CHAPTER 1

MEANING & DEFINITION INSURANCE INTRODUCTION HISTORY OF INSURANCE

Page 1

Meaning and definition

Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium. Insurer, in economics, is the company that sells the insurance. Insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

Definition
The term insurance has been defined by different experts. They can be classified into following 3 categories for the convenience of study: 1. General or Social Definitions 2. Functional/Economical/Business Definitions 3. Contractual/Legal Definitions

Page 2

1. General or Social Definitions:

The general definitions are given by social scientists and they consider insurance as a device to protect against risks, or a provision against inevitable contingencies or a cooperative device of spreading risks. According to John Magee, Insurance is a plan by which large number of people associate themselves and transfer to the shoulders of all, risks that attach to individuals. According to Boon and Kurtz, Insurance is a substitution for a small known loss (the insurance premium) for a large unknown loss which may or may not occur.

2. Functional/Economical/Business Definitions:
These definitions are based on economic or business oriented since it is a device providing financial compensation against risk or misfortune. According to Federation of Insurance Institutes, Mumbai, Insurance is a method in which large number of people exposed to similar risks make contribution to a common fund out of which, the losses suffered by the unfortunate few, due to accidental events, are made good. According to Rosenblatt, Bennington and others,

Insurance is a system of protection against financial loss in which risk is shifted to a professional risk bearer; an insurance

Page 3

company in exchange for a certain sum of money (the insurance premium), the insurer agrees to pay the insured if losses occur.

3. Contractual/Legal Definitions
These definitions consider insurance as a contract to indemnity the losses on happening of certain contingency in future. In the words of Justice Tindall, Insurance is a contract in which a sum of money is paid to the assured as a consideration of insurers incurring the risk of paying a large sum upon a given contingency. According to E. W. Patterson, Insurance is a contract by which one party, for compensation called the premium, assumes particularly risks of the other party and promises to pay him or his nominee a certain or ascertainable sum of money on a specified contingency.

Page 4

INTRODUCTION:
Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss. An insurer is a company selling the insurance; an insured is the person or entity buying the insurance. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

One of the- main features of the pre-nationalized insurance sector was the utilization of the insurance sector as a backup or extension by the wellknown industrial houses of India. There are mainly two forms, of insurance in India viz. Life and non-life. Life insurance provides protection to a household against the risk of premature death of its income-earning, member. Non-life insurance can be grouped under three heads viz., fire, marine and miscellaneous insurance. Life insurance Corporation of India carries on life insurance business and, the General Insurance Corporation and its four subsidiaries deal with non-life insurance.

After liberalization of the insurance sector in 1999 private players have entered both life and non-life business in India. The Insurance Regulatory and Development Authority (IRDA) was constituted in April 2000 as an autonomous body to regulate and develop the business of insurance and reinsurance in the country in terms of the insurance regulatory and Development Authority Act, 1999.

Page 5

As the insurance market in India is liberalized, the pattern of distribution is likely to undergo vast changes with new channels being introduced, A quantum jump in Insurance business in terms of premium, policies, lives covered, etc., would necessitate; corresponding increase in the capacity of the distribution channels.

Page 6

History of Insurance
In some sense we can say that insurance appears simultaneously with the appearance of human society. We know of two types of economies in human societies: money economies (with markets, money, financial instruments and so on) and nonmoney or natural economies (without money, markets, financial instruments and so on). The second type is a more ancient form than the first. In such an economy and community, we can see insurance in the form of people helping each other. For example, if a house burns down, the members of the community help build a new one. This type of insurance has survived to the present day in some countries where modern money economy with its financial instruments is not widespread (for example former Soviet Union). Turning to insurance in the modern sense (i.e., insurance in a modern money economy), early methods of transferring or distributing risk were practiced by Chinese and Babylonian traders as long ago as the 3rd and 2nd millennia BC, respectively. Chinese merchants traveling treacherous river rapids would redistribute their wares across many vessels to limit the loss due to any single vessel's capsizing. The Babylonians developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and practiced by early Mediterranean sailing merchants. If a merchant received a loan to fund his shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to cancel the loan should

Page 7

the shipment be stolen.

Achaemenian monarchs were the first

to insure their people and made it official by registering the insuring process in governmental notary offices. The insurance tradition was performed each year in Norouz (beginning of the Iranian New Year); the heads of different ethnic groups as well as others willing to take part, presented gifts to the monarch. A thousand years later, the inhabitants of Rhodes invented the concept of the 'general average'. Merchants whose goods were being shipped together would pay a proportionally divided premium which would be used to reimburse any merchant whose goods were jettisoned during storm or sink age. The Greeks and Romans introduced the origins of health and life insurance c. 600 AD when they organized guilds called "benevolent societies" which cared for the families and paid funeral expenses of members upon death. Guilds in the middle Ages served a similar purpose. The Talmud deals with several aspects of insuring goods. Before insurance was established in the late 17th century, "friendly societies" existed in England, in which people donated amounts of money to a general sum that could be used for emergencies. Separate insurance contracts (i.e., insurance policies not bundled with loans or other kinds of contracts) were invented in Genoa in the 14th century, as were insurance pools backed by pledges of landed estates. These new insurance contracts allowed insurance to be separated from investment, a separation of roles that first proved useful in marine insurance. Insurance

Page 8

became far more sophisticated in post-Renaissance Europe, and specialized varieties developed. Toward the end of the seventeenth century, London's growing importance as a centre for trade increased demand for marine insurance. In the late 1680s, Mr. Edward Lloyd opened a coffee house that became a popular haunt of ship owners, merchants, and ships captains, and thereby a reliable source of the latest shipping news. It became the meeting place for parties wishing to insure cargoes and ships, and those willing to underwrite such ventures. Today, Lloyd's of London remains the leading market (note that it is not an insurance company) for marine and other specialist types of insurance, but it works rather differently than the more familiar kinds of insurance. Insurance as we know it today can be traced to the Great Fire of London, which in 1666 devoured 13,200 houses. In the aftermath of this disaster, Nicholas Barbon opened an office to insure buildings. In 1680, he established England's first fire insurance company, "The Fire Office," to insure brick and frame homes. The first insurance company in the United States underwrote fire insurance and was formed in Charles Town (modern-day Charleston), South Carolina, in 1732. Benjamin Franklin helped to popularize and make standard the practice of insurance, particularly against fire in the form of perpetual insurance. In 1752, he founded the Philadelphia Contribution ship for the Insurance of Houses from Loss by Fire.

Page 9

Franklin's company was the first to make contributions toward fire prevention. Not only did his company warn against certain fire hazards, it refused to insure certain buildings where the risk of fire was too great, such as all wooden houses. In the United States, regulation of the insurance industry is highly Balkanized, with primary responsibility assumed by individual state insurance departments. Whereas insurance markets have become centralized nationally and internationally, state insurance commissioners operate individually, though at times in concert through a national insurance commissioners' organization. In recent years, some have called for a dual state and federal regulatory system for insurance similar to that which oversees state banks and national banks.

Page 10

CHAPTER 2

INSURANCE
CONCEPT OF DIABETES INSURANCE

Page 11

CONCEPT OF DIABETES INSURANCE

Diabetes is a major health care problem in India with an estimated 30 million persons with diabetes, mostly living in urban areas. Over 98% have Type 2 diabetes. There are no reliable figures on how many are diagnosed and how many are treated. Based on sales of anti-diabetic pharmaceuticals, we estimate that a meager 10-12% receives modern pharmacological treatment being a chronic disease; diabetes requires support service infrastructure and a team approach to care. Whereas, generally the level of clinical care in most big cities in India is good, lack of a support system, non-availability of trained paramedical personnel and no health care insurance for chronic diseases such as diabetes continue to be problematic. Availability of dialectologists is scarce and largely private general practitioners and internists provide primary care even in urban areas. The quality of care varies considerably from place to place and practice to practice, depending upon the physicians interest, expertise and available infrastructure. Given the massive load of acute illnesses such as infections, fever and infestations, even private medical practitioners, not funded by the state, tend to concentrate less on chronic diseases like diabetes which are unrewarding as the time, effort and commitment needed is far too much, both for the provider and patient. There are practically no nurse educators, no podiatrists and few dietitians: which means the treating doctor takes the entire burden of responsibility of caring for these patients. The patients inability or unwillingness to pay for these additional support services also hinders their development. Lack of medical reimbursement and patient involvement and participation in therapeutic decision making is limited. In chronic diseases this "mind set" doesnt work. There are no heroic efforts,
Page 12

no dramatic results (no cure), moreover, the patient may be asymptomatic, unaware or unwilling to comprehend the consequences of a long term, poorly managed disease. The position of power assumed by the physicians and the minimal need of patient involvement prevailing under acute conditions does not work under these circumstances and requires a different physician behavior that of a counsellor, a friend or family elder. This role transition is difficult in the setting of overburdened services and limited time. In good faith, physicians make decisions for the patients. Many have misplaced concerns about their patients fears, apprehensions and capability for self-care. These impressions are coloured by the "acute care" mind set and physicians own feelings and that are at the best subjective and empirical. The inability or unwillingness to discuss various treatment options and the patients inability (due to inadequate information) to initiate such discussions, deprives him/her of the opportunity to actively participate in their own management. To be able to understand the intricacies behind the current diabetes practice in our country, it is important, to understand the patients as well as their physicians perceptions, attitudes and practices. We have earlier reported on the former aspect .In this study, we report from a survey on 393 physicians providing diabetes care in urban India, on their practices and their perceptions.

Page 13

CHAPTER 3

HEALTH INSURANCE DIABETICS

Page 14

Diabetic Health Insurance Why and How

Finding health insurance for diabetics that will cover the basic medical care needed by diabetics is critical. Many complications of diabetes require specialized medical care, and even regular health issues often require specialized care if the patient is diabetic. In many countries, diabetics are lucky to have their regular care covered by a national health plan. In the U.S. however, finding insurance after diabetes has been diagnosed may be difficult, because of many common limitations on coverage of pre-existing conditions placed by most insurance companies. However, even if you have a good basic insurance plan that covers the cost of your basic medication and office visits, check and find out what kind of coverage you do or do not have for important accessories for diabetics, such as special diabetic shoes and socks, and custom shoe insoles. Proper pedorthic insoles and diabetic footwear can be expensive, and finding supplemental insurance to cover it (if your regular insurance does not) can be a great financial help in managing your diabetes. Finding insurance that will also cover the cost of special diabetic personal care items may be quite difficult, but prescription skin lotions to help prevent dry, cracked skin and encourage healing of scratches, ulcers and fungal infections can be an important part of diabetes care. If your insurance will cover such items, you may also want to ask if you are covered for other accessory items such as self- massage and exercise equipment, to help combat the effects of poor circulation and muscle wasting.

Page 15

If you cannot obtain coverage for such extra items with your primary insurer, you may be able to find supplemental insurance with less restrictive coverages, or even a specialty insurance policy designed for diabetics. Research your options, if youre having any financial difficulty with proper management of your diabetes, because the potential costs of improper or inadequate care are much higher than most insurance premiums ever could be.

Page 16

CHAPTER 4

DIABETIC LIFE INSURANCE DIABETES TERM LIFE INSURANCE

Page 17

Diabetic Life Insurance

ATTENTION: Life Insurance Is Important ! It is not uncommon for many individuals to consider their own mortality once a debilitating illness is discovered. There are a surprisingly large number of Americans who only see the value in life insurance after their diabetic diagnosis. While it is much easier to get life insurance when you are younger and demonstrate a greater degree over overall health it is still possible in many instanced to find life insurance coverage even if you have been diagnosed with diabetes.

A Few Tips

The IDA(INDIAN DIABETES ASSOCIATION) reports that life insurance policies can be much harder to obtain following a diagnosis of diabetes they also indicate diabetics may be surprised at what policies may still be available. You may be happy to know that if you have managed your diabetes well there may be more options available. The IDA provides the following tips for finding the best life insurance policy when you live with diabetes. A major factor in the cost of life insurance policies for people with type 1 or type 2 diabetes is how well they manage their diabetes. If you have a lower A1C, good blood glucose control, lead a healthy lifestyle, and do not have complications from diabetes, chances are your rate will be more reasonable too.
Page 18

 Find an insurance agent that is experienced in obtaining policies for individuals with "impaired risk" -- they will know what carriers may offer you a policy and which one(s) may not. Apply for a policy with a life insurance carrier that uses "clinical underwriting" -- a process that looks at your total health, not just what health conditions you may have. Shop around -- on the Internet, by phone, or through referrals from family and friends. Becoming your own advocate will help you to find a life insurance policy that best fits your needs. Never take no for an answer! Just because one company rates or declines your application does not mean that another company will not look at you more favorably.

Classifications There are four general classifications used when providing life insurance. Super Preferred (Preferred Plus) Preferred Standard Substandard These classifications will be used by an insurance company to determine the risks that may be associated with providing coverage to any potential customer including a diabetic. A track record that shows long-term control of your disease can go a long way in finding acceptance with a life insurance provider.
Page 19

Christopher Graham, vice president and chief underwriter for Hartford Life indicates. Most people with adult-onset diabetes are insurable at some rate. And many diabetics get standard products. Impaired Fasting Glucose and Impaired Glucose Tolerance There also exists a large group of patients whose glucose is not sufficiently elevated to meet the diagnosis of diabetes by the above criteria, but whose glucose level is too high to be considered normal. These individuals have fasting glucose levels between 100 and 125 mg/dl or a 2-hour postprandial glucose reading of 140-199 mg/dl. These patients are considered to have impaired fasting glucose or glucose intolerance, respectively. These patients may have normal A1C values and may be virtually normoglyemic but are at a high risk to develop overt diabetes. This risk may be reduced significantly by lifestyle changes or some medical therapies. Patient who are developing type 1 diabetes also develop glucose intolerance followed by impaired fasting glucose before the presence of overt diabetes. To date, prevention strategies for type 1 diabetes have not been successful. Type 1 Diabetes As discussed in the previous issue of Clinical Diabetes, type 1 diabetes is caused by an absolute deficiency in insulin production. It is thought to arise from autoimmune destruction of the -cells of the pancreas in genetically susceptible individuals and constitutes 10% of diabetes in the United States. Although this form of diabetes is more common in childhood, it can occur at any time in life. Adults misdiagnosed as having type 2 rather than type 1 diabetes may be expected to have very limited or transient response to oral agents and to progress rapidly to insulin therapy. Because these patients eventually develop an absolute deficiency of insulin, insulin is the mainstay of treatment. Progression to absolute deficiency is variable and tends to be rapid in children and slower in adults. Several markers of autoimmunity can help identify people with type 1 diabetes, including anti-islet, anti-GAD65, anti IA-2, and

Page 20

anti-insulin autoantibodies. Type 1 diabetes is further subclassified into type 1A diabetes if autoimmune markers are positive and type 1B diabetes if they are not. Approximately 90% of newly presenting patients will have at least one positive antibody titer. Positive status varies based on age, duration of diabetes, and ethnicity. Anti-GAD antibodies are positive in 7080% of patients at the time of diagnosis. They are also more commonly positive in adults who develop type 1 diabetes and generally remain positive, whereas antiinsulin antibodies are not reliably measured after initiation of insulin therapy. Other patients clearly have complete or near-complete insulin deficiency and other autoimmune diseases, such as autoimmune hypothyroidism, yet remain antibody negative. These patients are considered to have type 1B diabetes. It is important to note that history of diabetic ketoacidosis is suggestive of, but not diagnostic for, type 1 diabetes because some patients with type 2 diabetes may also develop this complication. Type 1 diabetes may also present during pregnancy. There is also evidence that early and intensive use of insulin in adults presenting with type 1 diabetes prolongs their ability to produce insulin, which further underscores the importance of early and accurate diagnosis of type 1 diabetes. Type 2 Diabetes Type 2 diabetes is a heterogeneous group of conditions that constitute 90% of diabetes in the United States. Previously, this group of conditions was known as non-insulin-dependent diabetes or adultonset diabetes. Type 2 diabetes involves insulin resistance and relative insulin deficiency rather than an absolute insulin deficiency as seen in type 1 diabetes. Insulin resistance is thought to precede insulin deficiency in most patients, and autoimmune destruction of -cells does not occur, although -cell mass may be reduced. Because the insulin deficiency is relative rather than absolute, diabetic ketoacidosis occurs less frequently than in type 1 diabetes. Therapy for type 2 diabetes varies considerably from that for type 1 diabetes. The majority of patients with this form of diabetes are clinically obese, and exercise and weight loss lead to improvements in the disease state and even clinical remission in

Page 21

some individuals. Pharmacotherapies directed toward increasing insulin sensitivity and increasing -cell insulin production are useful in type 2, but not in type 1, diabetes. Unlike type 1 diabetes, there is a strong genetic predisposition to developing type 2 diabetes, and the presence of several family members with type 2 diabetes suggests the diagnosis. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Unlike other forms of diabetes, GDM uses a different set of diagnostic criteria and screening because normal physiological levels of glucose are different during pregnancy. The pathophysiology and diagnostic criteria for GDM are discussed in detail elsewhere in this issue of Clinical Diabetes. It is important to note that GDM is a powerful predictor of the development of type 2 diabetes later in life. Some studies have demonstrated that as many as 70% of women who experience GDM will develop type 2 diabetes within 10 years after delivery. Which Type of Diabetes Is Most Insurable? The general consensus seems to be Type 2. The reason this may be true is that Type 2 diabetes can generally be controlled through an aggressive selfmanagement plan while Type 1 is controlled through insulin therapy. Add to this the fact that Type 1 is the type of diabetes generally associated with youth and can have lifelong health implications. Still there may be life insurance options available to both types of diabetics.

Just Diagnosed and Need Advice If you do not have life insurance, but you were recently diagnosed with diabetes you may have a strong urge to try and find a life insurance policy. We suggest waiting at least 3-6 months to allow any potential policy to be based on a track record of control.

Page 22

Is This Information Important:The IDA (INDIAN DIABETES ASSOCIATION) offers the following statistical data, There are 23.6 million people in the United States, or 8% of the population, who have diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. Only 24% of diabetes is undiagnosed, down from 30% in 2005 and from 50% ten years ago.

This information indicates more prudent diagnoses of diabetes. Having options available for life insurance coverage remains an important asset to diabetics and their families.

The Highlights Reel Lets review some of the major issues affecting life insurance for those with diabetes. Diabetics will likely fall into a standard category for insurance classification. They will not likely qualify for preferred status. Coverage type will depend on the total level of control you exhibit in your diabetes management. You shouldnt give up on finding a policy. If one company turns you down you should keep looking. You will likely be able to find a policy, but it will take diligence. It may be easier to gain insurance for Type 2 diabetes easier than Type 1, but policies are available for both. Guaranteed issue insurance products are very expensive and should be considered only as a last resort.

Page 23

Financial Help for Diabetes Care

Diabetes treatment is expensive. According to the American Diabetes Association, people with diabetes spend an average of $11,744 a year on health care expensesmore than twice the amount spent by people without diabetes. Many people who have diabetes need help paying for their care. For those who qualify, a variety of governmental and nongovernmental programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources.

Diabetes Term Life Insurance

Diabetes term life insurance is an important type of coverage for those who suffer from the disease. Since diabetes is considered a high risk disease, many companies have stringent guidelines regarding accepting high risk policy holders. Many companies do not even offer diabetic term life insurance because of the huge costs they may incur. However, there are companies that specialize in this sort of coverage if a person researches hard enough.

However, there are many companies that have designed special packages that can be purchased by diabetic patients. In fact, there are some companies that specialize in high risk coverage for patients who cannot find diabetic term life insurance coverage elsewhere. Since this disease is so changeable and has so many developmental issues for patients, these companies that
Page 24

offer diabetic term life insurance may offer differing policies for varying stages of the illness.

Other diabetic stages that affect coverage are juvenile and adult diabetes. Many parents, who realize that their family tends to develop diabetes, will purchase life insurance for their young children that are renewable in case they develop the disease. Since adult diabetic term life insurance coverage is more difficult to receive approval for, this is a way for parents to insure that their children can receive coverage in advance of any onset of diabetes. Check with several companies that offer high risk diabetes term life insurance. Anyone can receive more information regarding coverage and rates through many online sources. "For thy mercy is great above the heavens: and thy truth reached unto the clouds." (Psalm 108:4). It is important to always keep an open mind and remember that all things are possible with God's blessing on the situation

Whatever stage or type of diabetes a patient suffers will directly impact the coverage he or she may receive or at the very least, how much it will cost. Issues such as whether or not a patient's diabetes is stage one or stage two are important considerations companies. Also, whether or not a patient is insulin dependent or not is a major consideration for companies that offer diabetes term life insurance. If a patient's disease is stabilized and monitored properly, he or she may be able to find an insurance company that will offer reasonable diabetes term life insurance coverage. Talking to other people with the disease to get their opinion on where to find coverage is a great place to start researching.

Page 25

CHAPTER 5

STAR HEALTH AND ALLIED INSURANCE DIABETES POLICY 2010-11

Page 26

Diabetes Policy (2010-11)

Star Health and Allied Insurance presents a policy that helps those affected by Diabetes Mellitus

Type II and offers insurance protection for treating most commonly occurring complications .

India has a diabetic population of 30 million - the highest in the world and the number is increasing rapidly everyday. Diabetes needs immediate attention because it affects vital systems in the body over time and treatment can be very expensive.

Star Health and Allied Insurance presents a policy that helps those affected by Diabetes Mellitus Type II and offers insurance protection for treating most commonly occurring complications Salient Feature This insurance is for persons who are already known to suffer from Diabetes Mellitus Type II If the person who is already suffering from Diabetes Mellitus Type II develops further complications namely : 1. Diabetic Retinopathy requiring laser treatment. 2. Diabetic Nephropathy leading on to Chronic Renal Failure. 3. Diabetic Foot Ulcer requiring micro vascular surgical correction. The policy responds by paying for the cost of treatment.

Page 27

Any person between 26 years and 65 years of age who is already suffering from Diabetes Mellitus Type II can take this insurance. Renewals will be accepted up-to 70 Coverage Offered for Specific Conditions

Eyes: Diabetic Retinopathy requiring laser treatment Kidneys: Diabetic Nephropathy leading to chronic renal failure Feet: Diabetic foot ulcer requiring micro-vascular surgical correction The policy covers the cost of treatment up to the limit provided

Diabetes Benefits

Hospitalization Cover Boarding and room charges at 2% of the sum insured subject to a maximum of Rs.2500 per day in Class A cities and Rs.1250 per day in other locations

Nursing expenses Surgeon's fees, Consultant's fees and/or Anesthetist fees Cost of blood, oxygen, diagnostic expenses Cost of medicines and drugs

Special Features

Hospitalization expenses on donor of kidney for renal transplant surgery are payable subject to availability of sum insured

Post-renal complications on the insured person covered Second transplant following failure of the first transplant covered

Page 28

Pre-Acceptance Medical screening

All applicants will have to undergo a pre-acceptance medical screening at company nominated center

Sum Insured Options

The insurance is available for sums of Rs.50,000, Rs.1,00,000, Rs.2,00,000, Rs.3,00,000, Rs.4,00,000 and Rs.5,00,000

Premium in Indian Rupees (Service Tax extra) Sum Insured (in Rs) 50000 100000 200000 300000 400000 500000 Claim Procedure

26 - 35 Yrs

36 - 45 Yrs

46 - 55 Yrs

56 - 65 Yrs 66 - 70 Yrs

805 1140 1885 2300 4655 6385

990 1615 2565 3135 4990 6840

1235 1900 3420 4180 6650 9120

1485 2185 3765 4600 7315 10035

2225 2470 4105 5020 7980 10945

Call the Star Health 24 hour help-line to register the details of hospitalization.

Kindly mention your Star Health ID number for easy access to your policy details.

Page 29

In case of a planned hospitalization, please register 24 hours prior to admission to the hospital

In case of emergency hospitalization, please register within 24 hours of hospitalization

In all network hospitals, the cashless facility on payments can be availed

For treatment in non-network hospitals, payments must be made upfront to the hospital. Reimbursement of the expenses will be effected by Star Health, on submission of the necessary documents.

Exclusions

Patients who have already developed complications of Diabetic Retinopathy and/or Diabetic Nephropathy leading to Chronic Renal failure and/or Diabetic foot ulcer

Expenses on treatment of Diabetes Mellitus Type II (A detailed list of exclusions is available in the policy conditions document)

Eligibility

Any person between 26 years and 65 years of age who is diagnosed with Diabetes Mellitus Type II can take this insurance

This limit of 65 years is applicable only for initial entry in to the scheme. Renewals will be accepted up to 70 years

Non-insurance Benefits

24-hour Help Line for customers Cashless facility if the treatment is taken in any network hospital.

Page 30

Free General Physician advice Website with in-depth health information

Terms & Conditions

1. Every notice or communication to be given or made under this policy shall be delivered in writing at the address as shown in the schedule.

2. Organ transplant on the Insured Person shall satisfy the requirements of the Transplantation of Human Organs Act of 1994.

3. The premium payable under this policy shall be payable in advance. No receipt of premium shall be valid except on the official form of the company signed by a duly authorized official of the company. The due payment of premium and the observance and fulfillment of their terms, provision. Condition and endorsements of the policy by the Insured Person, in as fast as they relate to anything to be done or complied with by the Insured person. Shall be a conditions precedent to any liability of the company to make any payment under this policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unless made in writing and signed by an authorized official of the Company.

4. The Insured Person shall obtain and furnish the Company with all original bills, receipts and other documents upon which a claim is based and shall also give Company such additional information and assistance as the Company may require in dealing with the claim.
Page 31

5. Any medical practitioner authorized by the company shall be allowed to examine the Insurance Person in case of any alleged covered diseases/conditions requiring Hospitalization when and as often as the same may reasonably be required on behalf of the Company.

Important Note: This insurance is available to persons between 26 years and 65 years of age. Renewal of insurance is available up-to 70 years of age. The Policy Schedule and any Endorsement are to be read together and any word or such meaning wherever it appears. The terms conditions and exceptions that appear in the policy or in any Endorsement are part of the contract and must be complied with. Failure to comply may result in the claim being denied.

Page 32

CHAPTER 6

ICICI PRUDENTIAL DIABETES POLICY

Page 33

ICICI prudential life insurance Health insurance for diabetics

With 32 million known diabetics, India has the dubious distinction of being the diabetes capital of the world. A sedentary lifestyle, poor eating habits and genetic pre-disposition are some of the reasons for a rise in the incidence of diabetes in India. Moreover, India also has high prevalence of people suffering from pre-diabetic conditions like Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG), which, if not managed early, can develop into diabetes.

Diabetes can cause serious health complications which frequently affect the kidneys, eyes and limbs. Treating these complications can seriously impact your finances too, since most conventional medical insurance plans do not cover a diabetic for such expenses.

At ICICI Prudential Life Insurance, we are proud to present an innovative solution - Diabetes Assure, a policy for people with Type II diabetes and pre-diabetes. The policy provides financial support through lump-sum payments, exclusively to cover costs of treating kidney, eye and limb complications.

Page 34

Key benefits of Diabetes Assure How does Diabetes Assure work for you? Payment of lump-sum benefit in case of Kidney Failure Procedure based cover for multiple occurrences of: i. Limb Amputation due to diabetic complications ii. LASER Treatment for Diabetic Retinopathy Tax benefit on premium paid under Section 80D of the Income Tax Act, 1961

How does Diabetes Assure work for you? This is a 5-year term regular premium paying policy. You can buy a Sum Assured of Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs or Rs. 5 lakhs. Your premium is based on your age and the Sum Assured chosen by you. Premiums can be paid on an annual, half-yearly or monthly basis.

Page 35

In the unfortunate event of Kidney Failure, Diabetic Retinopathy or Limb Amputation due to diabetic complications, you will receive the applicable benefit amount.

Benefits in detail :Lump sum payment

We know that, when faced with a critical illness, money matters should be the last thing on your mind. Diabetes Assure policy offers a cover for a period of 5 years with 4 options of Sum Assured (SA): Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs or Rs. 5 lakhs. The coverage is provided for the following conditions:

a. End Stage Renal Failure (Kidney Failure) You are entitled to 100% of the Sum Assured on diagnosis of End Stage Renal Failure based on the cover chosen. The lump sum benefit will be payable independent of any other payout under this policy. You will receive the benefit amount irrespective of your expenses. This benefit amount can be used for meeting the cost of treatment and to take care of additional expenses arising from a critical illness. The policy would however close after the payout of this benefit. For further details, refer to the Payout Structure Table.

b. Procedure based cover As diabetes related complications are the leading cause of new cases of Retinopathy and Limb Amputations in adults, Diabetes Assure provides you procedure based cover for:
Page 36

 Limb Amputations due to diabetic complications LASER treatment for Diabetic Retinopathy 5% of the Sum Assured will be payable for multiple occurrences on the two procedures mentioned on the previous page, over the term of the policy, subject to the following conditions:

For Limb Amputation (any limb), each surgical procedure for a particular limb must be 180 days apart. Claims for both limbs can be made together.

For LASER treatment of the eyes, the incidence for the same eye must be 180 days apart. Claims for both eyes can be made together.

Claims process Description of critical iIllness

Our claims process is an easy 3-step process. This ensures that you get a hassle-free and convenient claims experience.

1. Submit a written notice along with proof of diagnosis of critical illness / undergoing surgery, required for the claim. 2. The company verifies the documents and admits the claim. 3. The company pays the entire benefit amount as applicable.

Page 37

1. End Stage Renal Failure (Kidney Failure)

End Stage Renal Failure is described as a chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is undertaken. Evidence of End Stage Renal Failure must be provided and the requirement for dialysis or transplantation must be confirmed by a consultant physician. 2. Procedure based cover Limb Amputation: The benefit shall be payable on the Life Assured actually undergoing Limb Amputation as a result of complications of Diabetic Neuropathy or Peripheral Vascular Disease. A post amputation X-ray of the affected limb is required to be submitted to the company along with the treating doctor's certificate. However, any amputation due to accident is not entitled for the above bene

ICICI prudential life insurance in 2010-11

Diabetes care is a unique critical illness insurance policy for type 2 diabetics and pre-diabetics. Diabetes care not only provides financial support but also helps you manage your condition more effectively.

Page 38

Key Benefits of Diabetes Care

Lump-sum payment on diagnosis of any one of the six critical illnesses

optional cover for eye & foot complications wellness program - 3 free check-ups and a consultation with a doctor every year

reduced premium on display of good control tie-ups with leading healthcare partners to help you manage diabetes web support for better diabetes control Tax benefit under section 80d of the income tax act

The lump-sum amount is paid on diagnosis, irrespective of your expenses. We don't require any medical bills and you can use the benefit amount to meet cost of treatment and any other concomitant expenses.

Product Features
Eligibility

Type 2 Diabetics or Pre-Diabetics (IFG/IGT)

o

Impaired Fasting Glucose - IFG is a condition wherein, after overnight fasting the blood glucose values are between 110 and 125 mg/dl.^

Impaired Glucose Tolerance - IGT is a condition wherein along with IFG, blood glucose values after 2 hours of meals are between 140 and 199 mg/dl.^
Page 39

Age (Nearer Birthday): 25-60 Years

Sum Assured

Base Sum Assured Options: Rs. 3 Lakhs, Rs 5 Lakhs, Rs 10 Lakhs Diabetes Enhanced Benefit Rider: 10% of Base Sum Assured No Maturity/Death Benefit is payable The Sum Assured will be paid as per the table below

Time of Diagnosis

CI Benefit Amount

Rider Benefit Amount

First 6 months of the Return of premiums policy paid till date

Return of rider premiums paid till date

6-12 months

50% of Sum Assured 50% of Rider Sum * Assured

After 1 year

100% of Sum Assured 100% of Rider Sum * Assured

Page 40

Premiums

Premium payment frequency: Monthly, Half Yearly and Annual Premiums payable for Sum Assured of 3 Lakhs for a male are given below: Base Premium(Rs.)# 10,023 12,263 14,319 17,485 21,294 Premium with maximum reduction after Year 1(Rs.)# 8,520 9,810 11,455 13,988 14,906

Age(Years) 35 40 45 50 55

Policy Term

There is a fixed policy term of 5 Years ^ As per Indian Council of Medical Research (ICMR) Guidelines * The claim is payable only on survival for 28 days from the date of diagnosis of the critical illness # The premiums shown are exclusive of service tax and education cess.

Page 41

Wellness Program Managing your diabetes is the key to staying healthy. As part of our Wellness Program, we will sponsor you for three diagnostic tests and one consultation every year, absolutely FREE.

In the 4th and 8th month every year after issue of the policy, you will need to undergo HbA1c test and need to get your blood pressure and pulse rate measured, which will help monitor your condition.

There will be a comprehensive and compulsory medical check-up every year (except at the end of 5th policy year), which will include tests such as sequential medical analysis of 12 tests (SMA 12 covering blood sugar, lipids, S Creatinine etc), HbA1c, ECG, routine urine analysis and urine test for Microalbuminuria.

We will also offer a free consultation every year with an empanelled doctor, for advice and an appropriate health care plan.

To make sure you don't miss any of your tests, we will send you periodic reminders also. Improving Health, Reducing Premiums We offer you an attractive incentive to keep in good health - a reduction in your premiums (as indicated in the table below). This premium reduction will be made after periodic check-ups to confirm your good health, for which we have created a Diabetes Control Index. This index uses key factors

Page 42

from your regular tests like HbA1c, blood pressure, lipids and weight and is an overall indicator of your control.

Therefore, if you show good control, your Diabetes Control Index will go down and your premium will be reduced for the next year by 5% to 30% of your 1st year's base premium!

Age at Entry (years) Premium Reduction Level 1 Premium Reduction Level 2 Premium Reduction Level

25-35 5%

36-50 10%

51-60 12.5%

10% 15%

15% 20%

20% 30%

If your results worsen or you miss any of the tests, your Diabetes Control Index will go up. If it rises beyond a scale, you will be required to pay a higher premium for the following year, as indicated below

Age at Entry (years) Higher Premium (over 1st year's Base Premium)

25-35 10%

36-50 15%

51-60 17.5%

Page 43

Coverage

What Diabetes Care covers/provides?

Financial Cover

Lump-sum amount paid on 1st diagnosis of any of the 6 critical illnesses, i.e. Coronary Artery Bypass Graft (CABG), Cancer, End stage renal failure, Heart Attack, Major organ transplant (as a recipient) and Stroke. Please refer to critical illnesses covered for a detailed description.

If Diabetes Enhanced Benefit Rider is taken, a lump-sum amount (equivalent to 10% of the Base Sum Assured) is paid in the event of limb amputation due to diabetic complications or LASER treatment for diabetic retinopathy. Please refer to Diabetes Enhanced Benefit Rider for details.

The payout is made only in case the critical illness occurs for the first time.

Page 44

Diagnosis & Testing

Regular free testing (HbA1c, Blood Pressure and Pulse rate check) every 4th & 8th month, during the policy term.

A comprehensive medical check-up will be provided every year, till the end of the first 4 policy years.

One free consultation every year with an expert physician, till the end of the first 4 policy years.

Free home collection of blood samples for testing. Test results will be available on the Diabetes Care website.

Partnerships

Concessions on products offered by our partners.

Page 45

What Diabetes Care does not cover/not provide? Financial Cover

If the policyholder does not survive beyond 28 days from the date of diagnosis of a critical illness, the policyholder will not be eligible to receive the critical illness payout. After the lump-sum payout is made for the 1st critical illness, the policy stands terminated. Diagnosis & Testing

Tests from diagnostic centers or doctors who are not from our empanelled network will not be accepted/will not be paid for. Any additional consultations or tests conducted will not be covered or reimbursed under the plan. Partnerships

There will be no reimbursement offered against drug purchases, insulin or insulin delivery mechanisms.

Page 46

CHAPTER. 7

FINDING ON DIABETES AWARENES

Page 47

FINDING ON DIABETES AWARENES

DIBETISE AWARENESS

7%

yes NO

93%

Interpretation- Among the people who were surveyed there were only 7% people who had taken insurance policy from their respective Insurance company. Remaining 93% respondents didnt opt to take a policy from their insurance company.

Page 48

CHAPTER .8

CONCLUSION

Page 49

CONCLUSION From the above project I have observed that 70-80% people are diabetes patient in India Diabetes is common dieses in now a days, but in Maharashtra among 22 companies along with LIC only 2 insurance companies we are founded diabetes insurance policy. From the above survey I have observed that among the people who were surveyed there were only 7% people who had taken insurance policy from their respective Insurance Company. Remaining 93% respondents didnt opt to take a policy from their insurance company. The reason for lack of awareness about diabetes insurance policy because of the some people dont know anything about it and they dont know about the procedure or terms and condition to take diabetes insurance policy and also main reason the company not promoting the diabetes insurance products through advertising and not improve its selling techniques.. There are no tough competitions among the insurance companies.

Page 50

CHAPTER.9

DIABETES INSURANCE AWARENESS SURVEY 1) Are you aware of diabetes insurance policy? 2) If you are diabetes patients then select any one of the following? 3) Have you taken an diabetes insurance policy? 4) Which company policy do you prefer? 5) How you pay your premium? 6) Which type of diabetes policy you prefer? 7) Do you think has diabetes insurance policy has been advantage to you?

Page 51

Chapter.10

Bibliography

Web Based www.investopedia.com www.google.com www.intimespectrum.com

Page 52

Page 53