2. Relicare - Critical care illness policy Integrated 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
5. At any given time there will be 3 million cancer patients in India.
6. 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 .
7. Over the last three decades, cases of coronary artery disease in India have risen threefold.
8. 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 )
9. 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.
10. 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.
12. 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 – creatinekinase- MB, and troponin I or T. 3) Angiography – coronary catheterization
16. 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.
17. 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.
18. 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
19. 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.
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21. By measuring the external environmental factor like competitor’s marketing strategy, awareness about the policy, penetration in the market etc..
22. 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.
23. The economical condition have to be taken in to consideration for the marketability of the policy.
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25. Despite of people belonging to medium or high economical strata, majority don’t have critical health policies.
26. 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.
27. 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.
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29. So in all the product covering such kind of disease do certainly have a place to exist in the market for longer time.
30. There seems to be more demand for such kind of health coverage.
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32. 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.
33. 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.
34. Main features Individual contract Pure risk product Multiple options insurance plan One year contract with possible extended terms Premium is payable yearly The critical illness cover can be enhanced by adding the optional additional benefits: accidental death. All optional benefits must be selected at the outset of the plan itself. Once such a claim has been met, no further claim can me made under this benefit
35. Unique Features 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. Second Opinion Benefit:Relicareprovides 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.
36. 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)
37. 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
38. 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.
40. Policy Coverage ReliCareoffers 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.
41. 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
43. 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.
44. 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.
45. Criteria for developing a market strategy 4 P`s Product Price Place Promotion 4 C`s Customer need and wants Cost to customer Convenience Communication
54. A health insurance company will charge the same rates for any one policy from all clients.
55. 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 .
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57. The customer is properly guided about the terms and conditions of the policy.
58. To increase the acceptance in the market it is being aggressively promoted.
73. 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.
77. 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.
79. 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
80. 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
81. 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 Premium Income - Policy Expenses Net Underwriting Margin = Total Assets
