Health Insurance Revolution: Crafting a Healthier Future for All

Mumbai, May 07: The General Insurance Council (GI Council), guided by the Insurance Regulatory and Development Authority of India (IRDAI), strives to ensure that health insurance serves as a crucial aspect of financial security for individuals and families across India.

Through initiatives promoting accessibility, affordability, and quality of health insurance products and services, alongside regulations advocating for consumer rights, the GI Council aims to alleviate the financial strain of healthcare expenses, thereby nurturing societal well-being and prosperity nationwide with empathy and care.

The Council is deeply committed to promoting societal well-being through its activities and efforts. With health insurance comprising 38 per cent of the insurance market, it serves as a vital pillar of national health security, reflecting our dedication to safeguarding community well-being.

The health insurance sector recorded a premium of close to Rs 1,00,000 crore in FY2024, reflecting a robust compound annual growth rate (CAGR) of 20 per cent.

More than 50 Crore citizens are now covered, with a clear target in mind of “Insurance for All by 2047”, set out by the IRDAI chairman.

The innovative 'Cashless Everywhere' initiative, spearheaded and announced by the GI Council, allows customers access to any hospital across the country, enhancing the convenience and reach of health insurance for all citizens. Currently, policyholders can avail themselves of cashless treatment at over 40,000 hospitals across various insurance networks.

In 2022-23, the industry settled claims close to worth Rs 75,000 Crores for more than 2.5 crore claims. This figure is expected to rise significantly in 2023-24 as efforts to streamline processes continue even further. Today more than 60 per cent of claims are settled on a cashless basis, with this only expected to go up over time, especially with Cashless Everywhere. The GI Council has constantly engaged with providers (hospitals), as well as TPA over the issue of streamlining experience for customers and making claims a friction-free process, through joint dialogue and collaborative solutions.

The council is spearheading various initiatives to make health insurance more accessible and user-friendly.

Partnership with the National Health Authority (NHA) to develop a digital healthcare ecosystem, including the National Health Claims Exchange (NHCX) to standardize data and ease information exchange using ABHA ID. Through the exchange, the endeavor is to get all the ecosystem players on one platform to ensure customer claims are handled at a very fast pace, with a high level of transparency. In addition, with the Customer Information Sheet (CIS) as mandated by the IRDAI, policyholders can have an overview of their policy's coverage and any exclusions in a clear and concise manner, thus bringing in more transparency for the consumers.

The IRDAI has facilitated significant industry growth through various initiatives, regulations, and improving clarity of coverage as boosting consumer confidence. These include simplified definitions of pre-existing conditions, reduced waiting periods, assurance of policy renewal, and expansions in coverage. Through the use and file regulation, IRDAI has opened a lot of room for innovation in the health insurance space and has actively encouraged insurers to come out with new products, especially when it comes to senior citizens, children, people with disabilities, and citizens with chronic ailments. Even today, many innovative products have hit the market that doesn’t just cover hospitalisation but also outpatient expenses.

In a major boost for consumer confidence, the Insurance Regulatory and Development Authority of India (IRDAI) has implemented a series of reforms that significantly improve health insurance coverage and clarity. These reforms include simplifying the definition of pre-existing conditions to only two specific situations: diagnosis and treatment within a specific timeframe. Additionally, the waiting period for pre-existing conditions has been reduced to 36 months, and the moratorium period for new policyholders with pre-existing conditions has been shortened to five years. Furthermore, policy renewals are now guaranteed, and individual premium loading based on health status is no longer permitted. The IRDAI has also brought more clarity to coverage details and expanded coverage to include modern medical treatments, mental illness, physical disabilities, and other previously excluded pre-existing conditions. These changes provide greater transparency and accessibility for policyholders, making health insurance a more attractive and reliable option for all citizens.

Efforts are underway to increase market penetration in underserved regions, with a specific focus on reducing the protection gap and enhancing insurance access through rural and social targets to insurers. Through the Bima trinity of Bima Vistaar, Bima Vaahaks, and Bima Sugam, the regulator wants insurance to reach every stratum and every corner of the country. The Bima Vistaar product which will be announced soon, will have not just coverage for life and property but will also be a health insurance cover at an affordable price.

The industry is focused on identifying and removing roadblocks to ensure speedy claim settlements. The 'Cashless Everywhere' initiative is expected to set new standards for quick, hassle-free settlements and reduce incidents of fraud. The industry has come together through the aegis of the council and is aggressively looking to tackle, reduce, and ultimately eliminate fraud. This will bring in greater trust in the system, augment claim settlement, and encourage more citizens to go for insurance.

Tapan Singhel, Chairman of the General Insurance Council says, “Our collective efforts are focused on making health insurance a key enabler of not just our citizen's health but societal health at large. We aim to make quality treatment accessible to everybody, irrespective of where they are from, and ensure we can take away their worries so that they can live a life of dignity. By fostering collaboration among insurers, the council, regulators, ministries, and fintech, we are dedicated to making health care affordable, accessible, and comprehensible to every citizen.”

A lot has already been achieved and we firmly believe we are on the right path to completely revolutionize the way health insurance is perceived. The aim is to alleviate concerns and simplify the lives of people, ensuring that they have the confidence and support they need to secure their health needs, he said.