CASES TO ANALYSE / ANALYSE THE THREE CASES BELOW AND PREPARE

YOUR ARGUMENTS AND DISCUSSIONS WITH SUITABLE PRODUCT RECOMMENDATIONS,

COMMENTS & ILLUSTRATIONS

1. MANAGING INSURANCE CLAIMS

Suresh is 45 years; due to some ill health he was hospitalized several times in the past

few months. He has Rs.4.00 lakh worth of sum insured under health insurance which

he purchased on 1 st May 2015 and he has company provided insurance of Rs.3.00 lakh.

His personal health insurance policy is valid from 1 st May 2019 to 30 th April 2020 and his

office provided insurance too is valid for the same period. During this period, first

time he was admitted in the morning and was discharged later in the night, the

hospital bill was Rs.20000; second time he got admitted and discharged after 2 days,

the bill was Rs.50000; third time he got admitted and had a surgery, stayed in the

hospital for 6 days, the bill was Rs.2.50 lakh; fourth time he got admitted and had

another surgery, stayed in the hospital for 10 days; the bill was Rs.3.50 lakh; he also

had pre-hospitalization tests and scans worth Rs.25000. It was diagnosed that he had

thyroid and was suffering from it for the last 2 years; Suresh had not disclosed this

fact with the insurance company while buying the insurance policy. Assess the

situation and give your answer on which of these expenses will be reimbursed /

rejected; he has also exceeded his sum insurance amount he has in his personal name;

how will the additional expenses be managed? Justify your answer

2. INSURANCE & FINANCIAL PLANNING

Ashwin is 35 years, employed in an oil exploration company as an engineer; he is part

of the project team that manages oil rigging world over; his net salary is Rs.1.50 lakh

p.m. He regularly travels to various countries on his work. He lives in Bangalore in his

own house worth Rs.1.25 crore; his wife Sumana works with a private bank, her salary

is Rs.50000 and the couple has two children aged 4 and 1 year respectively. Their

monthly household expenses are Rs.25000 and they pay EMI of Rs.50000 towards home

loan and Rs.15000 towards car loan. Ashwin pays Rs.10000 to his parents every month.

The couple have not financially planned yet and seeking your assistance for planning.

Guide them of how to manage financial risk, understanding human life value and other

insurances that assists them in securing their life from unforeseen events

3. INSURANCE PREMIUM ANAMOLIES

Saurabh and Anirudh are friends and both are 30 years of age married and one child

each; they both decided to buy Rs.2.00 crore worth of life insurance sum assured for a

period of 35 years; after assessing both the parties the insurance company gave a

premium payment quotation, but Saurabh's annual premium was higher than Anirudh's

annual premium despite the sum assured amount and the tenure were the same.

Explain the specific reasons of premium calculations undertaken by insurance

companies. Also, a few weeks ago Anirudh had visited Mumbai on personal matter; he

fell ill and was admitted into a local hospital for 12 hours where the bill was Rs.15000.

Will this claim be settled by the health insurance company? Justify your answers with

relevant arguments.