Challenges and Trends in India's Health Insurance Industry
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Issues & Challenges
faced by the Health
Insurance industry
Insurance Regulatory and Development Authority of India
1
P
O
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N
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S
O
F
D
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C
U
S
S
I
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N
1.
T
R
E
N
D
S
I
N
H
E
A
L
T
H
I
N
S
U
R
A
N
C
E
2.
VARIOUS STAKEHOLDERS
INVOLVED IN THE VALUE CHAIN
3.
POLICYHOLDER PROTECTION
4.
INSURERS’ PERSPECTIVE
5.
REGULATOR’S PERSPECTIVE
6.
LOOKING AHEAD
2
TRENDS IN
HEALTH
INSURANCE
PREMIUM
(Excl. PA& Travel)
3
Share of various
classes in No. of
Lives Covered
(Health excl.
PA& Travel)
4
Share of various
classes in Total
Premium
(Health excl.
PA& Travel)
5
TRENDS IN ICR
OF HEALTH
(EXCL. PA &
Travel)
6
P
O
I
N
T
S
O
F
D
I
S
C
U
S
S
I
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N
1.
TRENDS IN HEALTH INSURANCE
2.
V
A
R
I
O
U
S
S
T
A
K
E
H
O
L
D
E
R
S
I
N
V
O
L
V
E
D
I
N
T
H
E
V
A
L
U
E
C
H
A
I
N
3.
POLICYHOLDER PROTECTION
4.
INSURERS’ PERSPECTIVE
5.
ROLE OF THE REGULATOR
6.
LOOKING AHEAD
7
S
T
A
K
E
H
O
L
D
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R
S
I
N
T
H
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H
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A
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N
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R
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N
C
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V
A
L
U
E
C
H
A
I
N
Health Insurance Ecosystem
8
P
O
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N
T
S
O
F
D
I
S
C
U
S
S
I
O
N
1.
TRENDS IN HEALTH INSURANCE
2.
VARIOUS STAKEHOLDERS
INVOLVED IN THE VALUE CHAIN
3.
P
O
L
I
C
Y
H
O
L
D
E
R
P
R
O
T
E
C
T
I
O
N
4.
INSURERS’ PERSPECTIVE
5.
REGULATOR’S PERSPECTIVE
6.
LOOKING AHEAD
9
P
O
L
I
C
Y
H
O
L
D
E
R
P
R
O
T
E
C
T
I
O
N
Lack of Consumer Awareness
Lack of trust – mis-selling; misleading
advertisements
Lack of choice for need-based products
and affordability and accessibility
issues
Exclusion of Pre-existing conditions
and diseases
Portability related issues
Grievance redress and dispute redress
related issues
10
P
O
L
I
C
Y
H
O
L
D
E
R
P
R
O
T
E
C
T
I
O
N
Medical Underwriting and Rating
practices
Denial of cover
Protection of privacy and
confidentiality of personal information
Complete automation still not a reality
Claims servicing inefficiencies
11
P
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L
I
C
Y
H
O
L
D
E
R
P
R
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E
C
T
I
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N
C
L
A
I
M
S
S
E
R
V
I
C
I
N
G
Repudiated fully
Repudiated partly
Denial of cashless
Delays in cashless
Delays in discharge
12
P
O
I
N
T
S
O
F
D
I
S
C
U
S
S
I
O
N
1.
TRENDS IN HEALTH INSURANCE
2.
VARIOUS STAKEHOLDERS
INVOLVED IN THE VALUE CHAIN
3.
POLICYHOLDER PROTECTION
4.
I
N
S
U
R
E
R
S
’
P
E
R
S
P
E
C
T
I
V
E
5.
REGULATOR’S PERSPECTIVE
6.
LOOKING AHEAD
13
I
N
S
U
R
E
R
S
’
P
E
R
S
P
E
C
T
I
V
E
Health sector not regulated
Adverse selection and other
moral hazards
Fraud
Changing epidemiological
scenario
Spiralling healthcare costs
14
I
N
S
U
R
E
R
S
’
P
E
R
S
P
E
C
T
I
V
E
Impediments relating to data
collection, collation and
analysis
Lack of coordination between
various stakeholders
Legal challenges
Regulatory challenges
15
P
O
I
N
T
S
O
F
D
I
S
C
U
S
S
I
O
N
1.
TRENDS IN HEALTH INSURANCE
2.
VARIOUS STAKEHOLDERS
INVOLVED IN THE VALUE CHAIN
3.
POLICYHOLDER PROTECTION
4.
INSURERS’ PERSPECTIVE
5.
R
E
G
U
L
A
T
O
R
’
S
P
E
R
S
P
E
C
T
I
V
E
6.
LOOKING AHEAD
16
R
E
G
U
L
A
T
O
R
’
S
P
E
R
S
P
E
C
T
I
V
E
Need to increase Health
Insurance Penetration
Reaching out to the unserved and
underserved areas
Inclusive Insurance
Need to build consumer
confidence
17
R
E
G
U
L
A
T
O
R
’
S
P
E
R
S
P
E
C
T
I
V
E
Addressing both demand side and supply side issues –
Regulations and Guidelines
Addressing industry and policyholder related matters
Facilitating coordination amongst stakeholders
Addressing product design related issues
Facilitating design of simple Over The Counter products
Facilitating better distribution
Taking cognizance of lifestyle improvements and
wellness related activities
Viability of insurers to discharge liabilities
InsurTech
in Health Insurance
Renewability related issues – re-underwriting not
allowed
18
P
O
I
N
T
S
O
F
D
I
S
C
U
S
S
I
O
N
1.
TRENDS IN HEALTH INSURANCE
2.
VARIOUS STAKEHOLDERS
INVOLVED IN THE VALUE CHAIN
3.
POLICYHOLDER PROTECTION
4.
INSURERS’ PERSPECTIVE
5.
REGULATOR’S PERSPECTIVE
6.
L
O
O
K
I
N
G
A
H
E
A
D
19
L
O
O
K
I
N
G
A
H
E
A
D
Health sector needs to be regulated
Ease of doing business for insurers
State Insurance Plan
More product flexibility going
forward
Creation of a data repository that
will enable analytics
Need for an
e
-platform
20
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n
d
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t
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:
I
n
s
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r
e
d
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n
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i
a
21
THANK YOU
22
The Health Insurance Regulatory and Development Authority of India faces various challenges and trends within the health insurance industry. The content discusses issues such as trends in health insurance premiums, stakeholder involvement, policyholder protection, and perspectives from insurers and regulators. Key points include the growth in the number of lives covered, the share of various classes in total premium, and trends in incurred claims ratio. The ecosystem involves government, IRDAI, insurers, distribution channels, policyholders, health care providers, industry bodies, and TPAs.
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Presentation Transcript
Issues & Challenges faced by the Health Insurance industry Insurance Regulatory and Development Authority of India 1
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. REGULATOR S PERSPECTIVE 6. LOOKING AHEAD POINTS OF DISCUSSION 2
120,000 40% 26% 22% 21% 15% 13% 100,000 20% 80,000 TRENDS IN HEALTH INSURANCE PREMIUM (Excl. PA& Travel) 0% 73,169 60,000 -20% 58,238 50,758 40,000 44,873 -40% 37,029 20,000 -60% - -80% 2017-18 2018-19 2019-20 2020-21 2021-22 Premium in Crores Annual Growth Rate (In %) 3
7% 9% 9% 10% 10% 19% 15% 19% 23% 31% Share of various classes in No. of Lives Covered (Health excl. PA& Travel) 76% 75% 72% 67% 59% 2017-18 48.20Cr. 2018-19 47.20Cr. 2019-20 49.87Cr. 2020-21 51.47Cr. 2021-22 52.04Cr. Govt. Business Group Business Individual Business 4
39% 39% 41% 41% 44% Share of various classes in Total Premium (Health excl. PA& Travel) 48% 51% 48% 50% 48% 13% 11% 10% 8% 7% 2017-18 37,029 Cr 2018-19 44,873 Cr 2019-20 50,758 Cr 2020-21 58,238 Cr 2021-22 73,169 Cr Govt. Business Group Business Individual Business 5
120% 115% 120% 119% TRENDS IN ICR OF HEALTH (EXCL. PA & Travel) 99% 107% 98% 105% 96% 92% 85% 90% 73% 72% 71% 2017-18 2018-19 2019-20 2020-21 2021-22 Govt. Business Group Business Individual Business 6
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. ROLE OF THE REGULATOR 6. LOOKING AHEAD POINTS OF DISCUSSION 7
Health Insurance Ecosystem Government IRDAI STAKEHOLDERS Insurers IN THE HEALTH Distribution channels INSURANCE Policyholder VALUE CHAIN IIB Health Care Providers Industry Bodies TPAs 8
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. REGULATOR S PERSPECTIVE 6. LOOKING AHEAD POINTS OF DISCUSSION 9
Lack of Consumer Awareness Lack of trust mis-selling; misleading advertisements Lack of choice for need-based products and affordability and accessibility issues Exclusion of Pre-existing conditions and diseases Portability related issues Grievance redress and dispute redress related issues POLICYHOLDER PROTECTION 10
Medical Underwriting and Rating practices Denial of cover Protection of privacy and confidentiality of personal information Complete automation still not a reality Claims servicing inefficiencies POLICYHOLDER PROTECTION 11
CLAIMS SERVICING Repudiated fully Repudiated partly Denial of cashless Delays in cashless Delays in discharge POLICYHOLDER PROTECTION 12
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. REGULATOR S PERSPECTIVE 6. LOOKING AHEAD POINTS OF DISCUSSION 13
Health sector not regulated Adverse selection and other moral hazards Fraud Changing epidemiological scenario Spiralling healthcare costs INSURERS PERSPECTIVE 14
Impediments relating to data collection, collation and analysis Lack of coordination between various stakeholders Legal challenges Regulatory challenges INSURERS PERSPECTIVE 15
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. REGULATOR S PERSPECTIVE 6. LOOKING AHEAD POINTS OF DISCUSSION 16
Need to increase Health Insurance Penetration Reaching out to the unserved and underserved areas Inclusive Insurance Need to build consumer confidence REGULATOR S PERSPECTIVE 17
Addressing both demand side and supply side issues Regulations and Guidelines Addressing industry and policyholder related matters Facilitating coordination amongst stakeholders Addressing product design related issues Facilitating design of simple Over The Counter products Facilitating better distribution Taking cognizance of lifestyle improvements and wellness related activities Viability of insurers to discharge liabilities InsurTech in Health Insurance Renewability related issues re-underwriting not allowed REGULATOR S PERSPECTIVE 18
1. TRENDS IN HEALTH INSURANCE 2. VARIOUS STAKEHOLDERS INVOLVED IN THE VALUE CHAIN 3. POLICYHOLDER PROTECTION 4. INSURERS PERSPECTIVE 5. REGULATOR S PERSPECTIVE 6. LOOKING AHEAD POINTS OF DISCUSSION 19
Health sector needs to be regulated Ease of doing business for insurers State Insurance Plan More product flexibility going forward Creation of a data repository that will enable analytics Need for an e-platform LOOKING AHEAD 20
THANK YOU 22
