Page 231 - Ebook health insurance IC27

Sashi Publications

Questions and Answers

Q1. How consumer protection or policy holder protection can be achieved in
health insurance ?

Ans. Effective policy holder protection is one of the most important components of a
sound and competitive insurance market, without which the prospects and policy
holders could be exposed to unfair practices by insurers.

Thecrux oftheproblem from theconsumerprotectionpoint ofviewistheinformation
asymmetry and the imbalance of the power, information and resources between
policyholders and insurers. So prospects and policyholders find themselves
vulnerable due to lack of awareness of policy conditions.

Consumer protection or policyholder's protection can be achieved if certain
basic parameters are followed :
(a) Transparency/Clarity - The policy sale is the beginning of an insurance

contract. Initial clarity is very important to avoid dissonance later, at the time
of claims. Customers need to have transparency of information at every
stage of the policy lifecycle. All the contact points like website, emails, letters,
branches or call centre should be information driven, clearly informing the
customer what he or she needs to know.
(b) Customer Centric Service - Customer centric services revolve around
delivery of the promise undertaken by the insurance companies as their
commitment towards quality service. Service processes must be designed
from thepoint of view of thecustomer. Insurance being amatter of solicitation,
is not just restricted to presales service, but extends to the post-sales service
and renewal as well.

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