Changes Reshaping India’s Health Insurance Industry in 2021

Even in a Pre-pandemic world, the health insurance changes have been a constant in the industry dynamics. COVID-19 has put a spotlight on the need for healthy lifestyle choices and healthcare investments. 2021 will be the year of digitalisation and transparency for the healthcare industry.

If you have already invested health insurances, this article will help you understand the latest developments in health insurance. If you are still thinking about purchasing health insurance or just a beginner, you will gain insights to make an informed choice. So read on!

1. IRDAI Regulations Instigating Changes in Health Insurance 2021

The Insurance Regulatory and Development Authority of India (IRDAI) often issues public welfare focused regulations to the insurance companies. The latest developments in Health Insurance sector as per IRDA guidelines include

Combating COVID:The IRDAI guidelines to insurers for handling COVID-treatment related claims include
  • All hospitalisation claims due to Coronavirus infections are to be verified, approved and settled as a priority.
  • Domiciliary treatment expenses to be compensated subject to applicable terms of the policy guidelines. It is the treatment expense provided for patients quarantined at home.
  • All COVID related claims have to be thoroughly reviewed before rejecting them for valid reasons subject to contract regulations.
  • Benefit based policies are to be provided by the insurance companies to cover the specific costs of treatments for Coronavirus.

As a result, several insurers provide policies like Corona Kavach and Corona Rakshak that specifically cover COVID treatment expenses. The new health insurance changes are a welcome move that will benefit policyholders.

Standardisation of Proportionate Deductions:

IRDAI has proposed to standardisation of proportionate deduction in health insurance policies. The new health plan changes will benefit policyholders with inherent rent sub-limits.

The rent sub-limits are the reason why your health insurance could be only partially approved when you choose a room with rent higher than the permissible upper cap. The insurance companies make a proportionate deduction from other associated medical expenses as it’s generally assumed that the cost of services increases with the increase in the room rent.

The new standardisation as per IRDAI guidelines will ensure that the cost of medicines, implants and medical devices and diagnostics are not deducted with respect to the chosen room rent.

2. Penetration of Artificial Intelligence in Health Care Industry

With the ongoing race between healthcare costs and inflation, insurers are under pressure to implement effective claim management systems. This is a step towards cutting down administrative costs and providing fast, reliable and straightforward customer service experience. 

Gone are the days of hard copy documentation and verification which takes forever to process insurance claims. Even with traditional claim management software, there’s always a possibility of human error and data mismatch. Enter Artificial Intelligence!

Here are a few latest developments in the health insurance industry as a result of AI penetration,

  • Global insurers are increasingly adopting AI-based claim management systems to handle and verify data, identify fraudulent claims and auto-approve legitimate claims.
  • With AI in the picture, customers will get quicker reimbursement for claims or approval for network hospitals’ cashless treatments. In India, ICICI Lombard General Insurance has already started using AI based claim management software for stress-free customer experience.
  • Data centralisation with cloud technology will help insurers take data-driven decisions and launch need-based new health plans.
  • AI-powered chatbots can deliver human-like experiences while cutting down on the costs invested in monotonous manual tasks. Fluid AI, an Indian startup, has developed a mobile avatar to make chatbot conversations engaging.
  • An unexpected increase in the claims can be handled efficiently by an AI-based chatbot as it offers scalability. A few examples of such circumstances include natural calamity, human-made disaster or pandemic (Which needs no introduction!) 

3. Customer-centric Wellness Initiatives

Looking back over the past year, we all have realised one thing in common – The importance of good physical and mental wellbeing. The loneliness of a quarantine lifestyle coupled with the health risks of physical inactivity can lead to higher cost for the insurance companies.

As a strategic move, the insurers provide several initiatives to guide their policyholders towards a positive lifestyle change. New health plan changes include free online fitness classes, counselling and therapy, nutritional diet charts and critical condition management support.

IRDAI encourages health insurance changes to include additional coverage add-ons, discounts on premiums, and rewards like gift vouchers for policyholders with a healthy lifestyle.

4. The Blessings of Data Interoperability

Data interoperability is the timely and smooth exchange of patients’ medical data between the various systems involved in the healthcare industry. Latest developments in health insuranceoffer advantages like,

  • Providing timely treatment as the required data is made available to customers, insurers, healthcare providers, pharmacies and testing laboratories.
  • The availability of consolidated data makes it easier to build healthcare management tools like interactive mobile apps. The apps help customers safelyshare real-time updates with insurers and medical caregivers.
  • Previous medical conditions and vaccination history data can help identify the onset of chronic diseases based on recurring symptom patterns. Under the new health plans, early identification of critical illnesses and preventive care is made possible.

5. Bigtechs Enter the Healthcare Ground

BigTechs are the top five, powerful, technology-driven companies in the world: namely Facebook, Apple, Amazon, Microsoft and Google.  The Bigtechs have started leveraging their technical expertise and partner with healthcare insurers to provide a glitch-free customer experience. They implement data-driven decisions in launching new policies, risk assessment during underwriting and claim management.

As per a global insurance report by Efma, a non-Profit organisation, the customer willingness to invest in healthcare policies by Bigtechs had increased from 17% in2016 to 44% in 2020.  The health insurance changes brought by BigTechs will benefit policyholders with the execution ease of the entire insurance process.

6.Telehealth Services in the Age of Corona

The pandemic has initiated a shift inhealth insurance changesmaking them more inclusive of remote health care. 

With more patients quarantined at home and lockdowns restriction, several countries have allowed medical caregivers to co-ordinate with their patients using common social networking apps. As a result, Insurance companies have joined the band and launched Telehealth initiatives and compensation for treatment expense at home.

This latest development in health insurance makes telehealth makes accessible to low-income communities and people from remote locations. Customers are also more open to seeking mental health support due to the increased privacy offered by the teleconsultation facility. Insurers are considering new health plans with an increased focus on coverage for availing telehealth services.

7.Virtual Care Service Add-ons

In a post-pandemic world, insurers will launch several value-added virtual health care services like risk assessment tools to identify disease-specific symptoms and preventive care for customers in the health risk category.

Several insurers have provided health plan changes with value-added services like free delivery of medicines and virtual doctor consultation during the pandemic.  With the advent of smart wearables like fitness bands, the insurers can track customers’ health parameters using an integrated mobile app. This helps identify any potential health threat to the policyholder at an early stage and advice for seeking medical support if required.

More insurers expanding their digital capabilities to offer virtual care services can create a win-win situation for all systems. The latest development in the health insurance industry reduces healthcare expenditure for customers, the amount payable by insurers, and the healthcare system’s strain.

8.Understanding the Impact of Environment on an Individual’s Health

Several social determinants impact an individual’s health and their access to healthcare services. Some of them include

  • Environmental factors like the pollutant level in the local neighbourhood due to industrial proximity
  • Educational exposure that gives the individual to make informed lifestyle choices
  • The impact of financial insecurity on a patient’s mental health
  • The access to healthcare being denied to specific individuals on the context of social hierarchy

Recognising the impact of external factors on an individual’s health helps Insurers provide proactive care to their customers. This latest development in the health insurance plans helps cut down on the amount payable as hospitalisation expense reimbursements.

9. Integrated Healthcare – A 360o Approach

When insurance companies collaborate with healthcare providers by giving data-driven insights, cost-effective and quality healthcare becomes possible.  The collaborative effort ensures the diagnosis of the critical condition at the right time as the Insurers have access to your medical history and lifestyle habits. The access to centralised data makes it possible for insurers to direct patients with specific needs to a Medicare provider best suited for their unique needs.  This health insurance changealso helps identify fraudulent insurance claims and policy abuse.

Insurance companies partner with trust worthy healthcare providers to provide the quality and cost effective care to policyholders.

How Can Changes in Health Insurance Affect You in 2021?

The impact of COVID-19 has propelled several health insurance changes at a faster rate than expected. The latest developments in the health insurance industry will ensure more customer-centric additions, increased transparency and integrated approach towards healthcare. With several add-ons and lucrative options to choose from, identifying the right policy can feel like a hassle.

Our Insurance experts at Cover360 can give you a holistic view of the various policies elaborating their pros and cons. We help you identify the policy that suits you the best depending on your specific healthcare requirement. Cover360 will guide you in completing the required documentation, policy renewal, sending payment reminders, and making the insurance claim process easy for you despite the new health insurance changes.

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