Health in­sur­ers pre­par­ing for wear­ables

Health in­sur­ance is a low pri­or­ity for In­di­ans. This per­cep­tion needs to change be­cause an in­sur­ance cover can help a per­son meet a med­i­cal ex­i­gency with ease with­out hav­ing to spend his hard-earned cash:

Banking Frontiers - - Contents - ravi@glo­cal­in­fo­

Health in­sur­ance is a low pri­or­ity for In­di­ans. This per­cep­tion needs to change be­cause an in­sur­ance cover can help a per­son meet a med­i­cal ex­i­gency with ease with­out hav­ing to spend his hard-earned cash

It is an ac­cepted fact that health in­sur­ance has a low pen­e­tra­tion in In­dia, mainly due to lack of aware­ness about its ben­e­fits. There are other rea­sons too like lack of ap­pro­pri­ate in­fra­struc­ture, which makes it dif­fi­cult for health in­sur­ance com­pa­nies to reach out to the in­te­ri­ors of the coun­try in a cost-ef­fec­tive and sus­tain­able man­ner. Stud­ies have found that one out of every 4 health sit­u­a­tions in the coun­try re­sult in the pa­tients ei­ther sell­ing their as­sets or tak­ing loans for meet­ing the cost of treat­ment. Health­care costs are ris­ing ex­po­nen­tially, and the ob­jec­tive of in­sur­ance plans is to cover cus­tomers against such high costs be­cause of med­i­cal emer­gen­cies. Many peo­ple are not fully aware about the dif­fer­ent types of health in­sur­ance poli­cies and the ben­e­fits such poli­cies bring to the in­sured. For in­stance, there are ben­e­fit poli­cies like cash­less hos­pi­tal­iza­tion, against per­sonal ac­ci­dents and crit­i­cal ill­nesses or in­dem­nity poli­cies that cover hos­pi­tal­iza­tion ex­penses or Medi­claim poli­cies.

Ra­jiv Ku­mar, MD & CEO, Uni­ver­sal Sompo Gen­eral In­sur­ance Co, says to boost health in­sur­ance pen­e­tra­tion, there is need to en­cour­age the masses to buy health in­sur­ance plans cov­er­ing them­selves and their fam­i­lies. “I be­lieve that no in­di­vid­ual should fail to se­cure ad­e­quate med­i­cal care be­cause of the in­abil­ity to pay for it. In­dia’s pop­u­la­tion is very large and di­ver­si­fied and for most of the In­di­ans, health­care cost is un­af­ford­able. Be­cause of this, at the time of a med­i­cal emer­gency, they have to pay the ex­penses from their own pock­ets and they fi­nally end up avail­ing poor qual­ity of health care fa­cil­i­ties and bear the fi­nan­cial hard­ships,” he avers.

The out­look of the peo­ple to­wards health in­sur­ance is also an­other rea­son for the low pen­e­tra­tion. Peo­ple gen­er­ally think noth­ing can hap­pen to them and hence they do not feel the need to pro­tect them­selves with health in­sur­ance. Bhaskar Nerurkar, head – Health Ad­min­is­tra­tion Team, Ba­jaj Al­lianz Gen­eral In­sur­ance Co, be­lieves that peo­ple rely on the present health con­di­tion and ig­nore the in­creas­ing prob­a­bil­ity of life­style dis­eases and un­for­tu­nate ac­ci­dents. Also, a com­mon mis­take made by the salaried class, ac­cord­ing to him, is that they de­pend on the em­ployer-pro­vided group med­i­cal cover, which may not be ad­e­quate to cover ma­jor in­ci­dences and do not guar­an­tee a life-time con­ti­nu­ity of cover.


In the western mar­kets, med­i­cal costs up­wards of 95% are ei­ther funded by in­sur­ers or by the gov­ern­ment. This is pos­si­ble be­cause ei­ther the gov­ern­ment ex­pen­di­ture on pub­lic health care is very high, like in the UK, or health in­sur­ance is manda­tory for the pop­u­la­tion, like in

the USA. Nei­ther of these sit­u­a­tions is ap­pli­ca­ble in In­dia, since the gov­ern­ment ex­pen­di­ture on pub­lic health care is lim­ited and health in­sur­ance is purely op­tional.

Anurag Ras­togi, mem­ber of Ex­ec­u­tive Man­age­ment and chief ac­tu­ary & head, Re­tail Un­der­writ­ing & Claims, Marine, Crop & MSME at HDFC ERGO Gen­eral In­sur­ance Co, says: “The tax in­cen­tive un­der sec­tion 80D of the In­come Tax Act at­tracts only a small mi­nor­ity of the tax-pay­ing pop­u­la­tion to buy health in­sur­ance. Fur­ther­more, the low aware­ness among the In­dian pop­u­la­tion on in­sur­ance clubbed with lit­tle fi­nan­cial sup­port means that only those in the up­per strata of pop­u­la­tion and who are aware of the ben­e­fits of in­sur­ance will buy health in­sur­ance. The rest of the peo­ple are left to fund med­i­cal ex­penses from their pock­ets when any ill­ness strikes them.”


Med­i­cal in­fla­tion in In­dia is found to be in­creas­ing by 12%-15% an­nu­ally and in­sur­ance com­pa­nies are adopt­ing var­i­ous strate­gies to pro­vide bet­ter health cover to their cus­tomers. For in­stance, they are re­duc­ing the health­care costs by adopt­ing pre-ne­go­ti­ated rates with em­pan­eled hos­pi­tals and di­ag­nos­tic cen­ters, pro­vid­ing cus­tomers with cost-ef­fec­tive tests, drugs and other treat­ment pro­ce­dures. They also an­a­lyze the data of the claims re­ceived to mon­i­tor fac­tors that af­fect health­care ex­penses, health­care treat­ments which can help in­sur­ers pro­vide timely care at lower cost while prevent­ing hos­pi­tal vis­its and costly pro­ce­dures.

Com­ments Ras­togi: “We have ef­fec­tive cost con­trol mea­sures in place and have mu­tu­ally agreed on tar­iff rates across a large net­work of hos­pi­tals, thereby re­duc­ing the av­er­age cost of claims. Our net­work list of hos­pi­tals in­cludes over 200 ter­tiary plus hos­pi­tals and about 850 ter­tiary care hos­pi­tals that pro­vide best in class treat­ment fa­cil­i­ties. All our net­work tie-ups are as per IR­DAI norms for em­pan­el­ment of hos­pi­tals and we con­duct reg­u­lar vis­its to as­sess the qual­ity of treat­ment of­fered in the hos­pi­tals.”

Shree­raj Desh­pande, se­nior vice pres­i­dent - Op­er­a­tions, Cus­tomer Ser­vice & Health In­sur­ance at Fu­ture Gen­er­ali In­dia In­sur­ance Co, says the com­pany’s prod­ucts

of­fer cov­er­age to­wards hos­pi­tal­iza­tion for can­cer, di­a­betes, treat­ment for blind­ness and tu­ber­cu­lo­sis. Ex­penses to­wards treat­ment of men­tal ill­nesses are cur­rently ex­cluded, but group poli­cies be­ing tai­lor made, the com­pany may cover all ail­ments when re­quested (other than stan­dard ex­clu­sions).

Uni­ver­sal Sompo Gen­eral In­sur­ance pro­vides sev­eral ben­e­fits to its cus­tomers such as free health check-up coupons and health camps. The com­pany has a por­tal for its cus­tomers – ‘Aar­o­gyam’ -, which helps serve the com­mon goal of se­cur­ing an in­di­vid­ual’s well­be­ing by pro­vid­ing var­i­ous ser­vices through dis­counts on medicines, di­ag­nos­tic tests and al­lied health care ser­vices. Says Ra­jiv Ku­mar: “We pro­vide value added ser­vices such as ‘dial a doc­tor’, health ed­u­ca­tion li­brary, sec­ond opin­ion, news­let­ters with di­et­ing tips, nu­tri­tional in­for­ma­tion, health re­lated ar­ti­cles, etc. We have tied up with 4200+ net­work hos­pi­tals to pro­vide has­sle free cash­less ser­vices.”


Ba­jaj Al­lianz Gen­eral In­sur­ance is ac­tively en­gag­ing with its cus­tomers through well­ness ac­tiv­i­ties, health tips and aware­ness emails, which the com­pany be­lieves can help its cus­tomers in prevent­ing dis­eases or man­ag­ing the dis­eases in a bet­ter man­ner. It is also of the view that chronic dis­eases like

can­cer, di­a­betes, TB, etc can be pre­vented or con­trolled if de­tected early through ap­pro­pri­ate screen­ings, or through healthy habits and by re­ceiv­ing pre­ven­tive ser­vices such as can­cer screen­ings, coun­selling and vac­ci­na­tions.

Ras­togi speaks about spe­cial cov­ers: “We of­fer an in­sur­ance cover with cer­tain load­ing and con­di­tions to peo­ple suf­fer­ing from di­a­betes, TB, par­tial blind­ness, po­lio and other such al­i­ments. Ad­di­tion­ally, mul­ti­ple dis­ease spe­cific prod­ucts are be­ing eval­u­ated for pro­vid­ing more ben­e­fits to the cus­tomers.”

Uni­ver­sal Sompo Gen­eral In­sur­ance has a Crit­i­cal Ill­ness Pol­icy that pro­vides cov­er­age for deadly dis­ease like can­cer by ex­tend­ing fi­nan­cial pro­tec­tion to the pol­i­cy­hold­ers in the form of lump­sum ben­e­fit on di­ag­no­sis of can­cer of spec­i­fied sever­ity. Ra­jiv Ku­mar re­veals the de­tails: “Our Medi­claim pol­icy pro­vides for in-pa­tient treat­ment re­lated to com­pli­ca­tions of meta­bolic dis­or­der like type II di­a­betes mel­li­tus af­ter cer­tain wait­ing pe­riod if pre­ex­ist­ing. Sim­i­larly, dis­ease man­age­ment of in­fec­tious dis­ease like tu­ber­cu­lo­sis is also dealt with. Through our Medi­claim poli­cies, we pro­vide cov­er­age for cer­tain treat­able causes of eye and vi­sion disor­ders lead­ing to blind­ness. I be­lieve in­sur­ance com­pa­nies are now gear­ing up to bring men­tal ill­nesses such as autism, de­pres­sion

and anx­i­ety un­der in­sur­ance cover. We are in the process of eval­u­at­ing var­i­ous ways to pro­vide cov­er­age to the peo­ple with men­tal ill­ness, start­ing from of­fer­ing out pa­tients ben­e­fits to ba­sic hos­pi­tal­iza­tion costs. We would ex­tend the scope for com­pre­hen­sive man­aged care ser­vices like coun­selling etc.”


In­sur­ance com­pa­nies are now en­gag­ing with their cus­tomers to deal with the sit­u­a­tion of in­creased in­ci­dence of in­fec­tious dis­eases by pro­vid­ing them with pre­ven­tive mea­sures and cre­at­ing aware­ness about deal­ing health is­sues. They be­lieve this would help the cus­tomer to adopt healthy life­styles, which in turn can re­duce chances of get­ting af­flicted by dis­eases. “In our ex­pe­ri­ence, most fre­quent cause of suf­fer­ing in our coun­try is in­fec­tive dis­eases such as fever, dengue, gas­troen­teri­tis, ty­phoid etc. With the in­creas­ing aware­ness re­gard­ing per­sonal health, hy­giene and clean­li­ness, the fre­quency and sever­ity of these ail­ments are ex­pected to re­duce in near fu­ture,” says Ras­togi.

Desh­pande cites the use by Fu­ture Gen­er­ali In­dia In­sur­ance of post-pol­icy pur­chase sur­vey: “We in­vite cus­tomers to par­tic­i­pate in the sur­vey post pol­icy pur­chase, pre-re­newals and post re­newals. Af­ter the claims are set­tled and af­ter the in­ter­ac­tion with our cus­tomer ser­vice teams, we en­cour­age cus­tomers to share their ex­pe­ri­ence. These sur­veys are done through emails and we as­cer­tain the causes if any of dif­fi­cul­ties faced by the cus­tomers while deal­ing with us. Mind you, we have a claims set­tle­ment ra­tio of 98% as of March 2017.”


Health in­sur­ance com­pa­nies are con­tin­u­ously work­ing on im­prov­ing and sim­pli­fy­ing the claims process by en­hanc­ing cus­tomer ser­vices. Says Ra­jiv Ku­mar: “Keep­ing in mind that cus­tomers are al­ways look­ing for con­ve­nience and sim­plic­ity, we are com­ing up with a cus­tomer por­tal for the cus­tomers to sub­mit their claims with min­i­mal in­for­ma­tion. We are steadily im­prov­ing our back­end sys­tems and ap­pli­ca­tions to sup­port speedy claim pro­cess­ing through data in­te­gra­tion and the real time sta­tus tracker for all users – in­ter­nal and ex­ter­nal. Cus­tomers can sim­ply log in for get­ting in­for­ma­tion or any other as­sis­tance. For ac­ci­dent claim in­ti­ma­tions, we are de­vel­op­ing an ap­pli­ca­tion, which will help to pro­vide emer­gency as­sis­tance by cap­tur­ing the ac­ci­dent lo­ca­tion and help cus­tomers lo­cate nearby po­lice sta­tion and hos­pi­tal.”

He men­tions that in the case of an ac­ci­dent, the claim depart­ment will get an im­me­di­ate no­ti­fi­ca­tion so that claim pro­cess­ing can be ini­ti­ated forth­with. A no­ti­fi­ca­tion will si­mul­ta­ne­ously be sent with the claim in­for­ma­tion to the agent so that he can get in touch with the cus­tomer for fur­ther pro­cesses. To have faster and ac­cu­rate claims pro­cess­ing, the com­pany is lever­ag­ing tech­nol­ogy to sim­plify the process of cap­tur­ing and sub­mit­ting claim in­for­ma­tion, which will en­able the cus­tomer to lodge a claim and have the claim in­for­ma­tion at the fin­ger­tips, he adds.

Ba­jaj Al­lianz Gen­eral In­sur­ance too be­lieves in im­prov­ing the cus­tomer ex­pe­ri­ence and sim­pli­fy­ing the claim set­tle­ment process. Ac­cord­ing to Nerurkar, the com­pany staff proac­tively call cus­tomers to in­form them in case there are any de­fi­cien­cies in the claim doc­u­ments. Au­to­mated emails and SMSs are sent to the cus­tomers to in­ti­mate them about the sta­tus of the claim. “We have also lever­age tech­nol­ogy where we set­tle re­im­burse­ment claims of up to `20,000 with ‘Health CDC’, a fea­ture in com­pany’s self-ser­vice in­sur­ance wal­let app. The cus­tomer needs to scan and send the re­quired doc­u­ments to the com­pany and within 2 work­ing days the claim is set­tled un­like 7-10 work­ing days ear­lier,” he says.

The com­pany has also launched a unique well­ness plat­form ‘Pro-fit’ which acts as a one-stop so­lu­tion to all the health record track­ing needs of the cus­tomers. Through this plat­form, the cus­tomers can mon­i­tor and im­prove their health.


Ba­jaj Al­lianz Gen­eral In­sur­ance re­cently launched an AI driven chat­bot ser­vice plat­form called BOING, which of­fers 24/7 cus­tomer as­sis­tance and in­stant re­sponse to cus­tomer queries.

Uni­ver­sal Sompo Gen­eral In­sur­ance is fo­cus­ing on self-ser­vice chan­nels like web­site and mo­bile apps to re­duce time to make pol­icy pur­chases and de­velop brand loy­alty through en­hanced cus­tomer ex­pe­ri­ence.

Ra­jiv Ku­mar speaks on the use AI to pro­vide bet­ter cus­tomer ex­pe­ri­ence: “We are work­ing to­wards an AI-pow­ered de­ci­sion man­age­ment sys­tem for un­der­writ­ing to ap­pro­pri­ately price the

risks, to of­fer ac­cu­rate pre­dic­tions and to fa­cil­i­tate faster pro­cess­ing. This will ben­e­fit the cus­tomers in the form of re­duced pre­mi­ums. Cur­rently, we are work­ing on a model that en­ables agents to par­tic­i­pate in re­fer­ral shar­ing across dif­fer­ent prod­uct lines to reach cus­tomers avoid­ing de­lays to max­i­mize op­er­a­tional ef­fi­ciency, with rat­ings and re­views, en­abling each reg­is­tered agent to pro­mote their busi­ness and ac­quire cus­tomers.”

Says Ras­togi: “We at HDFC ERGO are in a con­tin­u­ous process of im­prov­ing over­all cus­tomer ex­pe­ri­ence and tech­nol­ogy is one of the most im­por­tant tools. Cus­tomers can ac­cess our mo­bile app to reg­is­ter claims, track their sta­tus, search both cash­less and re­im­burse­ment claims, do a geo-lo­ca­tion search for net­work hos­pi­tals. There is an e-locker to store im­por­tant doc­u­ments. They can also raise re­quests for changes in pol­icy de­tails. We have also in­tro­duced a pol­icy is­suance en­gine, which helps in in­stant pol­icy is­suance, premium cal­cu­la­tions, fix­ing ap­point­ments for med­i­cal checkups and more such ser­vices.”


Re­ten­tion of cus­tomers is an im­por­tant fac­tor in the op­er­a­tions of an in­sur­ance com­pany. Ra­jiv Ku­mar speaks about cus­tomer re­ten­tion strate­gies adopted by the com­pany: “We put our best ef­forts for cus­tomer re­ten­tion by pro­vid­ing them with world class ser­vices and highly ef­fec­tive claim set­tle­ment ser­vice with­out any has­sle. Such small boosts help us to grow long term profit im­mensely. Through our cus­tomer care unit, we call our cus­tomers be­fore the re­newal date to thank them for their con­tin­ued loy­alty and of­fer to an­swer any ques­tions they may have; this helps us to avoid dis­con­ti­nu­ity in the cus­tomer’s pol­icy. The dis­count re­view is done an­nu­ally, and we do pro­vide loy­alty dis­counts to cus­tomers for sub­se­quent re­newals.”

Ras­togi says his com­pany has en­abled auto-re­newals for cus­tomers with prior con­sent. Fur­ther, timely re­minders are sent to the cus­tomers via email, SMSs and re­newal no­tice. The com­pany’s prod­ucts are de­signed with cu­mu­la­tive bonus and free health checkups af­ter every 4 claim-free years. “All these help us to get re­newals,” says he.

Shree­raj Desh­pande claims Fu­ture Gen­er­ali In­dia In­sur­ance has a very good re­newal ra­tio - above 77%. Apart from send­ing re­newal notices and other forms of re­minders, he says the com­pany also en­gages the cus­tomers through well­ness of­fer­ings, con­duct­ing health aware­ness camps etc.


Many in­surce com­pa­nies are tak­ing steps to pro­vide holis­tic health­care so­lu­tions and are cre­at­ing aware­ness among the cus­tomers through well­ness plat­forms where cus­tomers can track their health records through self-mon­i­tored wear­able de­vices. Cus­tomers of var­i­ous age groups are us­ing wear­able con­nected de­vices such as Fit­Bit, Mi­crosoft Band, Ap­ple Watch etc, which con­tin­u­ously track phys­i­cal ac­tiv­i­ties, calo­ries burnt, sleep pat­terns, heart rate, blood pres­sure etc. Ir­reg­u­lar­i­ties can be de­tected and emer­gen­cies can be rec­og­nized be­fore they be­come prob­lems. A good in­di­ca­tion is that IR­DAI has re­cently set up a com­mit­tee to study the in­no­va­tions in in­sur­ance, specif­i­cally on por­ta­ble and wear­able de­vices.

Data cap­tured through these de­vices will help in­sur­ance com­pa­nies to as­sess the risk bet­ter and bring ma­jor changes in the pric­ing mech­a­nism. It is be­lieved that wear­ables will have an im­pact across the value chain in the health in­sur­ance space from sales, cus­tomer en­gage­ment, un­der­writ­ing the in­sur­ance poli­cies to set­tling claims.

Nerurkar sup­ports the use of wear­able de­vices for cus­tomer en­gage­ment: “It will help in iden­ti­fy­ing cus­tomer seg­ments bet­ter through the data re­ceived and hence as­sist in pro­vid­ing per­son­al­ized and tar­geted prod­ucts for each cus­tomer. Realtime data on cus­tomers’ habits and life­style will re­sult in to bet­ter risk man­age­ment. Var­i­ous ser­vices can be pro­vided to cus­tomers to im­prove their health and life­style through timely no­ti­fi­ca­tions, which leads to bet­ter cus­tomer en­gage­ment and in­ter­est. Once the im­pact of wear­able de­vices is an­a­lyzed by IR­DAI, in­sur­ers can launch new prod­ucts with flex­i­ble premium op­tions, re­sult­ing in ac­cu­rate pric­ing based on the risk. It will also help in iden­ti­fy­ing and prevent­ing fraud­u­lent ac­tiv­i­ties by us­ing photo, au­dio and video. Real time claim man­age­ment will lead to quick pro­cess­ing of claim, low­ers claims ex­penses and in­crease cus­tomer loy­alty.”

Ra­jiv Ku­mar high­lights the free health check-up coupons and health camps or­ga­nized by his com­pany Anurag Ras­togi points out that most fre­quent cause of suf­fer­ing in In­dia is in­fec­tive dis­eases

Shree­raj Desh­pande talks about the post-pol­icy pur­chase sur­vey his com­pany con­ducts to un­der­stand cus­tomer re­sponse

Bhaskar Nerurkar be­lieves peo­ple rely on the present health con­di­tion and ig­nore the in­creas­ing prob­a­bil­ity of life­style dis­eases

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