Page 14 - Insurance Times June 2024

The competitive market dynamics
spurred by this change may result in Health insurance a distant dream for women in 49
improved offerings and services for seats going to pools
consumers. Insurers will now be en- Constituencies from six states and two Union Territories going to vote in
couraged to design products that ca- the fifth phase of the Lok Sabha elections are off the mark in meeting sev-
ter specifically to the needs of senior eral sustainable development goals (SDGs).
citizens, including those with pre-exist-
Health insurance among women remains a key challenge for all 49 constitu-
ing conditions.
encies. More than half of these constituencies are off target on 20 of the
43% consumers faced 33 SDGs related to population, health, and socioeconomic well-being, ac-
cording to a Business Standard analysis of the dataset from a study titled
problems in health insur- ‘Call for action: presenting constituency-level data on population, health,
ance claims and socio-economic well-being related to 2030 Sustainable Development
Goals for India’.
As many as 43 per cent of insurance
policyholders had difficulties processing
their "health insurance" claims in the proval to the hospital's TPA desk before holding exorbitant hospital bills, in
past three years on an aggregate ba- admission of the patient, it said. what can only be described as 'fleec-
sis, says a survey. ing', Sridharan said. "Perhaps it's time
Despite some interventions by IRDAI,
"Challenges faced ranged from insur- consumers continue to grapple with to consider regulatory measures to
ance companies rejecting claims by insurance companies to get their restore affordability and bolster con-
classifying a health condition as a pre- health claims. One of the top issues sumer confidence in healthcare ser-
existing condition to only approving a that consumers have been regularly vices," he said.
partial amount," said the survey con- writing about is that of rejection of For instance, a health insurance poli-
ducted by LocalCircles. health insurance claims including can- cyholder, who sought anonymity, said
According to majority of those who cellation of policies by insurance com- that the annual premium for a Rs. 10-
commented on the subject, the pro- panies. lakh cover has increased from Rs.
29,740 for coverage period of April
cess of claiming health insurance is
extremely time consuming with many Rising health insurance 2018April 2019 to Rs. 31,305 for April
policyholders and their family members premium leaves buyers 2019-20, April 2020-21, April 2021-22)
spending the last day of their hospital to Rs. 34,822 (April 2022-April 2023) to
admission running around trying to get sore Rs. 42,486 for (April 2023-24) and to
their claim processed. With premiums going through the roof, about Rs. 51,000 for April 2024-25.
people are anxious over health insur- Health has been the fastest growing
"In several cases cited by policy hold-
ers on LocalCircles, it took 10-12 hours ance burning a hole in their pockets. insurance segment, clocking premium
after the patient was ready for dis- They want the government to expedite of close to Rs. 1-lakh crore in 2023-24,
charge for them to actually get dis- the setting up of a health regulator or reflecting a robust compounded annual
charged because the health insurance reduce the GST rate from current 18 growth rate of 20 percent, per latest
claim was still getting processed," the per cent to curb the surging cost of General Insurance Council data.
survey said. health insurance. Also, the health segment now ac-
By the time the claim is approved, the According to Srinath Sridharan, an in- counts for 38 per cent of the insurance
market with more than 50 crore
patients are so tired that they have no surance customer, the rise in health people having some form of cover.
energy to fight for any expenses that premiums exceeds the average retail Tapan Singhel, Chairman, General In-
are disapproved by the insurance com- inflation rate by 3-4x. surance Council and Chairman of the
pany. If they stay back at the hospital "The sector's foundation seemingly CII National Committee on Insurance
another day to do so, the cost of that rests on a distrust of its customers, and Pensions, said: "We have been
additional night's stay has to be borne burdening policyholders with the onus saying on various forums for a while
by them. of proof and claims efforts. This is evi- now that GST on health insurance
According to several patients, this is the denced by the persistently low claims should be brought down from the cur-
experience where the insurance com- ratio and payouts," he said. rent 18 per cent to the minimum slab
pany has already provided a pre-ap- Moreover, consumers are often left of 5 per cent."

14 June 2024 The Insurance Times