The health insurance industry is undergoing a transition from merely being claims pay to holistic healthcare management, says Dr Santosh Puri, Senior Vice President-Health Product & Process, Tata AIG General Insurance Company.
In an interview with MintGenie, Dr Puri said that getting health insurance coverage can provide financial protection and ensure access to quality healthcare services for individuals and families.
Q. This year, the theme for “World Health Day” is “Health for All”. However, is this possible without a health insurance plan in today’s times?
While the theme for “World Health Day" highlights the importance of healthcare for all, having a health insurance plan can be a significant step towards achieving this goal. In today’s fast-paced world, medical exigencies are unpredictable and can lead to financial upheaval, making people realize the importance of having a comprehensive health insurance plan.
With rising healthcare costs and unforeseen medical expenses, getting health insurance coverage can provide financial protection and ensure access to quality healthcare services for individuals and families. Hence, having a health insurance plan is extremely useful to instill financial confidence. A comprehensive health insurance plan can help people protect themselves and their loved ones while facing adversity without added financial stress.
Q. The Covid-19 pandemic caused an uptick in the sale of health insurance policies. Health insurance premiums soon rose. Did this affect people’s interest in buying health insurance or opting for extended coverage?
The Covid-19 pandemic played a significant impact on the health insurance industry in India. The pandemic made people realize the importance of having a comprehensive health insurance plan as an effective tool to safeguard against unforeseen circumstances. The pandemic also led to a surge in demand for health insurance policies.
Like any other industry, healthcare costs were also impacted and hospitalization costs scaled up. Asides, there is significant advancement happening each day in the field of medical technology, drugs and new-age treatments. This is further adding up to the medical inflation at large and costs of treatment are going up each day.
Despite the premium increase, nobody can shield oneself/family against this rising medical inflation. It is pertinent to state that having a health insurance policy safeguards one’s finances and aids in prudent financial planning despite premium hikes.
While some individuals may have been deterred by the higher premiums, the pandemic has reinforced the need for comprehensive health insurance coverage, and we expect interest in health insurance to remain strong in the future.
Q. What is people’s most common mistake when buying health insurance plans?
In today’s world, health insurance has become an integral part of overall financial planning. One of the most common mistakes people make is of choosing health insurance plans based solely on the premium cost without considering the coverage, benefits and fine print of the policy. It is essential to ensure appropriate coverage for medical conditions.
Most policies have a certain waiting time for pre-existing disease conditions. It is essential for people to carefully check the details of illnesses having waiting conditions. People should also carefully check the co-pay clause while purchasing a health insurance policy so as to avoid paying huge costs in case of emergencies.
Another important factor is having a comprehensive health insurance plan. There are plans which offer sub-limits on diseases or capping on room rent. Ignoring these will lead to surprises at the time of claim.
It is quintessential to read the policy documents carefully, understand the coverage details, and assess the policy’s suitability as per an individual’s healthcare needs. It is crucial to thoroughly review the policy document and understand the coverage offered, the exclusions, and the claim process. Greater emphasis should also be laid on disclosing facts (especially medical conditions, etc.) at the time of policy purchase to avoid hassles at the time of claims.
Q. There has been a rise in online aggregators selling health insurance. Do you think their presence has helped penetrate Tier-2 and Tier-3 cities left untouched to date?
Healthcare penetration has always been a concern in smaller towns and cities across India. Tier 2 and tier 3 cities are the key development regions for the economy and need a health infrastructure, especially at the grassroots level. We feel it starts with not only developing a robust healthcare facility but also by penetrating deeper in terms of health insurance which can be made affordable and accessible for all Indians.
Various steps and initiatives by the government to raise health insurance awareness including the Pradhan Mantri Jan Arogya Yojana (PMJAY), often known as Ayushman Bharat, Rashtriya Swasthya Bima Yojana (RSBY) and the Universal Health Insurance Scheme (UHIS) have led to deeper penetration in Tier-2 and Tier-3 cities.
Tata AIG observed as high as 150 per cent growth in the uptake of e-business between the years 2018-19 to 2020-21. Online aggregators and digital outreach of industry players have allowed customers to make a sound choice to buy health insurance by comparing the rates, benefits and coverage, with ease and security.
This digital outreach from the industry has made insurance reach the hinterlands where the insurance agents and information is limited. Online aggregators provide a user-friendly interface, and assisted buying journey allowing customers to browse and compare various policies and benefits, making the process of buying insurance more accessible and convenient.
Q. What is your take on the evolution and inclusion of innovative products in today’s health insurance sector?
The insurance industry is continuously innovating and evolving. Insurance companies have the ability to innovate using technological applications to cover new and existing risks. Innovation led to digitalization in various features of Insurance including collection, claims, 24*7 assistance, and policy upgradation have revolutionized the entire insurance industry. With AI-led initiatives, there is a lot more to unveil in times to come.
The industry is undergoing a transition from merely being claims pay or holistic healthcare management. There is a focus on preventive health rather than just curative. Value-added services, Wellness features and leveraging telemedicine have been upcoming trends in the recent past. End-to-end customer experience is of paramount importance. Customers expect seamless and better experiences right from comparing plans to policy purchases to claim services.
Another innovation seen is also noted in the auto-adjudication of claims for faster claims processing without any human intervention. Fraud and abuse management platforms are also noticing rapid upgrades to detect early fraud trends and built proper controls.
Insurance businesses may now build customized policies owing to the use of machine learning and wearable data processing. Wearables are becoming an increasingly essential aspect of the Indian health insurance business, providing insurers with vital data on policyholders' health and helping to incentivize good behaviour. Furthermore, Artificial Intelligence may greatly aid in the creation of suggestions for plans that will work best for patients' needs, depending on their location, age, health, and other criteria, and give insurance premium calculators to promote transparency.