Page 175 - India Insurance Report 2023- BIMTECH

India Insurance Report - Series II 163

10. Arogya Sanjeevani - A Basic Standard Health Insurance Policy

One of the most significant steps taken by the Regulator was the introduction of the ‘Standard
Health Insurance ‘policy, which was christened as ‘Arogya Sanjeevani’. The insurers have a wide range
of policies, and it is difficult for the common man to choose an appropriate one; besides, the conditions
could prove to be a challenge. Therefore, it was thought fit to design a vanilla health insurance policy
with simple terms and conditions which would be available with all insurers. The individual could
decide the insurer, and he would have the comfort of having a policy designed by the Regulator where
disputes/interpretation issues would be minimal.
It is interesting to note that NITI Aayog’s report “Health Insurance for India’s Missing Middle”
recommended that Arogya Sanjeevani policy be modified slightly and made available to approx. Forty
crore uninsured individuals constitute the “Missing Middle”. The missing middle has informal employment
and is not covered by any social security scheme. They do have the financial ability to pay premium but
not the premium at which current retail policies are priced. A partnership between the Government and
the private sector, clearly defining the parameters for a voluntary/contributory policy, make available
the service providers in the current PMJAY Scheme would be a step in the right direction to cover the
Missing Middle. To conclude, a sustained selling of a Standard health insurance policy could ensure
Universal Health coverage.

11. Health Insurance, A Panacea during COVID-19

The health insurance ecosystem’s strength and resilience can be gauged by its response to the health
crisis triggered by the Pandemic in 2020. The figures will speak for themselves! The number of claims
reported in FY 2020 -21 was 1.51 crores, whereas in 2021-22, the number of claims reported shot up to
2.40 crores because of Covid. The industry settled 80% of claims amounting to Rs 69,000 crores within
a month as against an amount of Rs 43,000 the previous year. This was at a time when the entire
working of the offices of Insurers /TPAs had turned on its head.

The crisis brought out the need for health coverage as a necessity. The Regulator brought out health
policies specifically covering Covid 19 – the Corona Kavach and Corona Rakshak considering the realities
on the ground like treatment at home, tele-consultation, and modified definition of hospitals with a
short policy period. The policies brought much-needed relief to the common man, who could buy a
cover for the dreaded disease without spending much. There was a surge of awareness amongst the
public about health insurance and the fact that all is not gloom and doom in the case of claims. The fact
that health insurance premium crossed the Rs 90,000 crore mark on 31/3/2023 with a growth of 23%
and cornering 35% of the premium pie indicates that health insurance would be the lead business segment
for insurers for a long time.

The Insurers have also been encouraged by the Regulator to promote wellness and preventive care
to its policyholders. To this end, insurers are now tracking the health parameters of their policyholders
and incentivising positive health behavior with award points, which are used for premium payment,
outpatient treatment, diagnostics etc.