Shefali Chhachhi, Director - Marketing, Max Bupa Health Insurance, elucidated on what works best for the common man in the health insurance sector in India.
What is the current status of health insurance in India?
The health insurance industry in India is in a nascent
stage. When compared to other markets worldwide, it is among the fastest
growing sectors in the Indian non-life industry. This is because the regulatory
environment and demographic scenario are rapidly changing, and healthcare needs
of the people are growing.
How many private players are there in health insurance?
There are 23 general insurance companies offering health
insurance as a vertical, out of which there are only 3 standalone Health
Insurance Companies including Max
Q. What are the current challenges facing the health
insurance industry in India?
There are many challenges in India - the lack of
availability of data on disease and on the usage patterns of different
socio-economic segments, poses a challenge for future innovations in product
biggest challenge, however, is the low levels of awareness about health
insurance among consumers. Also, there is lack of standardization in healthcare
costs and limited information about available healthcare, which leads to
under-insurance or inadequate insurance coverage.
health insurance policies do not cover full day care benefits, dental services,
vision services, preventative care like free health check-ups, home health
services or long-term care. Also, outpatient services or international cover,
urgently needed by many consumers, are rarely offered by insurers.
is also evidence of reactive purchase of health insurance, which could lead to
a number of conditions being excluded at the time of purchase. Pre-existing
conditions in India can be excluded for 4 years, after which customers need to
be included in a policy as per IRDA regulations. Proactive purchase of health
insurance could result in better health funding and long-term coverage for
What are the specific needs of the health insurance customer in India?
The Indian customer needs a health insurance policy
designed to suit his demands and also fit his budget. The policy should guard
against spiralling medical costs and guide the customer to wellness, providing
double protection - of coverage and prevention. The plan should also be able to
handle the whole family's health-related needs, right from consultation and
hospitalization to post-hospitalization.
How does a customer make sure that he is not under-insured?
While most Indians do not have health insurance, it is
likely that those who do have health insurance are under insured. This is
mainly because people buy health insurance without accurately assessing their
healthcare needs and the corresponding medical costs. However, as they say, one
size does not fit everyone. An individual's requirement of health insurance
depends solely on his/her life stage, family's needs and financial condition.
How does a customer decide upon the right health insurance option?
Health Insurance is not just a means of taking care of
healthcare needs. It also helps safeguard your savings. It does pay to know a
few crucial things before committing to a health plan.
choosing a health insurance plan, always consider the benefits before the
price. It is best to take a health policy which offers maximum coverage for
most major medical conditions.
buying a policy, please understand clearly, the services you paying for. Make
sure that you read the exclusions section very carefully, as many health
benefits are strictly optional, and will vary from one plan to the next.
buying a health insurance policy, always look for one that comes with assured
renewability - not one which may deny you coverage based on your claims history
the time of buying the health insurance, consider the following points -
flexibility in choosing the health care provider, cost of insurance premiums,
cashless hospitalization facility, level of coverage offered, and the benefits
Q. Cynics say that it is difficult to actually get the
benefit/claims that a customer pays for, in a medical insurance scheme. Is this
true? How does removing the TPA (Third Party Administrator) help?
In our case it is not difficult to settle your claims. Insurance
companies are typically seen as a faceless entity and the TPA is the person who
deals with the customers. We want our customers to know us and therefore, we
manage our relationship with them directly, not through any third parties. We
manage all customer services and claims requests directly through our in-house
Q. How would you analyse the crisis of Medicare and
Medicaid in the US? What are its learnings, if any, for the health insurance industry worldwide?
With increasing medical costs in the US, the burden on
both private insurance funding and government funded healthcare has increased.
What we see now is the result of an ongoing crisis, which has been increasing
in magnitude over a period of time.
like unsustainable spending growth, enormous crowding-out of private coverage,
perverse incentives that discourage work and financial planning, and cost
control mechanisms like low provider payment rates that limit access for
enrollees and contribute to a low quality of care have left Medicaid in a state
of the key learnings for all health insurers would be that they need to adopt a
long-term outlook for cost management. For example, preventative healthcare
helps manage healthcare costs better and it is important for health insurers to
consider helping their customers improve their health.
it may initially look like a large investment, in the medium and long term,
this will definitely lead to improved cost efficiency.
Q. Which nation or nations, do you think is following the
best health insurance practice for its people?
Health insurance has a varied level of acceptance across
different countries. Is there any country in the world where 100% of the
population has health insurance cover? The answer is 'no'.
many initiatives have been launched in a number of developed countries - a
combination of private health insurance and government-sponsored healthcare.
For example, the UK has the NHS (National Health Service).
In Australia and some
European countries, health insurance is well understood concept and is accepted
by citizens. This helps people better manage their health care expenses.