Page 15 - The Insurance Times July 2025

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initiative reflects their shared commit-
Insurers Roll Out State-Specific Health Plans to Re-
ment to customer-centric innovation
flect Regional Health-care Costs and digital transformation in the
Amid stark regional disparities in healthcare costs, Indian insurers are shift- health insurance ecosystem.
ing from uniform health insurance pricing to state-specific models. Bajaj The partnership marks a significant
Allianz General Insurance has introduced tailored health insurance plans step in modernizing India’s health in-
with premiums and benefits calibrated to each state's medical cost, infra- surance infrastructure and is expected
structure, and regulatory environment. to set a benchmark for seamless, tech-

This move aims to eliminate inefficiencies in one-size-fits-all pricing and make driven claims management.
health insurance more affordable for the underinsured segments. "At
present, there is an element of cross-subsidy where people in areas with Retail OPD Coverage Still a
low-cost healthcare end up subsidising those in high-cost areas," explained Challenge for Health In-
Bhaskar Nerurkar, head of health administration at Bajaj Allianz.
surers: Mayank Bathwal
Though policies are priced based on the policyholder's current residence,
treatment access remains nationwide. Narayana Health had earlier pio- Despite growing healthcare needs,
neered region-linked insurance tied to its hospitals, while Bajaj Allianz has health insurers in India have yet to ef-
refined this approach by applying it across states. fectively penetrate the retail Outpa-
tient Department (OPD) coverage
"Claims frequency and severity vary significantly across India due to diverse market, according to Mayank Bathwal,
hospitalization causes," added Satish Gidugu, CEO of Medi Assist.
former CEO of Aditya Birla Health In-
surance. He noted that while insurers
Star Health Insurance and such as claim validation, document have made strides in inpatient care,
verification, and fraud detection, en- retail OPD remains largely underdevel-
Medi Assist Partner to abling faster approvals and improved oped, with limited customer uptake
Launch AI-Powered Claims customer satisfaction. and operational hurdles.
Platform The AI platform is expected to signifi- Bathwal pointed out that pricing OPD
cantly reduce turnaround times and products accurately and managing
Star Health and Allied Insurance has
partnered with Medi Assist to imple- operational costs while ensuring accu- claim volumes cost-effectively remain
ment an AI-powered health claims pro- racy and compliance with regulatory major challenges. Unlike hospitaliza-
cessing platform, aimed at enhancing standards. It will also provide real-time tion, OPD services involve frequent,
efficiency, speed, and transparency in updates to policyholders, offering low-ticket claims, making it difficult for
greater visibility and control over the insurers to balance affordability with
the claims settlement process. This sustainability.
collaboration leverages cutting-edge status of their health insurance claims.
technology to automate key functions Both companies emphasized that the He also highlighted the need for robust

The Insurance Times July 2025 13