant of Bombay
High court Mrs Summer and his 6 friends.
4. The Insurance Act was framed in India was 1938.
5. The Life Insurance Corporation was formed in 1956.
Various Insurance Policies
Insurance are of two types
1- Life Insurance 2- General Insurance
Life Insurance
This type of the insurance is to insure the person itself. The basic of
life insurance is the amount will refund after the death of person or after a
maturity period.




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General Insurance
It will protect all the things under the fund and the accidents and
illness happened to man, agricultural products, vehicles, institutions
animals, birds, service etc.
The general insurance company are:-
1. United India General Insurance Company
2. The New India Assurance
3. National Insurance Company
4. Oriental Assurance
Among the general insurance companies product is mediclaim.
There are different types of policies in the general insurance.
Accidental Insurance
These are the main policies given in the accidental insurance
Motor Insurance The protection for the motor vehicle are 3 types:-
Accidents happens in vehicle through fire, theft and accidents
The difficulties caused by personality for this.
Death and injuries for person caused by vehicle sould take the
responsibility. This type of policy is called common policy.
Vehicle Accident Insurance
Fire Insurance
Marine Insurance

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Goods Insurance and Ship Insurance
LIC
Life insurance is one of the most common form of insurance. It has
acquired a top position all over the most. Since the nationalism of life
insurance companies in 1956 the entire life insurance business is helping
transacted by the life insurance corporation of India.
Life insurance is a contract whereby the insured promises to pay a
uniform rate of premium at fixed intervals of time against which the
insurer agrees to pay a fixed amount on the happening of the event which
may be the death of the insured or by the expiry of a certain number of
years.
If the payment is to be made on the death of the insured, the insured
may nominate a person to receive the amount. If the amount is to be paid
on the expiry of a certain number of years, then insure may himself receive
it if he is alive on the expiry date; otherwise his nominees will receive it.
The former type of insurance is called the whole life insurance and the
latter the endowment life insurance.
There is only one nationalize life insurance company and eighteen
private sector life insurance companies. The only nationalized life
insurance company in India is the Life Insurance Corporation of India.


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Life Insurance Products
There are four broad types of insurance policies to choose from
Endowment plan
Money-back policy
Whole life policy
Term insurance policy
Benefits of life insurance
Life insurance:
safeguards the insured family against an ultimately death and
provides for a secured income.
is means of compulsory savings
is a source of income during old age.
helps in meeting certain periodic financial needs, either for childs
education or marriage.
improves the life style of the insured and his family
take care of disabilities and certain future adversities of life
brings in tax benefit under section 88 of the income tax act 20% of
the contribution made towards life insurance premium quality for
deductions from total tax payable.


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Mediclaim :-
Medicliam scheme protects the members of a family against every
disease including hospitalization expenses, in one policy at a moderate
premium. Similar schemes have also been formulated to protect employers
who provide different medical schemes. For the benefit of their employees
instead of cash payment against medical expenses.
The mediclaim is given by the general insurance company for the
treatment of illness or accidents. Mediclaim is more important than food,
air and shelter. About 50 year is over this started by the government. But
unfortunately GIC agents are concentrated to give insurance to vehicles
because it is compulsory for the vehicles therefore the government and the
agents are failed to bring the benefit for the people.
About 50 lakh life insurance agents are working in India. They did
not bring mediclaim to the people because they get only commission
moreover policy has 1000 persons. About 500 persons had happen illness
or accidents in this phase they want to go to the insurance office. Many
times so they could happen time loss and they compelled to spend more
money than they got. Because of the agents getting less commission is the
main problem to bring the benefits of the people that is the reality.



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Importance of Mediclaim
Spreading diseases
1. life atmosphere and surroundings
2. pollution, air, water and food
3. fever, dengue fever, viral fever tetanus, pneumonia, typhus, malaria
etc..
- about 1.50 lakhs peoples were died in 2008 due to road accidents
- about 625 were injured badly and now under treatment
- in Kerala 6536 were died
- everyday about 280 people were dying in India due to road accidents
Natural Calamities
Earthquake, flood, tsunami, thunder and lightning, sea attacks,
heavy heat etc..
- so many persons died due to heavy heat in India
- more than 2 lakh people were killed by Tsunami
Here we want to realize that the death is sure one. Every human
being will die once. Deaths are in two types illness and accidents. It will
happen at any time at any age and any situations.
The benefits that given to the members of mediclaim.
1- Fees of the doctor
2- Room rent

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3- Price of the medicines
4- Expenses of the X-ray and ECG.
5- Expenses of the operation
Cholera, stomach problems, rat fever from the urinal of rats. Dengue
fever, malaria, japan fever from mosquitoes, Typhus from small creations,
bird flue from the waste of the birds. The non care diseases. Cancer, heart
problems, kidney problems etc.
Cancer :- every year about 5 lakh people were dying because of cancer
Every year the number of cancer patients will increase about 300.
Smoking, pesticides, the smoke that comes outside the vehicles, impure air
are the reasons of cancer. It is more happening in ladies and children. In
case of ladies they are affected by breast cancer, tumor etc.
Heart diseases :- It will happen any person after 30 years. The old foods,
foods that contains mere fat, and fast food culture are the reasons
increasing the number of kidney diseases.
Road accidents :- bad roads, increasing of vehicles absent minded driving.
The documents want to produce for getting the claims.
(1) claim form (2) medical report (3) discharge card (4) the bills of
medicines (5) original reports and bills of x-ray, ECG, scanning, laboratory
tests, operation (6) the bills of room rent and fees of doctor

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Anyway the health policy is more essential for the time increased
expenses of medicines. We want decide the nature of the policy. Better are
century there is no chance for selecting different health policies. On that
time we had the standard mediclaim policy only.
Life insurance companies and the non life insurance companies are
selling the policies when the claim will happen they give only their pre-
planned claim but the policy is non-life. Insurance company give the
expenses of the treatment. This may be cash or reimbursement. If the
person have the policies he can use the first for the other purpose on the
time of the illness and the coverage of non life policy can use for the
medical treatment.