Health insurance to see standardised rates, niche products

Customers will be able to choose hospitals based on location preferences, specialities and empanelment with insurance companies

Health insurance policies might soon not only have easier servicing and newer types of products but also standardisation. This would help check hospitals overcharging patients.

As the first step towards standardisation of hospitals and allied systems, the Insurance Information Bureau of India (IIB) last year launched the Registry of Hospitals in Network of Insurance (ROHINI) to ease inefficiencies in claim settlements. It has close to 35,000 hospitals which have been provided with a 13-digit identity number.

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ROHINI also has a hospital self-service portal for fresh enrolment, addition/deletion or amendment of already registered details. Also, alerts would be sent to insurers and third-party administrators (TPAs) for any changes in the registry.

Motor and health insurance form the biggest chunks of business for non-life insurance companies and for standalone health insurers. In the absence of a health regulator, malpractices including over-charging by hospitals lead to trouble for customers.

Insurance companies are trying to make products more customer friendly by offering these across income segments and reducing the waiting period.

“Pricing will be fixed in  a way, which will bring down waiting period,” said a senior official of this sector.

For easier access, insurance companies have already taken baby steps, including having own TPA teams to assist policyholders in processing claims for cashless policies and foreign medical insurance.

Earlier, the Insurance Regulatory and Development Authority of India (Irdai) had standardised health insurance rules to bring uniformity in coverage practices, including the exclusion of disease conditions and charges across policies. It proposed a standard nomenclature for critical illnesses for both hospitals and insurers to follow and put out a standard list of exclusions in hospitalisation indemnity-based policies.

While the problem of overcharging customers continues, insurers are trying to find a solution. In the past, consumer activists had sought pre-packaged rates for ailments but hospitals argued this wasn’t viable.

R Raghavan, chief executive officer of IIB, has said the ROHINI platform will be further enhanced by putting details like number of beds, specialisation, details of doctors, classification/categorisation of hospitals and diagnostic centres, among others, based on feedback from the stakeholders, their evolving needs and experience in the initial phases.

Further, customers can choose hospitals based on location preferences, specialities and empanelment with insurance companies. Insurers said this would be beneficial for customers who travel to other cities for treatment.

Insurers are also taking steps, ICICI Lombard has launched “Health Advisor”, a search registry for hospitals, treatments available and costs. Launched with information about 10 cities, this is available for all customers.

The insurer has created a hospital and consumer feedback-based rating mechanism wherein consumers can get treatment-related details and gain from actual experience from patients for  1,000 hospitals across primary, secondary and tertiary segments. The company has made this possible by sourcing feedback and over 10,000 ratings from customers who had availed treatment at these hospitals.

Bhargav Dasgupta, managing director and  chief executive officer, ICICI Lombard, said this would help customers in taking informed decisions. The company collated feedback from a large set of customers to build this platform, where more hospitals will be added in due course.

This portal is an open access platform that can be availed of by consumers through a website for this purpose.

Using this platform, a customer can compare cost of treatment for a particular ailment among hospitals and also compare quality of care for a particular ailment among hospitals.

It also gives an option to compare hospitals on the basis of infrastructure, room and procedure costs. Customer feedback and ratings on hospitals with authentication is also available on the portal.

Over and above, obtaining appointments at the hospital of their choice can also be done.

Going forward, insurance companies are also looking at bringing out mobile applications and devices that can send automatic health emergency-related information to nearby hospitals. The size of the covers could also go up to as high as Rs 3-4 crore depending on people’s needs.