eindia.eletsonline.com Health Insurance - Leveraging Technology for Scalable Models
Health Insurance Evolution <ul><li>Second largest portfolio for general insurance </li></ul><ul><li>Annual growth rate of ...
Role of Technology <ul><li>Distribution of Health Insurance </li></ul><ul><li>Servicing of Customers </li></ul><ul><li>Dat...
Distribution of Health Insurance <ul><li>E-enabled Population </li></ul><ul><li>The e - customers who buy policies online ...
Pre acceptance Medical Tests <ul><li>Pre-acceptance medical tests are conducted in empanelled diagnostic centers </li></ul...
Servicing of Customers - Enrolment <ul><li>Web issuance of policies </li></ul><ul><li>Web enrolment of members in corporat...
Servicing of Customers - Claims <ul><li>Online Intimation of claims </li></ul><ul><li>Pre-authorization process </li></ul>...
Data Flow And Capture <ul><li>Uniformity in data variables and data capture important </li></ul><ul><li>Insurers and TPAs ...
Challenges <ul><li>Expansion of reach vs. cost of administration: Use of existing infrastructure </li></ul><ul><li>Sharing...
What do we see ahead ? <ul><li>A) Smooth electronic data flow from  </li></ul><ul><li>Insured to Insurer </li></ul><ul><li...
Thank You Future Generali Health Insurance 2 nd  Floor, Kant Helix  Tower, Bhoir Colony, Opp Tata Motors, Chinchwad, Pune ...
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Health Insurance- Levaraging Technology for Scalable Models- Bishwajeet Nayak, Future Generali

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Health Insurance- Levaraging Technology for Scalable Models- Bishwajeet Nayak, Future Generali

  1. 1. eindia.eletsonline.com Health Insurance - Leveraging Technology for Scalable Models
  2. 2. Health Insurance Evolution <ul><li>Second largest portfolio for general insurance </li></ul><ul><li>Annual growth rate of 25% with increasing health awareness </li></ul><ul><li>Growing emphasis on social health insurance schemes </li></ul><ul><li>Innovations in products and service delivery mechanism </li></ul><ul><li>Frauds remain a major concern </li></ul>
  3. 3. Role of Technology <ul><li>Distribution of Health Insurance </li></ul><ul><li>Servicing of Customers </li></ul><ul><li>Data Flow and Capture </li></ul>eindia.eletsonline.com
  4. 4. Distribution of Health Insurance <ul><li>E-enabled Population </li></ul><ul><li>The e - customers who buy policies online - web enabled purchase </li></ul><ul><li>Customers who want to pay their premiums online </li></ul><ul><li>Employees of Corporate customers </li></ul><ul><li>Rural Customers </li></ul><ul><li>Web enabled - Common kiosks – single window concept for financial products </li></ul><ul><li>Traditional cost of reaching rural customer is much higher compared to the premium size </li></ul>eindia.eletsonline.com
  5. 5. Pre acceptance Medical Tests <ul><li>Pre-acceptance medical tests are conducted in empanelled diagnostic centers </li></ul><ul><li>Loss of customers due to the long time taken for processing and decision making </li></ul><ul><li>Data from systems of diagnostic centers systems to the systems of Insurers for underwriting </li></ul><ul><li>Will save clear one week time in the process and increase in business for both the centers as well as insurers </li></ul>eindia.eletsonline.com
  6. 6. Servicing of Customers - Enrolment <ul><li>Web issuance of policies </li></ul><ul><li>Web enrolment of members in corporates – E cards </li></ul><ul><li>Physical cards / misprints / courier problems have started disappearing and cost reducing </li></ul><ul><li>Customers can access their policy coverage information online as well as seek information online </li></ul><ul><li>Online Customer loyalty programs / wellness programs to keep the customer engaged and also reduce risk of sickness </li></ul>eindia.eletsonline.com
  7. 7. Servicing of Customers - Claims <ul><li>Online Intimation of claims </li></ul><ul><li>Pre-authorization process </li></ul><ul><li>Electronic communication between Insurance company / TPAs and Hospitals </li></ul><ul><li>E - payments to Hospitals as well as customers </li></ul><ul><li>Data transfer from Insured to Hospitals to TPAs / Insurers – save time and cost </li></ul>eindia.eletsonline.com
  8. 8. Data Flow And Capture <ul><li>Uniformity in data variables and data capture important </li></ul><ul><li>Insurers and TPAs bringing in uniformity through various efforts through regulator as well as industry forums </li></ul><ul><li>Uniformity in providers network would be very important </li></ul><ul><li>Uniform billing patterns / uniform Discharge card formats / Uniform hospital records formats will facilitate immediate transfer of information </li></ul><ul><li>ICD coding – insurers and TPAs do it - when will all providers comply to this? </li></ul>eindia.eletsonline.com
  9. 9. Challenges <ul><li>Expansion of reach vs. cost of administration: Use of existing infrastructure </li></ul><ul><li>Sharing of data between all stakeholders – privacy and security </li></ul><ul><li>Insurance (regulated sector) interacting with healthcare service providers (unregulated sector): Pricing of services / risk </li></ul><ul><li>Focus on activity or resource based pricing of services rather than statistical assumptions </li></ul><ul><li>Use of technology to manipulate the process – cards for members not existing, cashless utilization, documentation issues </li></ul>
  10. 10. What do we see ahead ? <ul><li>A) Smooth electronic data flow from </li></ul><ul><li>Insured to Insurer </li></ul><ul><li>Provider to Insurer </li></ul><ul><li>Insurer to Insured </li></ul><ul><li>Insurer to Insurer - Portability </li></ul><ul><li>B) Data from Providers to National Data Repository - Morbidity rates / ICD code wise, age wise – UID </li></ul><ul><li>C) Quality of Data </li></ul><ul><li>Uniform data capture and transfer between all stake holders </li></ul><ul><li>Quality of data helps business to save time as well as cost </li></ul><ul><li>Will help better fraud detection as well as fraud management </li></ul>eindia.eletsonline.com
  11. 11. Thank You Future Generali Health Insurance 2 nd Floor, Kant Helix Tower, Bhoir Colony, Opp Tata Motors, Chinchwad, Pune – 411033 (Maharashtra)

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