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Business News/ Money / Personal Finance/  Wrong to pose questions to a customer at time of making health insurance claim

Wrong to pose questions to a customer at time of making health insurance claim

Reliance Health Insurance CEO Ravi Vishwanath shares his views on resolving consumer complaints and making health insurance simpler for consumers
  • The growth rate of standalone health insurers in comparison with public and private general insurers is higher
  • Ravi Vishwanath, CEO, Reliance Health InsurancePremium
    Ravi Vishwanath, CEO, Reliance Health Insurance

    You are among the youngest health insurance companies in India right now. What is the most significant development in the health insurance segment according to you at present? How will Reliance Health Insurance be different from Reliance General Insurance that is from the same group and also offers health insurance? 

    From the customer point of view, exciting things are happening. The market size has increased from 3,000 crore in 2008 to 38,000 crore in 2018. We are quite sure it will go to about 1 trillion by 2021. So there is a lot of opportunity. Also, consumers are appreciating the need of health insurance products. Then, more people are coming to standalone health insurance companies. The growth rate of standalone health insurers in comparison with public and private general insurers is higher. And standalone health insurers are predominantly focussing on retail business. 

    Reliance Health Insurance is focussed on the retail space, and the end customer. It is too early to quantify, but as we go forward you will see that a substantial share of our portfolio will be retail. That focus is the difference. 

    How do you look at the health insurance market in India right now? 

    More and more products and services in health insurance will become customised based on individual needs. A lot of data will be used for that. 

    The claims process, with the help of technology, is also expected to get a lot smoother. A part of the Ayushman Bharat program that will happen over time is health records and coding across hospitals getting standardised. As those things start happening, it will make the claims process a lot more data-driven, rule-based and much faster. So customer experience will improve. 

    Also, the average coverage will increase and it needs to increase because most people having health insurance are underinsured. One thing that Ayushman Bharat has done besides highlighting the need for health insurance, is to put minimum coverage at 5 lakh, which is more than what many people covered under health insurance have. 

    As a new entrant, what will be your focus? 

    Our focus will be customer experience. Our research tells us that the two main pain points are finding the right hospital and, when they are in the hospital, figuring out pre-authorisation for health insurance and how to make sure that discharge is fast and smooth. 

    How will you do this? 

    We have integrated our systems with all our network hospitals, so the process is completely electronic. The hospital can log into our system and make a request through that. The second thing is our contracts with hospitals. I think we are unique in that we are giving incentives to hospitals to give our customers better service. If our customer gives a better rating to a hospital at the time of claim, there is an incentive to the hospital. It is a small amount, but it is to recognise that the hospital provided good service. 

    Another important aspect is underwriting. It is important to understand and accept the risk and tell the customer what is covered and what is not. We don’t want a customer to have a bad experience at the time of claim because we didn’t do the underwriting. 

    While talking of underwriting, a lot of companies are giving out health policies without doing medical check-ups. How do you see this practice? 

    It is important for us to know what is the risk that we are taking. It is very important that we do not cause inconvenience to a customer at the time of claims, that is the wrong time to ask questions. So we will do underwriting upfront. 

    We do a medical check-up for every customer above age 45 or having a coverage of 15 lakh and above. These decisions are data driven. Data shows that beyond 45 years, the risk of non-communicable diseases increases significantly. 

    We also ask specific questions at the time of application. Based on the answers, we decide if we need more information or a medical test. Going for a medical check-up is not required in all the cases. 

    A lot of complaints are about denial of claims or exclusions. How can that be resolved? 

    The regulator is working on standardisation of exclusions. The earlier it happens, the better it will be. Some of the consumer complaints are justified because typically health insurance products are complicated. So can the products be simplified? We are trying to simplify ours. For instance, we have removed all the sub-limits. We also try to explain the product simply. In our policy document, if somewhere it is written that a pre-existing condition is covered after three years, we explain what this means just below that. Typically, if something is mentioned on, say, page 16, the explanation is on page 64. Standardising exclusions and definitions is needed, which the regulator is doing. 

    We also have an extended policy cancellation period of up to 90 days, which is beyond the 15-day free-look period. Up to 90 days, we are ready to pay 100% of the money back. During this period, we also try to explain the policy details to customers. Even from the 91st day to the 364th day, a customer cancelling the policy will get pro-rated refund. 

    If everyone follows these things, I think consumer complaints will go away. 

    It’s been a few months since Ayushman Bharat was launched. Are some changes already visible due to the scheme? 

    The first benefit to the industry—even if it is not participating in the scheme to the extent it was anticipated—is there is increase in awareness among the masses. The second aspect is the realisation that if someone below poverty line is getting a 5 lakh cover, and if I have 3 lakh health cover and want better quality healthcare, then I am underinsured. 

    Reliance Health Insurance Ltd is among the newest standalone health insurers in the country—it got the regulator’s final approval in October 2018 and started operations in December 2018. CEO Ravi Vishwanath shares his views on resolving consumer complaints and making health insurance simpler for consumers

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    Published: 21 Jan 2019, 09:50 AM IST
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