Page 17 - Insurance Times May 2023

ees. One, the burden of paying premi- ing conditions, they find it difficult to buy for malpractices and serious frauds,"
ums is on the organisation. a retail health insurance cover. Their he said.
child's employer-provided cover is the
"The employer often covers the premi- In FY22, the company blacklisted about
only health insurance they have.
ums for the employee, the spouse, and 1,185 hospitals for fake claims and sus-
children, which is a valuable benefit for And five, employer-sponsored plans pended the cashless option for about
employees," says Vishal Dhawan, chief often include maternity benefits, 230 hospitals. In FY23, it blacklisted
financial planner, Plan Ahead Wealth which may not be covered by personal more than 1,300 hospitals, while sus-
Advisors. health insurance plans. pending the cashless mechanism for
300-odd hospitals.
Two, people who have pre-existing dis-
ease are often denied access to a re- Star Health's tech-enabled The reasons for blacklisting and sus-
tail health insurance policy. "In an pension of cashless include imperson-
mechanism detects fake
employer-sponsored group plan, there ation, fake claims, phantom billing,
is no health checkup, medical under- claims duplication, resubmission of rejected
writing, or requirement to disclose Star Health and Allied Insurance say its claims by others, claims under differ-
pre-existing conditions. Therefore, anti-fraud mechanism - medical expe- ent names, poor infrastructure, bad
employees get insured regardless of rience embedded with technology - has clinical governance, etc.
their health condition," says Kapil helped the standalone health insurer
"These fake claims are being raised for
Mehta, co-founder & chief executive achieve some savings in its claims
the insured people, imagine what will
officer (CEO), SecureNow. outgo while taking action against er-
happen to those poor or uninsured
Three, employer-sponsored plans pro- rant hospitals that claimed fake bills.
people who go to these hospitals. Be-
vide day-one coverage for pre-existing "We have moved from a manual pro- cause of few black sheep, there is a
diseases (PEDs). "Individual plans typi- cess of claims to a digital technology- large stress in the industry," he said.
cally have a waiting period for PEDs
enabled system," Dr S Prakash, Man-
before coverage begins," Says aging Director, Star Health told. "With Health insurance reach still
Abhished Poddar, co-founder and CEO,
our experience in the medical field, we
Plum. This waiting period can range low
have developed a very robust rule en-
from two years to four years in these gine for claims. Multiple checks have India's health insurance segment con-
policies. tributed 0.34 percentage point out of
been put in place to identify irregulari-
Four, in many cases, employer-sponsored ties," he said. While Star Health the overall 1 percentage point of gen-
plans also cover parents. Since elderly recognise good hospitals, it has also eral insurance (including health insur-
parents tend to have several pre-exist- taken action against "errant hospitals" ance) penetration in the country dur-
ing FY22, Lok Sabha was informed.
Health insurers plan common platform to check During FY22, the number of persons
covered under health Insurance stood
rising fraud
at 52.04 crore, said Minister of State
Non-life insurance companies are coming together under the General In-
for Finance Bhagwat Karad in a writ-
surance Council to create a platform for onboarding hospitals for cashless
ten reply to a Lok Sabha question.
claims settlement. The platform will make it easier for hospitals to tie up
The Minister said insurance regulator
with insurers and enable the industry check leakages by identifying bad play-
IRDAI has informed the government
ers in the healthcare sector.
that it has adopted a multi-pronged
"The platform will address a key pain point of the healthcare industry of
approach using print and electronic
having to deal with 30 insurance companies separately. It would also help
media to enhance consumer awareness
the industry check leakages due to fraud, waste and abuse and help bring
on various aspects of insurance, includ-
down costs," said S Prakash, MD, Star Health and Allied Insurance, and
ing health insurance on a pan-India ba-
executive committee member of General Insurance Council.
sis, encouraging all stakeholders to pro-
According to Prakash, the objective is to increase the share of cashless claims mote insurance awareness. Despite
to close to 100% from 55%. He said that the industry has grown at a com- these efforts, the outcome on health
pounded annual growth rate of 20.3% to Rs 73,000 crore in FY22 and was insurance penetration in the country
expected to touch Rs 90,000 crore this year. continues to be low, say experts.
16 May 2023 The Insurance Times