Chapter V Health Insurance Plans of Indian General ... - Shodhganga

Chapter V Health Insurance Plans of Indian General Insurance Companies: A Comparative Study with Reference to Coverage and Non Coverage As far as the status of health insurance in Indian insurance market is concerned, there are large of number of life and non life insurers, which are extending their existing network for the inclusion of health insurance and at the same time providing large number of health insurance policies ranging from individual mediclaim to group mediclaim; students’ health to senior citizens’ health; and domestic hospitalization to overseas hospitalization. Each of these policies has its own inclusion i.e. coverage of benefits; and exclusion i.e. non coverage of benefits. Depending upon the requirements, one can opt for health insurance plan and by paying the gradual premium can get coverage against health hazards. Keeping into mind such an important role being played by the health insurance, one part of the present study deals with the comparative study of various health insurance plans with reference to inclusion/coverage and exclusion/non coverage under these. Accordingly, this chapter deals with comparative study of health insurance plans and consists of two sections. Section A deals with the brief introduction, theoretical background and aim of study. Section B provides empirical results for the comparative study of health insurance plans offered by various general insurance companies in India, its analysis and interpretation. Section A 5.1

Introduction Predictions are the part and parcel of every ones’ life and associated with the

future. But the future is always uncertain, because it is full of twists and turns that can be related with death, an illness requiring hospitalization or loss of home or working assets which can upset or altogether turn the financial situation of the households. Alternatively, health treatment is becoming a very costly affair, as more than a disease it is the cost of treatment that takes its toll, thereby pushing the individuals into never ending vicious circle of poverty. One of the mechanisms to nullify or reduce the effect of such shock of uncertainties or to escape the trap of poverty is to take heath insurance policy and to get rid of health worries.

Health Insurance Plans of Indian General Insurance Companies: A Comparative Study with Reference to Coverage and Non Coverage

As far as the status of health insurance in Indian insurance market is concerned, there are large of number of life and non life insurers, which are extending their existing network for the inclusion of health insurance and at the same time providing large number of health insurance policies ranging from individual mediclaim to group mediclaim; students’ health to senior citizens’ health; and domestic hospitalization to overseas hospitalization. Each of these policies has its own inclusion i.e. coverage of benefits and exclusion i.e. non coverage of benefits. Depending upon the requirements, one can opt for health insurance plan and by paying gradual premium can get coverage against health hazards. Keeping into mind such an important role being played by the health insurance plans, one part of the present study deals with the comparative study of various health insurance plans with reference to inclusion/coverage and exclusion/non coverage under these. For the purpose of comparative study of health insurance plans, the companies under its scope are same as that used in first objective. In other word, the health insurance plans of all the general insurance companies taken above were considered. Moreover, the study is entirely based upon the use of secondary data, which is mainly drawn from the respective sites of the general insurance companies under consideration. The comparative study of health insurance plans is was exclusively done with reference to inclusion/coverage and exclusion/non coverage under these respective plans. The list of inclusion/coverage in health insurance plans of Indian general insurance companies is as:

Medical expenses

Hospitalization coverage

Non hospitalization coverage/domiciliary hospitalization

Day care expenses

Ambulance charges

Compensation for death

Total disablement/partial disablement/injury

Additional benefits/discounts etc. The list of exclusion/non coverage in health insurance plans of Indian general

insurance companies is as:

Pre-existing illness

Dental treatment

Disease within 30 days

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HIV/AIDS

Suicide/Attempt to suicide

Natural calamities, war, perils As far as the analysis of data collected is concerned, the use of content analysis

was made. Beside this, the use of percentages, independent sample t test and one-way ANOVA were made in order to draw the meaningful inference. This was done with the help of SPSS software package as well as use of MS-Excel 2007 was made. Section B 5.2

Empirical Results for Comparative Study of Health Insurance Plans, its Analysis and Interpretation Table 5.1 Descriptive of Various Health Insurance Plans

Health insurance plans by sector Public Private Total Health insurance plans by company New India Assurance Company Limited (P) Oriental Insurance Company Limited (P) National Insurance Company Limited (P) United India Insurance Company Limited (P) Tata Aig General Insurance Company Limited (Pvt) IFFCO Tokio General Insurance Company Limited (Pvt) Reliance General Insurance company Limited (Pvt) Royal Sundram Alliance Company Limited (Pvt) Bajaj Allianz General Insurance Company Limited (Pvt) ICICI Lombard General Insurance Company Limited (Pvt) Total

Frequency 32 29 61 Frequency 6 8 12 6 5 4 3 3 8 6 61

Percentage 52.5 47.5 100 Percentage 9.8 13.1 19.7 9.8 8.2 6.6 4.9 4.9 13.1 9.8 100

As far as the descriptive of various health insurance plans are concerned, on the whole 61 total health insurance plans are provided by the various public and private sector insurers under consideration. Out of which maximum plans belonged to public sector companies i.e. more than 50% of plans are provided by the public sector insurance companies. Having in-depth analysis of this, it was found that out of public sector

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companies, maximum number of plans i.e. 12 were offered by the National Insurance Company Limited, whereas out of private sector general insurance companies, maximum numbers of plans i.e. 8 were offered by Bajaj Allianz General Insurance Company Limited and the least numbers of plans i.e. 3 were offered by Reliance General Insurance Company Limited and Royal Sundarm Alliance General Insurance Company Limited. Table 5.2 Descriptive of Inclusion/Coverage under Health Insurance Plans of Indian General Insurance Companies Medical expenses coverage Yes No Total Hospitalization coverage Yes No Total Non Hospitalization/Domiciliary coverage Yes No Total Day care treatment coverage Yes No Total Ambulance charges Yes No Total Compensating for death Yes No Total Disablement/injury due to an accident Yes No Total Additional benefits/Discount available Yes No Total

Frequency 30 31 61 Frequency 38 23 61 Frequency 7 54 61 Frequency 8 53 61 Frequency 7 54 61 Frequency 14 47 61 Frequency 22 39 61 Frequency 30 31 61

Percentage 49.2 50.8 100 Percentage 62.3 37.7 100 Percentage 11.5 88.5 100 Percentage 13.1 86.9 100 Percentage 11.5 88.5 100 Percentage 23.0 77.0 100 Percentage 36.1 63.9 100 Percentage 49.2 50.8 100

The inclusion/ coverage of health insurance plans were analyzed in terms of eight sub variables (Medical expenses; Hospitalization coverage; Non hospitalization coverage/

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domiciliary hospitalization; Day care expenses; Ambulance charges; Compensation for death; Total disablement/partial disablement/injury; and Additional benefits/discounts etc.) has provided with the fact that maximum numbers of plans i.e. 62.3% of plans are providing hospitalization coverage, whereas 49.2% of plans are extending coverage for medical expenses and additional benefits, and 36.1% of plans are providing coverage for disablement/injury due to an accident. Alternatively, only 11.5% of plans are providing for non hospitalization/domiciliary coverage. Table 5.3 Descriptive of Exclusion/Non Coverage under Health Insurance Plans of Indian General Insurance Companies Pre-existing disease Not covered Information not available Total Dental treatment Not covered Information not available Total Disease within 30 days of insurance policy Not covered Information not available Total Disease within 90 days of insurance policy Not covered Information not available Total Disease within 120 days of insurance policy Not covered Information not available Total Variables which are exclusively not covered HIV/AIDS Natural disaster/war perils Suicide/attempt to suicide

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Frequency 40 13 61 Frequency 57 4 61 Frequency 13 48 61 Frequency 2 59 61 Frequency 40 21 61 Frequency 61 61 61

Percentage 78.7 21.3 100 Percentage 93.4 6.6 100 Percentage 21.3 78.7 100 Percentage 3.3 96.7 100 Percentage 65.6 34.4 100 Percentage 100 100 100


Likewise inclusion/coverage, the exclusion/non coverage was also analyzed in respect of eight sub variables: Pre-existing illness; Dental treatment; Disease within 30 days; Disease within 90 days; Disease within 120 days; HIV/AIDS; Suicide/Attempt to suicide; and Natural calamities, war, perils. The results of analysis as shown in table 5.3 provided with the fact that HIV/AIDS, Natural disasters/war perils and suicide/attempt to suicide are the variables which are excluded from all the health insurance plans under consideration. Beside this, maximum numbers of plans i.e. 93.4% are not providing for dental treatment followed by 78.7% and 65.6% of health insurance plans are not extending coverage for pre-existing disease and disease within 120 days of insurance policy. Moreover 21.3% and 3.3% of health insurance plans are not providing coverage for disease within 30 and 90 days of insurance policy. Thereafter, an effort was made to test the various hypothesis formulated. But before the test of hypothesis, the inclusion/coverage and exclusion/non coverage scores of various health insurance plans of insurance companies under consideration were calculated with the help of content analysis. The use of content analysis was made to determine the number of time the sub variables appearing in the policy wording of health plan of insurance companies under consideration. Further, on the basis of which the inclusion/coverage and exclusion/non coverage scores of health plans was calculated. These inclusion/coverage and exclusion/non coverage scores were further utilized in hypothesis testing. :

There is no significant difference in the inclusion/benefits/coverage scores of health insurance plans.

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Table 5.4 Descriptive of Inclusion/Coverage Scores of Health Insurance Plans Std. Error

95% Confidence Interval for Mean Lower Upper Bound Bound

N

Mean

Std. Deviation

New India Assurance Company Limited

6

33.333

10.2062

4.1667

22.623

44.044

25.0

50.0

Oriental Insurance Company Limited

8

20.313

6.4694

2.2873

14.904

25.721

12.5

25.0

National Insurance Company Limited

12

33.333

13.4136

3.8722

24.811

41.856

12.5

62.5

United India Insurance Company Limited

6

37.500

7.9057

3.2275

29.203

45.797

25.0

50.0

Tata Aig General Insurance Company Limited

5

30.000

6.8465

3.0619

21.499

38.501

25.0

37.5

IFFCO Tokio General Insurance Company Limited

4

40.625

18.7500

9.3750

10.790

70.460

25.0

62.5

Reliance General Insurance Company Limited

3

41.667

14.4338

8.3333

5.811

77.522

25.0

50.0

Royal Sundram Alliance Company Limited

3

33.333

26.0208

15.0231

-31.306

97.973

12.5

62.5

Bajaj Allianz General Insurance Company Limited

8

26.563

4.4194

1.5625

22.868

30.257

25.0

37.5

ICICI Lombard General Insurance Company Limited

6

35.417

20.0260

8.1756

14.401

56.433

12.5

62.5

Total

61

31.967

13.2139

1.6919

28.583

35.351

12.5

62.5

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Minimum Maximum


The table 5.4 shows that mean of inclusion/coverage scores is highest in case of Reliance General Insurance Company Limited i.e. 41.667 and least in case of Oriental Insurance Company Limited i.e. 20.313, whereas standard deviation is highest in case of Royal Sundram Alliance General Insurance Company Limited i.e. 26.563 and least in case of Bajaj Allianz General Insurance Company Limited. On the whole it has provided with the fact that that difference exist in inclusion/ coverage scores of health plans. Now the question arises, is this difference is significant or not? The answer to this is provided in the forthcoming tables. Table 5.5 Test of Homogeneity of Variances of Inclusion/Coverage Scores of Health Insurance Plans Levene Statistic

df1

df2

Significance

3.768

9

51

.001

One of the assumptions of the one-way ANOVA is that the variances of the groups should be similar. The table 5.5 shows the result of Levene's Test of Homogeneity of Variance, which tests for similar variances. If the significance value is greater than 0.05, then we have homogeneity of variances. But here the Levene's Statistic has a significance value of .001, which is less than 0.05, which shows that assumption of homogeneity of variance is not met i.e. variance of the group are significantly different. However for main ANOVA, we have two selected procedure (Brown-Forsythe and Welch) that should be accurate when homogeneity of variances in not true. Table 5.6 ANOVA Results for Inclusion/Coverage Scores of Health Insurance Plans Sum of Squares

df

Mean Square

F

Significance

Between Groups

2216.018

9

246.224

1.520

.166

Within Groups

8260.417

51

161.969

Total

10476.434

60

Table 5.6 shows the output of the ANOVA analysis and whether we have a statistically significant difference between our group means. In this case the significance level is 0.166, which is more than 0.05 and, therefore, null hypothesis is accepted which state that there is no significant difference in the inclusion/coverage/ scores of health 109


insurance plans of insurance companies. However this might be the wrong answer because of assumption of homogeneity of variance was not met. So accordingly we will proceed with the Robust Tests of Equality of Means can be used. Table 5.7 Robust Tests of Equality of Means of Inclusion/Coverage Scores of Health Insurance Plans Statistic

df1

df2

Significance

Welch

2.457

9

14.622

.061

Brown-Forsythe

1.152

9

12.581

.398

The table 5.7 shows the significance value of Robust Tests of Equality of Mean. Here the significance value is .061 which is again more than .05, so we will still accept the null hypothesis which state there is no significant difference in the inclusion/benefits/coverage scores of health insurance plans of insurance companies. The reporting result of ANOVA is as:

There is no significant difference in the inclusion/benefits/coverage scores of health insurance plans of insurance companies, F (9, 51) = 1.520, p value is .166 which is more than .05.

The assumption of homogeneity of variance was violated; therefore BrownForsythe F-ratio is reported. There is no significant difference in the inclusion/benefits/coverage scores of health insurance plans of insurance companies, F (9, 12.581) = 1.152, p value is .398 which is more than .05.

The assumption of homogeneity of variance was violated; therefore Welch Fratio is reported. There is no significant difference in the inclusion/benefits/ coverage scores of health insurance plans of insurance companies, F (9, 14.622) = 2.457, p value is .061 which is more than .05. The reason might be attributable to the fact that that due to competition almost all

the companies are providing coverage and benefits at par with that of their competitors, which leads to the results that there is no significant difference in the mean inclusion/coverage scores of health insurance plans. : There is no significant difference in the exclusion/non coverage scores of health insurance plans. 110


Table 5.8 Descriptive of Exclusion/Non Coverage Scores of Health Insurance Plans Std. Error

95% Confidence Interval for Mean Lower Upper Bound Bound

N

Mean

Std. Deviation

New India Assurance Company Limited

6

64.583

14.6131

5.9658

49.248

79.919

50.0

87.5

Oriental Insurance Company Limited

8

56.250

9.4491

3.3408

48.350

64.150

50.0

75.0

National Insurance Company Limited

12

54.167

6.1546

1.7767

50.256

58.077

50.0

62.5

United India Insurance Company Limited

6

52.083

5.1031

2.0833

46.728

57.439

50.0

62.5

Tata Aig General Insurance Company Limited

5

57.500

6.8465

3.0619

48.999

66.001

50.0

62.5

IFFCO Tokio General Insurance Company Limited

4

78.125

6.2500

3.1250

68.180

88.070

75.0

87.5

Reliance General Insurance Company Limited

3

62.500

.0000

.0000

62.500

62.500

62.5

62.5

Royal Sundram Alliance Company Limited

3

62.500

.0000

.0000

62.500

62.500

62.5

62.5

Bajaj Allianz General Insurance Company Limited

8

59.375

5.7864

2.0458

54.537

64.213

50.0

62.5

ICICI Lombard General Insurance Company Limited

6

58.333

6.4550

2.6352

51.559

65.107

50.0

62.5

Total

61

59.016

9.4459

1.2094

56.597

61.436

50.0

87.5

111

Minimum Maximum


The table 5.8 shows that mean of exclusion/non coverage scores is highest in case of IFFCO Tokio General Insurance Company Limited i.e. 78.125 and least in case of United India Insurance Company Limited i.e. 52.083, whereas standard deviation is highest in case of New India Assurance Company limited i.e. 14.6131 and .000 in case of Reliance and Royal Sundram general Insurance Company Limited. On the whole this table shows that differences exist between the exclusions/non coverage of health insurance plans. Now the question arises, is this difference is significant or not? The answer to this is provided in the forthcoming tables. Table 5.9 Test of Homogeneity of Variances of Exclusion/Non Coverage Scores of Health Insurance Plans Levene Statistic

df1

df2

Significance

3.691

9

51

.001

Table 5.9 shows that the Levene's Statistic has a significance value of .001, which is less than 0.05, which shows that assumption of homogeneity of variance is not met. However for main ANOVA, we have two selected procedure (Brown-Forsythe and Welch) that should be accurate when homogeneity of variances in not true, but these will not run in this case because atleast one group has 0 variance. Table 5.10 ANOVA Results for Exclusion/Non Coverage Scores of Health Insurance Plans Sum of Squares

df

Mean Square

F

Significance

Between Groups

2366.504

9

262.945

4.490

.000

Within Groups

2986.979

51

58.568

Total

5353.484

60

Table 5.10 shows the output of the ANOVA analysis and whether we have a statistically significant difference between our group means or not. In this case the significance level is 0.00, which is less than 0.05 and, therefore, null hypothesis is rejected which state that there is no significant difference in the exclusion/non coverage scores of health insurance plans. In other words the results provided that significant

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difference exists between the exclusion/non coverage scores of health insurance plans. The reason might be attributable to the fact that exclusion/non coverage under each plan of insurance companies depends upon health of the person availing it, which entirely differ from that of other and leads to significant difference in exclusion/non coverage of health insurance plans of insurance companies. Further for the testing of null hypothesis (

and

the use of

independent sample t-test was made. :

There is no significant difference in the number of health insurance plans offered as far as the public and private sector general insurance companies are concerned.

:

There is no significant difference in the inclusion/coverage scores of public and private insurance companies. There is no significant difference in the exclusion/non coverage scores of public and private insurance companies. The result along with the interpretation for null hypothesis (

and

is discussed below: Table 5.11 The Group Statistics

No. of Plans

N

Mean

Std. Deviation

Public Company

4

8.00

2.828

1.414

Private Company

6

4.83

1.941

.792

32 30.859

11.8731

2.0989

29 33.190

14.6674

2.7237

Public Company plans

32 56.250

9.5250

1.6838

Private Company Plans

29 62.069

8.5060

1.5795

Inclusion/Coverage Public Company plans Scores Private Company Plans Exclusion/non coverage scores

Std. Error Mean

The table 5.11 shows that there are variations in the number of plans offered as far as public and private sector companies are concerned. Similarly the inclusion/coverage scores and exclusion/non coverage scores differentiate between the plans of public and private sector insurance companies. Now the question arises, is this variation is significant or not? The answer to this is provided in the table 5.12.

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Table 5.12 Results of Independent Sample t-test Levene's Test for Equality of Variances

(

(

(

Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed Equal variances assumed Equal variances not assumed

t-test for Equality of Means

95% Confidence Interval of the Difference Lower Upper

F

Sig.

T

df

Sig. (2tailed)

.360

.565

2.120

8

.067

3.17

1.494

-2.78

6.611

1.953

4.890

.109

3.17

1.621

-1.029

7.362

-.685

59

.496

-2.330

3.4029

-9.1395

4.4790

-.678

53.946

.501

-2.330

3.4386

-9.2243

4.5638

59

.015

-5.819

2.3217

-10.4648 -1.1732

.014

-5.819

2.3087

-10.4387 -1.1993

1.788

3.298

.186

.074 -2.506

-2.520 58.990

Mean Difference

Std. Error Difference

Levene’s test indicates by the p value, helps us in deciding whether we should assume equal or unequal variances. If p value is < 0.05 the evidence suggests that the variances are unequal. Here, the value of Levene’s test is .565 so we use the equal variance line for the t test for the means. The value of t-test for mean for equal variance assumed is .067 (which is more than 0.05), thereby it leads to the acceptance of null hypothesis (

which state there is no significant difference in the number of health

insurance plans offered as far as the public and private sector general insurance companies are concerned. In another case the value of Levene’s test is .186 which is more than 0.05, so we use the equal variance assumed line for the t test for the means. The value of t-test for equal variance assumed is .496 (which is more than 0.05); thereby

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it leads to the acceptance of null hypothesis (

which state that there is no significant

difference in the inclusion/coverage scores of public and private insurance companies. The reason might be attributable to the fact all the insurance companies are offering health insurance plans by considering their competitors in the market. Moreover, due to competition almost all the companies are providing coverage and benefits at par with that of their competitors. In another case the value of Levene’s test is .074 which is more than 0.05, so we use the equal variance assumed line for the t test for the means. The value of t-test for equal variance assumed is .015 (which is less than 0.05); thereby it leads to the rejection of null hypothesis (

which state that there is no significant difference in the

exclusion/non coverage scores of public and private insurance companies. The reason might be attributable to the fact that exclusion/non coverage under each plan of insurance companies depends upon health of the person availing it, which entirely differ from that of other and leads to significant difference in exclusion/non coverage of health insurance plans of insurance companies. 5.3

Conclusion The above study was an effort in the area of health insurance to analyze the

various health insurance plans of Indian general insurance companies with reference to inclusion/coverage and exclusion/non coverage under these. On the whole 61 total health insurance plans are provided by the various public and private sector insurers under consideration. Out of which maximum plans belonged to public sector companies i.e. more than 50% of plans are provided by the public sector insurance companies. Having in-depth analysis of this it was found that out of public sector companies, maximum number of plans i.e. 12 were offered by the National Insurance Company Limited, whereas out of private sector general insurance companies, maximum numbers of plans i.e. 8 were offered by Bajaj Allianz General Insurance Company Limited and the least numbers of plans i.e. 3 were offered by Reliance General Insurance Company Limited and Royal Sundarm Alliance General Insurance Company Limited.

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Further, the inclusion/ coverage of health insurance plans were analyzed in terms of eight sub variables has provided with the fact that maximum numbers of plans i.e. 62.3% of plans are providing hospitalization coverage, whereas 49.2% of plans are extending coverage for medical expenses and additional benefits, and 36.1% of plans are providing coverage for disablement/injury due to an accident. Alternatively, very few i.e. 11.5% of plans are providing for non hospitalization/ domiciliary coverage. Likewise inclusion/coverage, the exclusion/non coverage was also analyzed in respect of eight sub variables has provided with the fact that HIV/AIDS, Natural disasters/war perils and suicide/attempt to suicide are the variables which are excluded from all the health insurance plans under consideration. Beside these the maximum numbers of plans i.e. 93.4% are not providing for dental treatment followed by 78.7% and 65.6% of health insurance plans are not extending coverage for pre-existing disease and disease within 120 days of insurance policy. Moreover 21.3% and 3.3% of health insurance plans are not providing coverage for disease within 30 and 90 days of insurance policy. Thereafter, an effort was made to test the various hypothesis formulated. But before the test of hypothesis, the inclusion/coverage scores and exclusion/non coverage scores of various health insurance plans of insurance companies under consideration were calculated with the help of content analysis. The use of content analysis helped to determine the number of time the sub variables appearing in the policy wording of health plan of insurance companies under consideration. Further, on the basis of which the inclusion/coverage and exclusion/non coverage scores of health plans was calculated. These inclusion/coverage and exclusion/non coverage scores were utilized in hypothesis testing. Further, the analysis and testing of hypothesis has provided that there is no significant difference:- in the inclusion/benefits/coverage scores of health insurance plans; in the number of health insurance plans offered as far as the public and private sector general insurance companies are concerned; and in the inclusion/coverage scores of public and private insurance companies. The reason might be attributable to the fact all the insurance companies are offering health insurance plans by considering their

116


competitors in the market. Moreover, due to competition almost all the companies are providing coverage and benefits at par with that of their competitors. Alternatively, significant difference exists: - between the exclusion/non coverage scores of health insurance plans; in exclusion/non coverage scores of public and private insurance companies. The reason might be attributable to the fact that exclusion/non coverage under each plan of insurance companies depends upon health of the person availing it, which entirely differ from that of other and leads to significant difference in exclusion/non coverage of health insurance plans of insurance companies.

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