MC Exclusive | Coming soon: A digital platform that standardises health insurance claims processes, says IRDAI chairman Debasish Panda

IRDAI chief Debasish Panda said that insurance companies would be answerable to their boards when fixing commissions that they pay to their agents, which will ensure fair play.

The Insurance Regulatory and Development Authority of India (IRDAI), National Health Authority (NHA) and the life as well as general insurance councils are working towards on-boarding insurers onto the National Health Claims Exchange, IRDAI chief Debasish Panda has said.

This will facilitate smoother health insurance claim settlement processes as well as prudent underwriting, he said. Greater adoption of technology by the industry would also help in increasing efficiencies and reducing cost. “In this direction, National Health Authority, IRDAI and the Insurance Councils are working towards on-boarding insurers on the National Health Claims Exchange to support seamless claim settlement as well as prudent underwriting,” Panda said.

National Health Claims Exchange is a tech-driven initiative announced under the Ayushman Bharat Digital Mission (ABDM) in September 2022. Aimed at ensuring faster claim processing and reduction in costs, it will serve as a tech-enabled platform for exchanging claims-related information among insurance companies, claimants or beneficiaries and regulators, among others.

Responding to Moneycontrol’s query on rising health insurance premiums - often prohibitively high renewal premiums, particularly for senior citizens - Panda said that a concerted effort from all stakeholders was the need of the hour.

“A common hospital network for all insurers may be one option; efforts towards onboarding more and more people under the ambit of health insurance would also facilitate efficient pricing and also, better underwriting by the insurers would result in competitive pricing,” he said.

He emphasised the fact that the insurance industry had disbursed health insurance claims of around Rs.1.83 lakh crore in the last three financial years against around six crore claims received.

“More than Rs 70,000 crore was paid in FY 2022-23 itself against 2.4 crore claims approximately. Thus, health insurance plays an important role in providing assistance when it is needed the most. Therefore, the affordability of health insurance becomes a major aspect. There are several factors at play when it comes to health insurance pricing including inflation, healthcare costs, varied expenses for treatments, claim history etc. These get reflected in the premiums for health insurance,” Panda said.

Insurance companies also need to focus on introducing innovative cover and add-ons to serve the needs of policyholders better. This, in turn, could lead to reduction in premiums. “Need-based products would generate greater demand and uptake of insurance. Accordingly, the law of large numbers would facilitate in rationalising the cost of insurance,” said Panda.

Insurance companies ought to focus on product customisation, developing policies tailored to the needs of senior citizens with age-specific benefits, coverage for chronic conditions, and preventive care provisions.

Most importantly, transparent and clear communication, along with consumer education, is vital to empower policyholders in making informed decisions.