Need for Customised Health Insurance

There is an urgent need to ramp up the health insurance coverage in the country as out-of-pocket payments are still among the highest in the world, informs Dr Sriharsha A Achar, Chief People Officer & Chief Information Security Officer (CISO), Apollo Munich Health Insurance, to Romiya Das of Elets News Network (ENN)

How do you find the health insurance market in India vis-àvis global scenario?

The health insurance segment is exploding, literally. With more than 75 per cent of the population without any form of health insurance cover (whether provided by government or private sector), there is a critical need to improve the infrastructure, which not only helps creation of innovative insurance products, but also enables easier distribution of the same amongst the large population. In comparison to the mature, global health insurance segment that supports the ever-ending demands of customers, India is still evolving. The segment still remains an unexplored territory in India. Health insurance has become one of the most prominent segments in the insurance space today and is expected to grow significantly in the next few years. As spending on healthcare in India is expected to double in a couple of years, it is believed that health insurance will eventually become the biggest contributor in the non-life segment.

Could you brief us about Apollo Munich’s insurance model?

Our operations are heavily hinged on our customers. As a company we have made a conscious choice of taking all our decisions, whether on product, distribution, service, based on what our customers’ expect from us. We invest heavily in customer research to find their latent needs for health insurance, how are they enjoying our services, and exploring newer technology which can help us deliver our promises to the customers.

How has the adoption of IT impacted your operations?

At Apollo Munich, we have adopted technology across the board in areas such as CAREculator and an underwriting rules engine for easy customer purchase decision processes. To ease customers sourcing process, we have also used technology to offer over the counter policy issuance, tab and mobile based issuance, online buying solutions. We offer automated e-fax, two hour cashless authorisations across the country, and biometrics to ease claims processes.

The adoption of technology in all facets of the organisation has helped us to achieve a pan India presence, quadrupling of productivity per employee, enhancement of provider satisfaction, consistent decision making tools and reduction of our carbon footprint.

How does technology adoption help in addressing the challenges in the sector, including fraudulent practices?

There are three broad categories of fraud. Policyholder and claims fraud – where the fraud is against insurer by policyholder and/or other parties in the purchase and/or execution of an insurance product; Intermediary fraud by intermediaries against insurer and/or policyholders and Internal fraud against insurer by employee on his/her own volition or in collusion with parties that areinternal or external to insurer.

All these three categories of fraud can be addressed using high-end analytics and technology to enable validations using results thrown by analytics. For example, if we have a common ID (like SSN) quoted across financial transactions; it would be easy to check it against past history and similarity. The check for an individual’s transactions can be likened to the Credit Information Bureau (India) Limited (CIBIL) score and an instant alert using modern day communication methods like email, SMS etc, can prevent the fraud from being committed. Also, usage of technology like biometrics can prevent impersonation – one of the biggest frauds faces by health insurers today.

How can IT bridge the gap between health insurance companies, TPAs and hospitals?

Today, health insurance companies, TPAs and hospitals work on different platforms, under different coding and reporting regimes. This is the biggest challenge and poses a big gap in servicing of customers. IT can play a vital role in bringing all under the same roof.

Adoption of common coding methodology such as WHO’s International Classification of Diseases (ICD) can ensure minimal gaps in understanding and reporting. Standardisation of rates will allow a customer options to choosefrom for a provider, a doctor and can aid in competitive fees for procedures. IT can help build this information repository. The use of Biometrics can help link all entities and aid in the prevention of fraud.

How beneficial are the websites comparing medical insurance for the commoners?

Insurance aggregator websites are beneficial to digital media users as they can provide comparative details on health insurance products and their approximate premiums. However, owing to differentiated products and lack of a common definition on many sub-elements, one often ends up comparing apples to oranges. The credibility of online information is judged differently by different consumer segments. Some value them as they get quotes from health insurance companies, while others find them intrusive for the same reason. For a value seeking Indian customer, it more often than not results in being a premium comparing exercise.

How can IT help in tapping the rural health insurance market?

IT has so far piggy backed on the Government’s bio-metric infrastructure to reach out to the rural masses. The approach needs to be widened and the aim should be to utilise the connectivity being offered by the Government via e-choupals, district centers, village key men, mobiles and Internet. Interoperability and reach via common IT platform with payment banks, small banks and institutions like National Bank for Agriculture and Rural Development (NABARD) must be enhanced in near future.

How is cashless health insurance facility benefitting this sector?

Cashless insurance claims procedure reduces the stresses of nerve wrecking medical casualty experiences.Cashless settlements offer the customer the feel of having the promise fulfilled by the insurer in terms of offering financial help, when it is needed. This allows the whole process of claims to be turned around in a very quick manner, sometimes in as less as 60 minutes! Today our company settles most of cashless claims within an hour. This also reduces costs for the insurer as cashless claims covers standard procedures, the procedures and likely costing of which is prescribed by word medical bodies which insurers uses to convince the hospitals to charge at the right levels for the treatment.

How do you see the sector’s growth in the coming years?

As health insurance companies adopting newer technologies faster and making use of it in all spheres of business to make life simpler for all stakeholders viz, customer, employees, shareholders, hospitals and vendors. The overall growth of the sector is expected to be in high double digits for next 10 years as per research reports, highlighting the fact of underinsured market in India. We are already seeing foreign partners in health insurance companies agreeing to increase their stakes from 26 per cent to 49 per cent, which means more capital, will be infused in the health insurance sector. This will in turn help improve distribution reach as well as productivity of the health insurance industry. With the advent in technology in the healthcare sector, the rising cost of health care will only spur the need for financial protection at time of medical distress even more pronounced triggering the growth in health insurance businesses. The Government of India is focusing on healthcare and its intention of ensuring it reaches the masses in a standardised form is apparent.

What are Apollo Munich’s business plans for next five years?

Apollo Munich continues its path to be a trusted leader in health insurance sector by providing innovative solutions to the citizens of India. We see a huge opportunity before us in terms of the untapped market potential. Our endeavor will be to reach out to all and grow as fast as possible. The sky is the lower limit in my view. And becoming an `8,000 – 10,000 crore company in the next five to seven years is very much achievable.

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