While most health insurance policies available in the domestic market today cover only hospitalisation expenses, increasingly, insurers have expanded health insurance policies to cover a much wider range of benefits.
These benefits include pre-hospitalisation expenses such as out-patient department (OPD), where even day-care procedures are covered. Increasingly, insurers have also started including a worldwide emergency cover, disease- specific covers such as diabetes, hypertension, dengue, cancer among others, value-added services in the form of discounts, health maintenance benefits, physiotherapy, alternative treatments such as Ayurveda, Yoga, Unani, Siddha and Homoeopathy (Ayush), dental treatment and consultation charges for second opinion.
It is estimated that almost 60% of expenses incurred in the overall medical spends in the country is towards outpatient department expenses such as doctor visits, medicines and other diagnostic tests. For insurers, the idea behind launching feature-rich policies is to bridge the gap between the total cost of healthcare incurred and the amount covered by health insurance.
Additionally, by covering these ailments at the inception stages, it will also help to cure it earlier so that it does not escalate into a major illness, which may result in a longer hospitalisation and treatment.
Incidentally, the insurance regulator too in its recent health insurance regulations 2016 has emphasised the importance of wellness and preventive elements as part of the product design in health insurance policies.
The regulator has asked insurers to promote wellness amongst policyholders of health insurance by offering outpatient consultations or treatments, pharmaceuticals, and health check-ups including discounts at specific network providers.
The regulations also stipulate insurers can look at putting in place procedures to offer discount on premiums on renewals based on fitness and wellness. This aspect may be a game-changer in the health insurance industry, which has typically relied on just providing incentives in the form of no-claim bonus to its healthy policyholders who have not claimed for every claim-free year.
There is a call now to initiate incentives to those customers who follow wellness programmes. At present, some health insurance companies are offering discounts in bills for certain health check-ups and wellness programmes, which in the future maybe a more prominent part of all health insurance schemes.
The insurance regulator believes that such incentives would push more people to follow a healthy lifestyle, which would be helpful for insurance companies as well in the long run as the number of claims may reduce over time.
Insurers are working on creating customised health risk assessment tools, to help its group health insurance clients realise their business goals and ramp up productivity. Insurers will increasingly adopt these data analytics tools to identify current and future health and wellness risks, based on an analysis of a wide range of information provided by customers, including health status, lifestyle, family history, work and resident environment, physical activity, nutrition, and modes of transportation.
Many insurers have already started recognising yoga as an eligible preventive healthcare tool by making it part of their comprehensive health insurance policy, where customers can claim discounts on reimbursement of expenses on yoga sessions enrolled in by the customer.
The focus on wellness and maintaining good health will in the end be a win-win situation for both customers and insurers. It is therefore imperative that customers look beyond insurance premiums and look for comprehensive insurance plans with added features and minimum capping.
The writer is head, Health Insurance, Bajaj Allianz General Insurance