Insurers Offer Home Care, Outpatient Covers Amid Covid Pandemic

Pain reliever pills arranged for a photograph. (Photographer: Tiffany Hagler-Geard/Bloomberg)

Insurers Offer Home Care, Outpatient Covers Amid Covid Pandemic

Indian health and general insurers are looking to introduce newer products to cover outpatient treatment and remote consultations as the pandemic increased awareness in one of the world’s most under-insured countries.

The second wave stretched healthcare system of Asia’s third-largest economy, inundating hospitals with patients and forcing people to depend on social media for help. While it was deadlier than the first wave, life insurers had seen claims spike even before that. Health insurers, also facing higher claims, increased premiums.

They are also looking to tweak their policies to offer additional covers.

Healthcare At Home

Health insurers are looking at creating policies that will incorporate remote consultations of doctors.

Following the first Covid-19 wave, nearly 80% of doctors used audio or video calls and messaging applications like WhatsApp to connect with their patients, EY said in a recent report. The proportion of patients using teleconsultations, the report said, rose to 64% after the pandemic’s first wave from 28% previously.

“In the last two-three-four years, more and more specialists are providing home treatments,” Mayank Bathwal, chief executive officer of Aditya Birla Health Insurance, said. “We’re looking at incorporating more ‘healthcare-at-home’ feature in our products.”

Healthcare-at-home covers ailments that can be categorised under outpatient treatment and require no hospitalisation, Bathwal said. Specialists required for providing online or tele-consultations was a problem in the past, he said. But it’s rapidly changing now.

Also read: Didn’t Get A Hospital Bed For Covid-19 Care? Won’t Be Easy To Get Insurance

Outpatient Cover

The pandemic increased awareness about the importance of having a health cover, said Sanjay Datta, chief of underwriting, claims and reinsurance at ICICI Lombard General Insurance Co. “We’re a heavily under-penetrated country in terms of covering our full gamut of health risk,” he said, adding people are either not covered or are covered for minimal amounts.

“Out-of-pocket expenses in India have risen to 60% of healthcare costs and a lot of it is because OPD (outpatient department) costs aren’t covered,” Datta said. As a result, domiciliary hospitalisation and OPD are slowly getting into health insurance coverages, he said.

The industry views these policies as evolving and anticipates an incremental outflow. Executives BloombergQuint spoke with said an additional premium would be charged depending on factors like the extent of coverage, specified list of ailments, doctor consultations and differential sum assured.

Some firms are providing cover for outpatient treatments as an add-on to existing policies or as a benefit accompanying a regular policy. Edelweiss General Insurance Ltd. said it has conceived a product that caters to outpatient and wellness initiatives as part of a pilot run. Shanai Ghosh, executive director and chief executive officer at the insurer, said the product is under consideration and is yet to receive approval from the Insurance Regulatory and Development Authority of India.

Bathwal of Aditya Birla Health Insurance said the quantum of hike in premiums for such plans shouldn’t be “too substantial”. The insurer would look at providing services through a network of partner hospitals on a cashless basis to avoid fraudulent claims, he said. The company is partnering with pharmacies to deliver medicines at home.

Ghosh said Edelweiss General Insurance is also working on similar partnerships with networks for their new product.

Also read: Insurers Refuse To Renew Group Life Covers Or Want Up To 150% Higher Premiums

Startups Doing Their Bit

Among the many startups that have targeted insurance is Vital, which is emulating the U.S. model of “plans with small deductibles” to make insurance plans affordable in India. In such cases, policyholders agree to foot expenses up to a pre-determined amount, beyond which the insurance claim gets activated.

“It’s a win-win for customers and insurers alike with customers having to pay lower premiums and insurance companies not having to deal with small claims and having lower loss ratio on their books,” Rahul Kumar, co-founder and chief executive at Vital, told BloombergQuint. He expects such consumer-driven plans—which comprise 70% of healthcare plans in the U.S.—to drive business in India in the future.

The potential is vast, according to an insurtech report by BlinC Invest, the venture capital firm that has invested in Vital. Only 35% of the Indian population is covered by health insurance compared to about 92% in the U.S, it said.

Prasad Kompalli, co-founder and chief executive officer of MFine, an aggregator providing tele-consultations with doctors, diagnostic firms and pharmacies, said insurers are increasingly looking to partner with his firm to service cashless claims.

All of this hinges on accurate capture and processing of consumer data, according to Amit Ratanpal, managing director of BlinC Invest. “Data of customers undergoing regular medical check-ups and availing wellness benefits under these remodelled health policies will help insurance companies obtain accurate data on the health of a larger population and will in turn modify the way health insurance premiums are calculated going forward.”

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