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We have engaged service providers not only for claim assessment but also to play a proactive role to facilitate the claim process

Asia Insurance Post, 04 February, 2009

What kind of focus you have on your health insurance portfolio?
The Indian health insurance industry stands at INR 5,125 crores with less than 2% of the population covered by private health insurance.  These figures while being a little disappointing are also encouraging because they highlight the huge potential for growth among this vast untapped sea of uninsured. Therefore it makes sense for us to focus on this segment which has such a tremendous potential for growth.

What kind of growth you have witnessed during the current years and growth targeted in next two years?
We have been witnessing over 17% year on year (YTD, January) growth which is above the average market growth rate and in these challenging times we are targeting to maintain our year on year growth in the next financial year. However, we are looking at more steep growth in retail segment including the Health insurance portfolio. We plan to achieve this growth by increasing our distribution network with pan India penetration. The rural market is also a huge potential growth area.

What kind of product portfolio (health insurance) you have? How customer friendly they are in claim settlement?
We have a diversified product portfolio catering to different segments and needs. We have a good track record of claim settlements with the high level of customer satisfaction.
We recently received an ISO 9001:200 certification from Bureau Veritas for our accident and health insurance claims services. This certification is an endorsement to our process efficiency, customer friendliness, fair and prompt claims practices.

Settlement of the Personal Accident claim arising from the recent terrorist attack is a testimony to our approach to claims. One of the deceased from the Mumbai terrorist attacked was insured with us under the Personal Accident policy. Within five working days the claim was settled and the payment was delivered to the family.

Do you think demands for cash less health insurance is growing fast? Is the coordination between you and rest of the factors like hospitals, TPAs have improved?
The demand for cashless health insurance has certainly grown with the increase in awareness. There is a continuous improvement in TPA facilitation and engagement of the hospital networks. The coordination with TPA's has also improved over the last few years and the fact is that improved coordination also results in a better customer experience at the time he needs it the most. The network of cashless hospitals has grown three times over the last three years from 1000 to 3000.

There is definitely scope for improvement and further expansion of the same. The need of the hour is also to further increase the aweareness and also to increase the network of hospitals in the rural areas.

Is there any competition in the industry on pricing terms? How do you see the competition from the life insurers?

As of today with the extremely low penetrations in the markets, the opportunities are so huge that there is enough room for all. Instead of competing, companies are focusing on expanding their market size and reaching out towards achieving higher penetration.
Having said this, there is competetion cropping up among the General Insurance companies due to novel and attractive benefits offered by players.

Life insurance companies are focusing more on unit linked health insurance policies which are slightly more expensive, whilst our policies are cheaper and more affordable for the common man. Life insurers are looking at a different segment of savings and health insurance while we and the general insurance companies are focused on affordable health insurance.

Have your health portfolio become a profitable one? Or else how long it would take to become one?
It is always a challenge to make one's health portfolio profitable. It is essential to strike a balance between a premium which is affordable for the common man and also ensuring that the same is sufficient to meet the claims.

How much group health insurance is contributing to your portfolio? Are the prices still going up for the portfolio?
Our focus has been more on retail insurance and post detarrification, in the other portfolios, the group health insurance premiums are expected to rise.

What kind of claims that is happening in the portfolio?
How are you checking fraudulent and inflated claims? What is your claim rejection ratio?
We have both cashless and reimbursement claims which range from admission for normal illnesses to major surgeries. Our claims ratio is manageable and  within the industry standards.
We have a panel of experts and doctors who help identify fraudulent claims. There is a constant effort for checking the veracity of claims by engaging investigators and also involving the TPA's. We have engaged service providers not only for claim assessment but also to play a pro-active role to facilitate the claim process. We have unique customer service arrangement called CIMS whereby the customer can interact with us regarding any kind of query including claims.

Is it a good idea to confine the size of the health insurance portability to Rs 1 lakh?
As the concept of portability becomes clearer and works better for the customers as well as the insurers, we can definitely look at increasing the size of the portability.

What more IRDA and Govt should to popularise the health insurance products?
The salaried middle class are aware of the existence of health insurance although they may not generally choose to go for a health cover. This is the Indian psyche which does not attach much importance to a health cover. The insurance companies are going all out to change this mind set and disseminate the message about the importance of health insurance. On the other hand a number of state governments have been recently coming out with schemes in collaboration with NGO's to provide a basic health cover to families below the poverty line.Given the low penetration of health insurance in India there has to be a consistent effort to change the mind set as well as increase awareness.

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