Page 34 - Insurance Times May 2019

(ii) A TPA and a Network Provider(Hospital) Areas:
(iii) A TPA, an Insurer and a Network Provider. Time taken for approval of pre-authorization of cashless
claims to Hospital.
TPA ensures that Policyholder gets hassle-free services.
Time taken for final approval of cashless claims to Hospital.
Insurance Companies pay for efficient and cost-efficient
service, and Network Providers get their reimbursement on Visit and guidance to patient in Hospital.
time. Their activities include issuing identity cards to the Negotiation of cost with the hospital on a case to case basis
Policyholders, 24-hour help-line for customer services, and getting early payment discount on bills and passing the
informing the customer regarding empanelled hospitals, benefit to customer.
arranging for specialized consultation and claim processing Time taken for settlement of re-imbursement claims after
during admission of the policyholders. By doing this it was submission of all documents.
expected that the TPAs would develop appropriate systems
and management structures aiming at controlling costs, The outcome of this assessment of the customer experience
developing protocols to minimize unnecessary treatments/
is reflected in the selection of Insurer. Creating WOW
investigations, improve quality of services and ultimately feelings at the time of claim ensures customer loyalty and
lead to lowering of insurance premiums.
develops rock solid security in the minds of the prospective
customers. Because most customers believe more in the f-
Few Private Insurers and Stand Alone Health (SAH) Insurers factors----friends, families, face book fans, than in marketing
do not utilize the services of TPAs for Retail Health Business. communications. Insurers have introduced a system through
They provide service to customers through their In-House which they monitor the performance of the TPAs ensuring
Health Administration (IHA) Team.
appropriate service provided to the customers at the time
of claim. Quality of service perceived by the customer is
Therefore, the health Insurance customers are getting converted into business.
service either from the independent service provider (TPA)
or from the In-House Service Administration (IHA).
Let us see some numbers on Business growth of major
Insurers for Retail Health Business only. We have taken two
But the present day customers are not persuaded by the Private General Insurers, two Stand alone Health Insurers
age-old product-driven attitude of Insurers. They look for and four Public Sector General Insurers. Since Group health
quality of services and past experience--specifically in the Insurance and Government sponsored health Insurance
area of claim settlement. The following areas may be most have different compulsions/perspective, we discuss only
important in moment of truth i.e., when a customer gets
Retail Health Insurance.
the impression about service.

Premium on Retail Health for Major Insurers in Rs. Crores (Net Earned)

Insurer 2013-14 Market share in % 2016-17 Market Share in % Service Provider
Bajaj Allianz 224 3.9 350 3.6 In-house
ICICI Lombard 225 3.9 466 4.8 TPA
Apollo Munich 329 5.8 656 6.8 In-house
Star Health 551 9.7 1652 17.1 In-house
New India 1252 22.1 1707 17.7 TPA
National 1040 18.3 1243 12.9 TPA
Oriental 708 12.5 1007 10.4 TPA
United India 611 10.8 993 10.3 TPA
We find, Market Share for almost all Private Insurers and Stand Alone Health Insurers have increased whereas reverse is
the case for Public Sector Insurers during the same period.
Often it is said that there is peculiar relationship between the business growth and Incurred Claims Ratio (ICR). Therefore
it is relevant to compare the ICR of these Insurers.

34 The Insurance Times, May 2019