Page 29 - Insurance Times December 2020

is made and paid. This is available up to sum insured of Rs Providers and after introducing standard retail health
2.5 lacs. Benefit based policies hands over the sum insured insurance product recently in April 2020 and Covid specific
to policyholders if they are diagnosed with the covered products in July 2020 these guidelines will rationalize and
ailments or health contingencies under the policy. This is not standardize the exclusions in health insurance contracts and
available when home treatment is taken. However, the set will provide uniformity and transparency.
up or make shift hospital designated by the government for
treatment of Covid falls under the definition of hospital to It is right time for forward looking insurers to work upon
trigger the benefit under the policy. The minimum entry age their Health Underwriting Policies with defined objective
for both standard Covid products is 18 years and the criteria. Products may not address the larger aspects of
maximum age is 65 years. corporate philosophy on broad and wider underwriting
philosophy &controls. These aspects are strategically
Health Insurance Risk Landscape is covered in the underwriting policy and it determines the
changing Segments and Pool Company is looking forward for health
portfolio. This policy provides ease in underwriting at all
The health insurance is in new era. It has occupied the top levels. With new PED definition, moratorium period and
segment position in non-life sector. It is developing and lifelong renewal clause it should strategically deal effectively
undergoing significant changes at all levels be it government, as to how disclosures on existing diseases by the proposer
regulator, insurers or service providers. Government's should be considered by an insurer.
flagship health insurance programme 'Ayushman Bharat'
(PMJAY) has completed glorious two years and it has covered Some disclosures may be addressed by applying pre-defined
13.13 crore households i.e. 53% of population base including loadings to provide coverage but in certain cases the
converged State schemes. Government is inching towards disclosed risk may not enable the insurer to offer coverage
Universal Health Coverage through convergence and and such risks need to be excluded permanently. If a risk is
expansion of beneficiary base. accepted it should be based on consent of proposer with
disclosure of applicable loadings. The Regulation prescribes
Convergence of various schemes within State and other such policy to be approved by the Board of the Insurer and
schemes such as ECHS, Indian Railways etc. may reduce the if no such policy exist the officials of company won't be able
overlap and gain the higher efficiency by collective to have discretions for such decisions.
bargaining for lowering prices. National Health Authority has
also issued expression of interest for its pilot product offering The pandemic is regularly challenging the engagement rules
health insurance covering missing middle population. It is in health insurance. Standardization of health insurance
important to see how general and health insurers grab this contracts will set the new course of operational efficiencies.
opportunity. It is observed that 32 States and UTs out of 36 Consumers will gain more trust and faith with more
have implemented Ayushman Bharat. standardization. This sector has already occupied the top
segment position in terms of premium. Pace of recovery in
However the programme is being implemented in 'Trust late 2020 or in 2021 will depend on speed of containment
mode'. Out of 32 States and UT only seven have of the pandemic and the effective business continuity plans
implemented the scheme in 'Insurance mode' and 4 have of the insurers. The landscape of health insurance is changing
gone for 'hybrid mode'. It shows that a great opportunity at fast pace and Insurers shall build operational resilience
of growth has been lost by insurers as the schemes in to emerge as relevant insurers in this fast evolving era.
insurance mode are also going back to trust mode. This
scheme has not only created awareness amongst population There is no prescriptive solution to drive growth or
at large but it provides great learning for technology profitability in the segment but clear strategic vision as to
implementation, handling of fraud, abuse and wastage and where you want to go and who will carry you there may
deciding on package rates for treatment of various medical determine the future of players in this sector. Health is going
and surgical procedures. to remain unchallenged business growth driver for health
and general insurers and it is time for them to reposition
Regulator has standardized exclusions and these shall be their resources, engage in collaborations and come out with
mandatorily applicable across all insurers in India w.e.f. 1st right products on right price to remain self-sufficient and
of October 2020. After standardizing common definitions, relevant in changed landscape.
critical illnesses, standard protocols for network providers,
minimum standard clauses in health agreements, standard (The views expressed are purely academic and his personal
discharge summaries and standard hospitals bills by network capacity.)
The Insurance Times, December 2020