How health insurance plans have changed since Covid 19: OPD, ment

How health insurance plans have changed since Covid 19: OPD, mental health, surrogacy, pay as you go and more

The Covid-19 pandemic was a wake-up call for both health insurance companies and policyholders. While it exposed the vulnerabilities in the healthcare system, it also offered the regulator an opportunity to eliminate many lacunas and add new features that can offer enhanced and adequate protection to health insurance policy buyers. Here is how the health insurance coverage has improved after the pandemic.

Specific need-based products

Senior citizens, who had very few options until a few years ago due to pre-existing diseases like diabetes or high BP, are now getting more and more health insurance coverage options. “There are many plans specifically designed for senior citizens; plans that ideally work better for people with pre-existing diseases. However, there might be some limitations like limit of sum ..

Specific need-based products

Specific need-based productsSenior citizens, who had very few options until a few years ago due to pre-existing diseases like diabetes or high BP, are now getting more and more health insurance coverage options. “There are many plans specifically designed for senior citizens; plans that ideally work better for people with pre-existing diseases. However, there might be some limitations like limit of suminsured or co-payment in these plans. Instead of a family floater plan, look for individual health policies for senior citizens,” says Siddharth Singhal, Business Head-Health Insurance, Policybazaar.com.

Star Health Insurance, New India Assurance, HDFC Ergo (erstwhile Apollo Munich Health Insurance), National Insurance and Care Health Insurance (erstwhile Religare Health Insurance) were already offering Senior Citizen Red Carpet Plan, Senior Citizen Mediclaim Policy, Optima Senior, Varistha Mediclaim Policy and Care Senior, respectively. Many new players came up with senior plans later. Niva Bupa (erstwhile Max Bupa) launched the Senior First Plan For Senior Citizens in 2021. Aditya Birla Health Insurance launched a plan in 2021 called Activ Health Essential, an affordable health solution plan for the special health needs of senior citizens. ICICI Lombard came up with a health insurance plan dedicated to senior citizens in 2022. ManipalCigna Health Insurance came up with a special policy for senior citizens in 2023 called ManipalCigna Prime Senior.

Another development is related to maternity; people can also get surrogacy cover now. The Insurance Regulatory and Development Authority (IRDA) recently allowed insurance companies to offer up to 36 months’ coverage to surrogate mothers. “Surrogacy is a medical option for those families or individuals who, due to medical conditions, are unable to conceive on their own and are unable to start a family. The circular by the IRDAI is a welcome move to provide cover for such families and truly fulfil their dream of having children, especially now with medical advancement in the domain. This inclusive step will provide these individuals access to quality medical care," says Bhaskar Nerurkar, Head-Health Administration Team, Bajaj Allianz General Insurance.

Customised solutions that suit your requirement

The more knowledge insurers have about the policyholders, the better they can manage their risk. “Data is being used to create personalised health insurance products as per a consumer’s family history, lifestyle, income bracket. Wearable tech like fitness bands are being used to provide insurance companies with real-time health-related data of policyholders — again, a step towards helping insurers create customised insurance,” says Chatterjee. Equipped with more data, insurers are offering personalised products with more confidence. “Personalised health insurance products offering critical illness plans, maternity plans, OPD based health cover, health insurance covering lab tests, medications, no room rent capping are increasingly getting popular among consumers today,” says Chatterjee.

New innovative products through “Use and file” process

From starting with sandboxing, the regulator has now given more flexibility to insurers under the “use and file” process. "The IRDAI has increased the experimental period of the ‘Regulatory Sandbox’ from 6 months to up to 36 months," says Vivek Chaturvedi, CMO and Head of Direct Sales, Digit Insurance. “However, in June 2022, the IRDAI introduced the ‘use and file’ concept for multiple non-life products, which allows insurers to market products without prior approval and has helped insurers avoid long waiting periods for filing a product. This has brought down the need of experimenting the products under sandbox as insurers are now able to do extensive research and quickly launch a full-fledged product without the limitation of the sandbox experimental period. For example, when IRDAI allowed insurers to offer ‘pay as you drive’ add-on in motor insurance, Digit already had the product under sandbox. This allowed us to become one of the first insurers to launch PAYD features for for customers in record time.

This has enhanced the speed with which insurers can now bring in new policies. Chatterjee says “use and file” has significantly helped insurance companies introduce niche products in the market at a faster frequency, improved the ease of doing business and has led to an expansion of choices available for the policyholders.

Flexibility to go for enhanced features or affordable planHealth insurers are giving higher flexibility to policyholders to add or remove features based on their requirements and affordability. “Need-based health insurance products are devised in such a way that they cater to specific medical needs of today’s consumers. Niche products are being offered by insurance companies that allow consumers to include or exclude product benefits as per their requirements,” says Indraneel Chatterji. Co-Founder, RenewBuy.

Most insurers are now offering multiple variants of health plans where the basic variant is targeted at people looking for an affordable plan and the enhanced coverage is offered in other variants at higher premiums. You also have cost management features in new health plans that you can use to manage your premium.

“Lot of health insurance plans now come with options to manage premiums either via co-payment management, deductibles, option to modify room rent limits, etc. Health insurance plans with modular products offer more flexibility. Customers can compare the features of various available health plans online and read the inclusions, exclusions, and terms and conditions before making the final selection,” says Singhal.

Higher sum insured to deal with rising medical cost
Many treatments are now available to cure many diseases considered incurable in the past. However, these come at a price. And high medical inflation is a reality we have to live with. This is why people are now looking for higher health insurance coverage as well. “With the rise in critical illnesses and large hospitalisation expenses, consumers now understand the significance of being adequately equipped with a higher sum insured. Th ..

Higher sum insured to deal with rising medical costMany treatments are now available to cure many diseases considered incurable in the past. However, these come at a price. And high medical inflation is a reality we have to live with. This is why people are now looking for higher health insurance coverage as well. “With the rise in critical illnesses and large hospitalisation expenses, consumers now understand the significance of being adequately equipped with a higher sum insured. Thus, few insurers have launched plans that provide up to 10x sum insured benefit as renewal bonus,” says Singhal. Earlier, policies with sum insured of Rs 25 lakh or above were rare. But now more insurance players have come up with higher sum insured offerings.

Coverage for OPD and other expenses
One of the major disadvantages of health insurance plans have been the lack of coverage for outpatient treatment — which does not require 24-hour hospitalisation. But that is also changing slowly. “OPD has become an important part of healthcare expenditure. An individual with a health insurance policy with OPD as a rider, which approximately costs (15%-20% extra premium), can claim expenses such as doctor's consultation fees, diagnostic tests, pharmacy bills, etc. The coverage also guards agains expenses like lab tests, X-rays, routine check-ups, vaccinations, dental, hearing and optical treatments. The range of sum insured for OPD coverage can range between Rs 5,000 and Rs 50,000. Some plans also give an option to upgrade the coverage as per policy and provide worldwide coverage,” says Siddharth Singhal, Business Head-Health Insurance, Policybazaar.com.

Chatterjee says RenewBuy recently launched its Health Wellness Plan, which offers a host of benefits in pre-hospitalisation and OPD treatments. “The products are simple, easy to understand, 30% cheaper than the usual plans and a permanent solution to non-hospital costs. The plans offer OPD benefits, unlimited doctor on phone consultations, free lab tests, heavy concession for offline OPD consultations, modern treatment under very low sum insured, no room rent capping, maternity cover with cover with significantly low waiting period; along with an array of other benefits (under certain T&C),” he says. More launches of affordable productsStandard basic health insurance coverage still remains low in non-metro locations. Many people in these locations were looking for affordable plans which had also begun with standard basic coverage products. “Consumers who do not have deep pockets; young adults/ millennials; consumers in Tier 2/3 cities and beyond; people with limited incomes have shown significant inclination towards these products,” says Chatterjee. The IRDA introduced standard health insurance products like Arogya Sanjeevani, Corona Kavach, Corona Rakshak and Saral Suraksha Bima that offer consistent coverage and benefits to policyholders, from various insurers.

Wellness and preventive measuresPrevention is always better than cure. Health insurers have of late been putting greater emphasis on encouraging policyholders to develop healthier habits and also rewarding them for their efforts. “As per the directions of Insurance Regulatory and Development Authority of India (IRDAI), health insurers give reward points to policyholders who adopt healthy behaviours and engage in physical activity, such as jogging, cycling, or exercising. Customers can can use these reward points to pay their premiums at the time of renewal. These points can also be exchanged for savings on prescription costs, diagnostic fees, outpatient visits, and so on,” says Singhal. Digitally integrated buying to claim settlement processAn integrated platform to manage all insurance needs will help policyholders immensely. “The ongoing wave of digitisation in the insurance sector, especially with the inception of Bima Sugam by IRDAI, will serve as a one -stop technology platform for all insurance needs, right from policy buying to claim settlement and much more in real-time, across life, health and general insurance,” says Bhabatosh Mishra, Director of Underwritings, Products, and Claims, at Niva Bupa Health Insurance. Focus more on efficient claim handlingAdvancements in IT and artificial intelligence have made their way into health insurance processes as well. “Robotic process automation (RPA) and artificial intelligence
(AI) are increasingly enhancing the operational efficiency of health insurance companies. AI/ML is also extensively being used to help insurance companies reach out to more consumers with data-backed underwriting. Most importantly, insurance and insurtech companies are working relentlessly to reduce the turnaround time for claim settlements and make it smooth, which will bring a transformational change in the insurance industry,” says Chatterjee.

Other prominent IRDA’s move to broaden health coverageThe IRDAI made it mandatory for health insurers to offer coverage for treating mental health issues, with the same care as physical ailments.

Mental illness coverage: “Insurers are making sure that mental conditions must be treated the same as physical illnesses. Most mental health issues such as anxiety disorders, post-traumatic stress disorder, dementia, acute depression, and bipolar disorder are covered under the comprehensive health policy. Moreover, it is recommended that policyholders already using antidepressants must declare it as a pre-existing disease (PED) in advance so that the underwriter can evaluate the possible risk,” says Singhal.

Coverage for HIV and disabilities: "The IRDAI in February 2023 directed general insurers to offer a specific cover for persons with disabilities (PWD), persons afflicted with HIV/AIDS and those with mental illness and put in place a board-approved underwriting policy in place," says Chaturvedi.

Clear and consistent expense guidelines: The IRDAI has given clear definitions of pre-existing diseases, pre- and post-hospitalisation expenses, day care treatments, etc.

Efficient and transparent claim settlement process: IRDAI has made it compulsory for insurers to not reject a claim after 8 years of uninterrupted renewal of the policy, to settle a claim within 30 days of getting all the documents, to offer cashless facility at network hospitals, etc.

Allowing health insurance portability: The insurance regulator also issued guidelines to make it easier for policyholders to switch or upgrade their health insurance policies across insurers and plans. For example, the regulator has made it mandatory for insurers to allow switching without any extra underwriting or waiting period, to allow upgrading to a higher sum insured or a better plan without any loss of benefits, etc.

Introducing preventive features in health insurance: IRDA issued guidelines to motivate insurers to offer wellness and preventive features in health insurance policies. For example, the regulator has made it compulsory for insurers to reveal the wellness benefits and rewards given to policyholders, insurers have to offer discounts or vouchers for health check-ups, fitness activities, healthy food, etc.

The Economic Times
17/05/2023