Page 50 - The Insurance Times April 2025

Health Insurance

Fixing senor citizen health insurance pricing

beyond the premium caps

T he Insurance Regulatory and Development Authority latory guidelines that balance cost management without com-
of India (IRDAI) has capped annual health insurance
promising the quality of service seniors rely on.
premium hikes for senior citizens at 10%, offering much- Empathetic communication
needed relief to an age group often hit hardest by unpre-
dictable price surges. Cold transactional communication has been a major reason
that rubs salt to the premium hike wound. Most insurers
While the move promises stability, it also raises a crucial simply sneak in a renewal notice with a big premium hike,
question: Will insurers find new ways to offset costs, tight- and thus end up creating shock and significant emotional
ening underwriting and claim scrutiny? There are some ar- distress for policyholders. Clear and proactive communica-
eas where additional refinements could enhance consumer tion explaining the reasons behind the price increase can
protection and clarity. ease the friction.
Shielding seniors Standardising hospital charges
The 10% cap prevents the sudden, steep premium hikes that While state-level healthcare pricing regulation remains a
have long troubled senior citizens. These increases often persistent demand, its on-ground execution seems far away.
stemmed from age-related adjustments, price revisions, or The more feasible alternative is for the industry to collec-
both. While the cap ensures more predictable costs, concerns tively negotiate "bulk" rates with hospitals, standardising
linger that insurers might treat it as a benchmark, opting for pricing and ensuring fair billing practices. The General In-
annual price revisions instead. A balanced approach, driven surance Council's "Cashless Everywhere" initiative is a prom-
by ongoing dialogue between the regulator and insurers, is ising step in this direction, but its success hinges on strong,
crucial to maintain affordability without compromising the unified support from all stakeholders.
sustainability of health insurance offerings.
Wellness-driven insurance
Policy safety net A sustainable solution to high premium hikes lies in a broader
The provision that prevents insurers from withdrawing prod- approach beyond merely managing premiums and claims.
ucts without seeking IRDAI's approval is a thoughtful safe- Integrating personalised wellness management and preven-
guard. It signals IRDAI's commitment to protecting con- tive care into health insurance products can play a signifi-
sumer interests and preventing abrupt changes that could cant role in reducing hospitalisation claims.
disadvantage senior citizens. This guideline should ideally be By empowering primary care, insurers can guide customers
coupled with a uniform approval process that promotes toward the most appropriate and cost-effective treatments,
prudent decision making. A more transparent process, per- proactively reducing overall healthcare expenses and ensuring
haps including a publicly accessible summary of pricing de- more affordable premiums. The future lies in insurers evolving
cisions and their justifications, could help build confidence from mere risk financiers to proactive risk managers.
among policyholders.
Responsive customer support
Capping costs There is an urgent need to strengthen the grievance
While the 10% cap offers much-needed relief, it raises concerns redressal mechanism, ensuring customers have clear, acces-
about insurers tightening underwriting standards, potentially sible channels to raise and escalate complaints. Currently,
limiting access for new senior citizens. Claims processes, too, many are left with no choice but to turn to social media or
might become more stringent as insurers navigate cost con- contact the CEO directly, while others simply abandon their
trols. However, these adjustments need not be seen as set- efforts. Enhancing this process would not only empower
backs. Instead, they present an opportunity for collaborative customers but also improve the industry's reputation, mak-
solutions, where regulators and insurers can develop self-regu- ing premium hikes easier to accept. (Source: Mint)

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