Page 173 - India Insurance Report 2023- BIMTECH

India Insurance Report - Series II 161

take the policy. It was easier to pick up a “Group” policy with a huge outlay of premium than to manage
a vast network of agents or any other distribution channel to sell individual medical insurance. The fact
that more than 60% of health insurance premium comes from group policies confirms this premise.

7. Ensuring Continuous Protection Under Health Insurance

The beneficiaries in a group insurance policy seldom realize that the protection they are getting is
temporary, viz., until they are in employment or until a Bank or the entity thinks it makes good business
sense to themselves. Probably, Government schemes are the only ones which are likely to continue,
albeit in different forms. Then, the individuals are in the cold without any cover, and when they do try
to purchase, it is an uphill task – the terms and conditions would be quite different from what they were
used to. Every family or individual should have adequate medical insurance, which needs to be stressed
by the corporate/entity themselves or the insurers servicing the client.

The present PMJAY scheme has the potential to cover nearly 10.9 crore families, or 49 crore
individuals – identified as deprived in the Socio-Economic Caste Census (SECC) 2011 – for fully subsidized
health insurance cover. If the State schemes are included, then approx. 70% of the population is eligible
for health cover. Despite the PMJAY and several States having schemes either through insurers or in the
trust mode, the insurance coverage is not inclusive of all the marginalized sections of the population. A
large section of people who are eligible to be covered have not yet been brought into the net of PMJAY.
The actual numbers covered in the schemes, both the PMJAY and the State schemes, fall short of this
optimum figure due to a lack of awareness and not enough done to identify and enrol such populace.

8. Evolving Canvas of Health Insurance

Retail medical insurance for individuals and families has incurred claims ratios hovering between
70% - 75%. Therefore, every insurer has a basket of such policies catering to all sections of the population.
Today, the public has nearly 300 plus policies to choose from! Disease-specific policies covering diseases
like Diabetes, waterborne disease etc., are available, and policies for Senior Citizens, Women, etc., have
been devised. Further, health insurance may be extended to any category of individuals, such as LGBTQ
and so on. From having no choice or very restricted options, the public is spoilt for choice when it
comes to Health Insurance. The marketing of retail policies is mostly done by individual agents but this
network is unable to reach out to all sections of the uninsured population with disposable income to
purchase the cover. The agents, insurers and some distribution channels like web aggregators and corporate
agents have online purchase facilities, which have not yet gathered the required momentum. Online
buyers probably need assurance that their claims process will be as easy as the purchase of insurance.

The Regulator had insisted on ‘File and Use’ of the products and went through the products with a
fine tooth to ensure that the policy was fair to the policyholders and that the insurers were not having
the upper hand or taking unusual advantage. The Regulator also realized that policyholders were not
aware of the ‘jargon’ used by insurers. Certain definitions were nebulous; exclusions were sometimes
harsh and waiting periods long. Therefore, regulations were framed with clearly defined terms, especially