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Risk awareness is crucial for understanding insurance and its benefits. Risk, in the insurance context, is any incident that exposes us to financial danger. Risk is a possibility that harms our lives. Insurance is a mechanism to protect us financially when risk becomes a reality. A person needs to be aware of what risks can cause them financial damage, which may become irrecoverable. More than 10 lakh people have asked for financial assistance from insurance companies in the last financial year, and these numbers are going to grow each year with higher insurance adoption.

Claim is a crucial term associated with insurance. A claim is a process of requesting financial assistance from an insurance company when unforeseen damage happens. To simplify the health insurance claims process, the General Insurance Council (GIC) has come up with the Cashless Everywhere initiative. As part of Cashless Everywhere, the hospital admission section will initiate a claim with the insurer when the policyholder takes medical treatment. If a health insurance policy covers patients’ medical expenses up to the full bill amount, the insurer will pay it directly to the hospital. Cashless Everywhere for hospitals that are not impaneled with insurers will be able to provide cashless hospitalization facilities to their patients.


As part of digital health insurance adoption, IRDAI and GIC are taking multiple initiatives to make the health insurance claim process as smooth as possible. Insurance and TPA companies are working towards establishing a frictionless process. Companies like Healspan are working towards making these advancements accessible to each hospital in India. To make the insurance claim process simple, leveraging the latest technologies is the need of the hour. In India, people can buy insurance at their fingertips, and with the support of companies like Healspan, patients will now be able to initiate the health insurance claim process at their fingertips as well.

India has a population of 1.4 billion. There are multiple challenges to achieving smooth claim processing as insurance adoption is increasing in India. The first challenge is digitizing all health insurance policies so they can be processed by systems at each level. From policies issued until claim settlement, all records need to be digitized. The Nation Health Claim Exchange is an initiative that will empower the ecosystem to process digitized claims faster. Ayushman Bharat will play a crucial role as a repository for health records. Multiple health systems, from pharmacy to insurance processing, need to interact with each other to provide a best-in-class hospitalization experience. Financial transactions are subject to fraud. Since insurance settlement will involve a huge volume of transactions, identifying fraudulent claims has a lot of scope. Generative AI, data lakes, the latest SaaS infrastructure, innovation from cloud providers, next-generation edge computing, plus a lot more innovations are happening and will continue to happen to make “claim at a fingertip” happen smoothly.

Awareness of what is covered in a health insurance policy plays a crucial role during claims. Policyholders must keep their policy and insurance card handy and let their family members be aware of the coverage. Each policyholder needs to be aware of the risks to which they can get exposed. Asking for coverage against them during the fresh issuance or renewal of a policy is crucial. Insurance is based on utmost good faith. People need to disclose their information with utmost good faith during policy creation and claims. This will come in handy during claim processing. It is always best to avoid such risk events. If not, people must take adequate safety measures to nullify the risks. It is best to have a peaceful life without getting exposed to risk. Just in case that happens, it is important to be covered.


Views expressed by: Vinayaka Naik V, CTO, Healspan


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