The health insurance industry is shifting from simple claims payment to holistic healthcare management, says Dr. Santosh Puri, Senior Vice President, Healthcare Products and Processes, Tata AIG General Insurance Company.
In an interview with MintGenieDr. Puri said obtaining health insurance coverage can provide financial protection and ensure access to quality health services for individuals and families.
Edited excerpts:
Q. This year, the theme for “World Health Day” is “Health for All”. However, is it possible without a health insurance plan at present?
While the theme of “World Health Day” emphasizes the importance of health care for all, having a health insurance plan can be an important step towards achieving this goal. In today’s fast-paced world, medical requirements are unpredictable and can cause financial upheaval, making people realize the importance of having a comprehensive health insurance plan.
With rising health care costs and unexpected medical expenses, obtaining health insurance coverage can provide financial protection and ensure access to quality health services for individuals and families. . Therefore, having a health insurance plan is extremely helpful in instilling financial confidence. A comprehensive health insurance plan can help people protect themselves and their loved ones while dealing with adversity without added financial stress.
Q. The Covid-19 pandemic has caused a surge in the sale of health insurance policies. Health insurance premiums have risen rapidly. Has this affected people’s interest in purchasing health insurance or opting for extended coverage?
The Covid-19 pandemic has had a significant impact on the health insurance industry in India. The pandemic has made people aware of the importance of having a comprehensive health insurance plan as an effective tool to guard against unforeseen circumstances. The pandemic has also led to a surge in demand for health insurance policies.
Like any other industry, healthcare costs have also been affected and hospitalization costs have increased. Additionally, significant advancements are occurring every day in new age medical technology, drugs, and treatments. This is on top of overall medical inflation and treatment costs are rising every day.
Despite rising premiums, no one can protect themselves or their families against this growing medical inflation. It is relevant to clarify that having a health insurance policy protects one’s finances and helps in prudent financial planning despite increases in premiums.
Although some people may have been put off by the higher premiums, the pandemic has heightened the need for comprehensive health insurance coverage, and we expect interest in health insurance to remain strong going forward.
Q. What is the most common mistake when buying health insurance?
In today’s world, health insurance has become an integral part of overall financial planning. One of the most common mistakes people make is choosing health insurance plans based solely on premium cost without considering policy coverage, benefits, and fine print. It is essential to ensure appropriate coverage for medical conditions.
Most policies have a waiting period for pre-existing conditions. It is essential that people carefully check the details of diseases with waiting conditions. People should also check the co-payment clause carefully when buying a health insurance policy to avoid paying huge costs in case of emergency.
Another important factor is having a comprehensive health insurance plan. There are plans that offer sub-limits on illnesses or room rent caps. Ignoring them will lead to surprises at claim time.
It is essential to read the policy documents carefully, understand the details of coverage and assess the suitability of the policy based on an individual’s health needs. It is crucial to carefully review the policy document and understand the coverage offered, exclusions and the claims process. Greater importance should also be placed on disclosing the facts (especially medical conditions, etc.) at the time of policy purchase to avoid hassles at the time of claims.
Q. There has been an increase in online aggregators selling health insurance. Do you think their presence helped penetrate the Tier 2 and Tier 3 cities that have remained intact to this day?
Healthcare penetration has always been a concern in small towns in India. Tier 2 and Tier 3 cities are the main development regions for the economy and need health infrastructure, especially at the grassroots level. We believe that it starts not only with the development of a robust healthcare facility but also with deeper penetration in terms of health insurance which can be made affordable and accessible to all Indians.
Various measures and initiatives taken by the government to raise awareness about health insurance including the Pradhan Mantri Jan Arogya Yojana (PMJAY), often known as Ayushman Bharat, Rashtriya Swasthya Bima Yojana (RSBY) and the insurance scheme Universal Disease (UHIS) led to deeper penetration in Tier 2 and Tier 3 cities.
Tata AIG observed growth as high as 150% in e-commerce adoption between the years 2018-19 and 2020-21. Online aggregators and the digital reach of industry players have enabled customers to make the smart choice to purchase health insurance by comparing rates, benefits and coverage, with ease and security.
This digital spread of the industry has allowed insurance to reach the hinterland where insurance agents and information are limited. Online aggregators offer a user-friendly interface and assisted buying journey for customers to browse and compare various policies and benefits, making the insurance buying process more accessible and convenient.
Q. What do you think of the evolution and inclusion of innovative products in today’s health insurance industry?
The insurance industry is constantly innovating and evolving. Insurance companies have the ability to innovate using technology applications to cover new and existing risks. Innovation has led to the digitization of various insurance features including collections, claims, 24/7 support and policy upgrades, revolutionized the entire industry insurance. With AI-led initiatives, there is a lot more to unfold in times to come.
The industry is moving from simple claims management to holistic healthcare management. The emphasis is on preventive health rather than simply curative. Value-added services, wellness features and the use of telemedicine have been the upcoming trends in recent years. The end-to-end customer experience is of paramount importance. Customers expect smooth and better experiences from comparing plans to purchasing policies to claiming services.
Another observed innovation is also noted in self-adjudication of claims for faster processing of claims without any human intervention. Fraud and abuse management platforms are also noticing rapid upgrades to detect early fraud trends and put appropriate controls in place.
Insurance companies can now create custom policies through the use of machine learning and portable data processing. Wearable devices are becoming an increasingly essential aspect of India’s health insurance industry, providing insurers with vital data on policyholders’ health and helping to encourage good behavior. In addition, artificial intelligence can greatly help to create suggested plans that will best meet patients’ needs, based on their location, age, health status and other criteria, and provide calculators insurance premiums to promote transparency.
85% of respondents would consider cutting back on some luxury items so they can spend more on health insurance