Health insurance revolution will help in crafting a healthier future for all

Efforts are underway to increase market penetration in underserved regions, with a specific focus on reducing the protection gap and enhancing insurance access through rural and social targets to insurers

Guided by the Insurance Regulatory and Development Authority of India (IRDAI), the General Insurance Council (GI Council) strives to ensure that health insurance serves as a crucial aspect of financial security for individuals and families across India.

Talking to Bizz Buzz, V. Jagannathan, former CMD of United India Insurance and former chairman of Star Health & Allied Insurance, says “It is true that GI Council has covered considerable area while looking into various needs of the society. Moreover, needs of various sections of the society will keep changing and I have no doubt that the Council will address it in a progressive manner taking into account the interest of all the stakeholders.”

In the latest, health insurance sector recorded a premium of close to Rs. one lakh crore, reflecting a robust compound annual growth rate (CAGR) of 20 per cent.

More than 50 crore citizens are now covered, with a clear ‘insurance for all by 2047’ target in mind.

In 2022-23, the industry settled claims close to worth Rs. 75,000 crore for more than 2.5 crore claims. This figure is expected to rise significantly in 2023-24 as efforts to streamline processes continue even further. Today more than 60 per cent of claims are settled on a cashless basis, which is expected to go up over time.

The GI Council has constantly been engaged with providers (hospitals), as well as TPA over the issue of streamlining the experience of customers and making claims a friction-free process, through joint dialogue and collaborative solutions. Towards this, the council is spearheading various initiatives to make health insurance more accessible and user-friendly.

They include partnership with the National Health Authority (NHA) to develop a digital healthcare ecosystem, including the National Health Claims Exchange (NHCX) to standardize data and ease information exchange using ABHA ID. The endeavour is to get all ecosystem players on one platform to ensure customer claims are handled at a fast pace, with a high level of transparency. In addition, with the Customer Information Sheet (CIS) as mandated by the IRDAI, policyholders can have an overview of their policy's coverage and any exclusion in a clear and concise manner, thus bringing in more transparency for the consumers.

Efforts are underway to increase market penetration in underserved regions, with a specific focus on reducing the protection gap and enhancing insurance access through rural and social targets to insurers. Through the Bima trinity of Bima Vistaar, Bima Vaahaks, and Bima Sugam, the regulator wants insurance to reach every stratum and every corner of the country. Bima Vistaar, which will be announced soon, will not just cover life and property but will also include health at an affordable cost.

The industry is focused on identifying and removing roadblocks to ensure speedy claim settlements. The 'Cashless Everywhere' initiative is expected to set new standards for quick, hassle-free settlements and reduce incidents of fraud. The industry has come together through the aegis of the council and is aggressively looking to tackle, reduce and ultimately eliminate fraud. This will bring in greater trust in the system, augment claim settlement and encourage more citizens to go for insurance.

Tapan Singhel, Chairman of General Insurance Council, says, “Our collective efforts are focused on making health insurance a key enabler of not just our citizen's health but societal health as well. We aim to make quality treatment accessible to everyone, irrespective of where they are from, and ensure that we can take away their worries so that they can live a life of bliss. By fostering collaboration among insurers, the council, regulators, ministries, and fintech, we are dedicated to making health care affordable, accessible and comprehensible.”

He added, “A lot has already been achieved and we firmly believe we are on the right path to completely revolutionize the way health insurance is perceived. The aim is to alleviate concerns and simplify lives of people, ensuring that they have the confidence and support they need to secure their health needs.”