Health insurance seems far cry in our country where we are yet to adequately address issues like Roti, Kapda, aur Makan (food, cloth and shelter). IT enabled health insurance schemes give a ray of hope by offering un-served rural population a healing touch. An analysis! By Sharmila Das, ENN

With a reach of just about two percent of the countrys 1.2 billion population, India offers a huge potential in health insurance market.
There are over 30 health insurance products in the category offered by both life and non-life insurers. And for both the Insurers IT is crucial Shreeraj Deshpande, Head – Health Insurance, Future Generali India Insurance Company Ltd feels, IT has a very major role to play in the Indian health insurance sector. The major adopters of such applications are the insurers, the TPAs as well as brokers (intermediaries). IT in health insurance sector has made the availability of various products much easier to the common man with web based applications, online premium payments, online policy issuance and renewals. IT has played a big role in under-writing for the insurers as well as claims settlement has become very quick and easy making it very customer focused.

Antony Jacob,
CEO, Apollo Munich

The growth of the mobile platform, the increase in the countrys telecom infrastructure and web penetration are all forces that are boosting the adoption of technology by the  health insurance industry.

The use of IT applications in the Indian health insurance segment has been growing rapidly over the past decade. With changing demographic base of customers across the vast expanse of the country, it is critical to deploy technology to serve the customers. The growth of the mobile platform, the increase in the countrys telecom infrastructure and web penetration are all forces that are boosting the adoption of technology by the health insurance industry. Customers now demand faster, cheaper and better solutions that can only be attained through a combination of innovation and technology. Adopters of technology include the entire insurance ecosystem – customers, insurers, providers, TPAs, regulator, etc. The efficiency of integrated processes lies in the efficient collaboration across this network and therefore technology adoption has been apparent across all these entities.

Suresh Sugathan, Head-Health Insurance, Bajaj Allianz General Insurance says, IT forms a backbone of the operations for Bajaj Allianz
and serves as a key enabler to a lot of hassle-free transaction and related servicing aspects. We have deployed several applications for an enhanced customer service experience. When a customer contacts us through call center, information about the customer such as policy details, claim history, previous complaints, status of any pending requests etc. is provided by an intelligent CRM application. This information is available in a singlescreen view which equips the Bajaj Allianz Customer Service utive for proactive communication and service. The other area where Bajaj Allianz uses IT effectively is in ensuring the pre-authorisation of cashless claims at the hospitals is completed in less than an hour. Pre-authorisation is a crucial step in case of cashless claims which used to take more than three hours earlier.

In addition, IT applications also enable agents and distributors to respond to customers requirements on a real-time basis as all information is available at their fingertips. This isenabled through applications on mobile and Internet platforms that allow the sales team to access information on products, targets, achievements etc. at their convenience. Agents also receive SMS alerts for renewal of their customers policies and our portals serve as a mini-office for them.

Mukesh Kumar, Member Of utive Management & Head HR Marketing & Strategy Planning, HDFC ERGO General Insurance Company Limited shares, Use of IT applications in Indian health insurance sector has gained significant importance especially in retail space, implementation of Government health schemes as well as in group health insurance schemes . Today, end to end product offerings, service delivery and feedback mechanism operates on various IT platforms. Various IT applications are also available to maintain individual health records. This in turns helps the insurance companies in data analy- ses, product innovation, multi channel distribution,consumer wellness programmes, value added services, health risk management and hospital /TPA management. The three pillars of successful innovation are wider range of health insurance products covering risks, financial mechanism and  reventive care along with health advisory services.

Role of RSBY
Rashtriya Swasthya Bima Yojana (RSBY) has been operational since 1st April, 2008. The objective was to cover the pitfalls of various existing national and state level health insurance schemes. It has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families.

Anil Swarup, Director General- Labour Welfare, Ministry of Labour and Employment, Government of India says, The RSBY came into being consequent to an announcement made by the Prime Minister to provide health insurance cover to the poorest of the poor in the country. Consequent to the announcement, a Task Force was set up to formulate the scheme which was subsequently approved by the Government. Till March 2013, more than 34 million families have been covered under the scheme and around five million persons have received hospitalisation benefit under the scheme. The scheme has now been extended to many such categories of unorganised workers as well who are not below poverty line. RSBY uses IT in its different payment structures. Swarup adds, IT applications have enabled cashless and paperless benefits that are portable throughout the country. There are 24 sets of software that are making this scheme happen. The IT platform is now gradually stabilising and the smart card is now also being used for delivering other services like life insurance and Public Distribution  System (PDS). The scheme allows a beneficiary from Bihar to get treated in a Mumbai or Kochi hospital and the bills are paid in his home state by the insurance companies linked to the  scheme.

Growth drivers
Apart from the rise of lifestyle related diseases the factors that have contributed to the improved health insurance portfolio of insurers are more options in coverage, employers including health insurance for employees as an attraction, increase in medical care costs driving people towards insurance, introducing cashless hospitalisation, quicker turnaround times for claim settlement and competition created by standalone health insurers.

Shreeraj Deshpande,
Head – Health Insurance,
Future Generali India Insurance
Company Ltd

IT in health insurance sector has made the availability of various products much easier to the common man with web based applications, online premium payments, online policy issuance and renewals 

Strength and weakness of Indian health insurance sector 
As per industry experts, despite the growth factors Indian health insurance has not been able to create ex-pected turnaround because lack of willingness to get insured. Mostly, the masses are dispirited about taking a health insurance scheme as there is no immediate benefit. Therefore, they look at health insurance as expense rather than a life saving investment. Kumar says, Indian health insurance sector has huge potential as it is under penetrated. Post privatisation of Insurance sector, the general insurance penetration in India has grown from 0.55 percent in 2001 to 0.7 percent in 2011. However, the health insurance portfolio has grown more than 20 percent over last few years and it is estimated that in the coming 6 to 7 years, it might overtake motor insurance in terms of the overall premium. The core weakness of the health insurance sector is lack of awareness and low penetration level as compared to the other developed countries. Further, there are limitations in distribution network / reach as compared to the population spread in the country. The inequitable growth pattern also is not helping wider spread of the general insurance products in general and  health insurance in particular.

Deshpande says, Indian Health Insurance sector is now the second largest line of business among the General Insurance or non life insurance companies and also the fastest growing segment with a very high potential for growth. The only drawback is that the retail line of business is still not growing at the rate it has been accepted to grow. Health Insurance Industry on the whole is still not generating profits though some companies have broken even. One major reason is the unregulated healthcare sector in this country.

Newer developments As they say, necessity is the mother of invention; market demand will surely give room for fresh and customised
health insurance schemes. Meeting the need of the market, fresh initiatives are on the way. Jacob says, The health insurance industry is growing rapidly and is poised to become the largest contributor in the non-life sector in the years to come. As for the industry, insurers have innovated.

Mukesh Kumar,
Member Of utive Management &
Head HR Marketing & Strategy Planning, HDFC ERGO General
Insurance Company Limited

Use of IT applications in Indian health insurance sector has gained significant importance especially in retail space, implementation of Government health schemes as well as in group health insurance schemes 

Researched, developed and marketed products that cover maternity benefits, cashless hospitalisation, no claim bonus, sum insured restoration facility and also covers such as critical illness riders, top up plans, senior citizens plans. We have come a long way from the basic mediclaim product.

Our customer research shows that there isnt a single product that has been able to garner widespread acceptance, as peoples requirements have changed over the years. One size doesnt fit all and hence the need for customisation has become the norm today in the insurance segment. Customers now demand individual attention and products that cater to differing needs. With the rising level of awareness and income levels, customers would seek specific benefits suitable for their lifestyle and requirements. Insurance companies are using customer research to develop much needed products with features such top up covers, restore benefits, multiplier benefits, OPD coverage, lifelong renewal, critical illness covers, etc

Suresh Sugathan,
Head-Health Insurance,
Bajaj Allianz
General Insurance

When a customer contacts us through call center, information about the customer such as policy details, claim history, previous complaints, status of any pending requests etc is provided by an intelligent CRM application 

Deshpande says, We do have a wide range of products in place for corporate clients. The market has seen new products being introduced into the market for retail lines on a continuous basis which are innovative in terms of coverage and also wider in coverage and sums insured offered. We still have to see a true comprehensive cover which includes true out-patient cover, preventive covers, etc on a wider basis. Some insurers have introduced covers to this effect including wellness programmes however we still have a long way to go. One major impediment is the unregulated health- care sector. Sugathan says, As compared to other countries, health insurance in India is a relatively new market. Although there is still much to be desired from awareness point of view, even in urban towns, health insurance has gone through an evolution in the last decade. The industry has today moved beyond the mediclaim mindset and features like OPD, dental cover, benefits like hospital cash etc have been introduced in the portfolios of health insurers. Geography wise pricing is another innovation which will catch on in the future. Gender-specific benefits such as maternity covers, cover for women specific illnesses and gender based pricing are other upcoming trends.

Galore of opportunities for IT vendors
With each passing day, the scope of IT in different aspects of healthcare has been increasing. In health insurance too, the scope is tremendous. For this, the IT vendors should understand the need of different health insurance companies and then should develop their products and solutions. To understand the need, better authentic market surveys, R&D initiatives should be the way forward. Deshpande feels, IT has a major role to play. Good integrated software from policy administration to claims settlement

web based applications, fraud detection software, work flow management, etc is a basic requirement. IT has a major role to play to make data flow from insurers to providers/ hospitals/ TPAs flow easily and quickly to allow quicker service levels. Jacob says, With a burgeoning health insurance industry, IT solutions providers will be able to introduce a plethora of solutions that fit the needs of the segment. IT products that are developed for life and other general insurance streams are being customised to fit the needs of health insurance, as there is a need for tailored products and not basic solutions anymore. There is great opportunity ahead for IT companies
to create integrated opportunities through software solutions that can bind and seamlessly connect insurers with their customers, providers, Insurance Regulatory & Development Authority (IRDA) and TPAs for better customer services. IT companies can use this opportunity to leap-frog technology with solutions, by borrowing best practices from the more mature western world and fit them for local requirements.

Kumar says, Going forward, IT intervention would be required to aid distribution in the untapped markets. Low cost solutions for transmission of data and funds needs to be developed. The transmission would need to not only ensure correct data / fund transfer at the time of enrollment, but also accurate and efficient distribution at the time of claim payment. Essential to the development of such solutions would be standardisation and seamless networking of various stake holders viz. insurers, banks, service providers, hospitals etc. Taking all these under consideration, it would be safe to conclude that Indian health insurance with required level of IT involvement and a customise approach can shape the future better and sound.

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