While the to-go-or-not-to-go-the-cashless-way debate continues to rock the insurance boat, choppy waters notwithstanding, a few insurance firms have managed to ensure steady claim processing for their clients.
Tata AIG bagged second place in claim settlement satisfaction, according to a Hindustan Times-MaRS survey of health insurance firms.
“We had not stopped accepting claims even when the controversy over cashless hospitalisation was on last year,” explained Gaurav Garg, managing director, Tata AIG.
The impasse over cashless hospitalisation began in July last year when alleging over-billing by hospitals, state-owned general insurance companies withdrew the facility of cashless treatment.
Now, this step would have made little difference even in 2006, when the insured revenue was less than 10% of hospital billing. But since then the health insurance market has consistently grown at a 40% CAGR, as stated by the Confederation of Indian Industry report, and naturally the implications are huge.
According to the industry average, settlement ratio of the industry is about 65-75% for individual policies and 100% for group insurance policies.
Many companies offer group health insurance policies to their employees. Group insurance premium comes at a fraction of individual policies, and dresses up the package nicely while being easy on the employer’s pocket.
While an individual policy of a cover of R2 lakh could cost about R3,000 annually for a 30-year old person, a group insurance cover for the same person would barely cost his employer a few hundred rupees.
Lately, insurance companies have quietly raised premium rates alleging that hospitals have been inflating bills hurting their bottomlines.
Non-life insurance companies have also started charging higher premiums from corporations offering group health insurance to their employees. In the last few months, group insurance premiums have gone up by about 25%.
To keep costs under control some companies have already started restructuring health insurance benefits, such as curtailing benefits for dependants, offered to employees.
“To keep costs in control from this year onwards any cover for additional benefits to dependent parents will have to be borne by the employee,” said the human resources director of one of India’s largest information technology companies, who did not wish to be identified. In fact, not being present in group insurance may have helped Tata AIG.
Although Garg says, “Though we are not present in group insurance at the moment, we may consider entering the segment in wake of the free pricing policy.” But for all the insurance players out there, the expert advice seems to be: iron out outstanding issues between hospitals and insurance firms and work on better service delivery and customer satisfaction.
Gopal Verma, director, e-Meditek, a third party administrator, says, “Insurance firms must work towards having a framework to settle claims within a week to ensure that customers do not have to go through uncertainty.” Like they say, healthy, wealthy and wise.