Mahavir Chopra, Head–eBusiness & Personal Lines, Medimanage is a Chartered Accountant by qualification. Mr Chopra pioneered the first online insurance broking website in India. He has over 12 years of experience in varied fields of finance. He is responsible for strategising and managing personal lines and eBusiness at Medimanage. He is known for his key role in leading the launch of online insurance broking/comparison websites in India, way back in 2006. Mr Chopra has been time and again acknowledged as one of the foremost experts in online and personal lines insurance in India.
Medimanage is an IRDA licensed direct insurance broker. The Mumbai-based health insurance broker has branches in Bangalore and Chennai. Founded in 1999, Medimanage provides its customers unbiased health insurance advisory right from purchase assistance, medical insurance claims assistance and renewals into one package.
Replying to Dolly Mirchandani, of IIFL, Mahavir Chopra says, “More than 80% of hospital bills are still paid out-of-pocket, than through a health insurance. An average lower-middle class household would have two mobile phones, a TV, but may not have more critical thing like a health or a term life insurance.”
What are the challenges faced by health insurance industry in India?
Penetration of health insurance products—which is just 0.7%—is a big challenge for non-life insurers. This is mostly due to the lack of deep distribution channels which have led to poor awareness of the product. People need to understand the importance of long-term financial planning and risk management. We, Indians are so accustomed to risks that a large part of the population considers risk as a part of life, and don’t feel the need for insurance or risk management.
Insurance including health insurance still does not appeal to the masses in India. An average lower-middle class household would have two mobile phones, a TV, but may not have more critical thing like a health or a term life insurance. The challenge for the industry is to innovate products and develop strong marketing strategies, which appeal to this mass class, converting their ‘needs’ into ‘wants’.
Health insurance is deeply affected by the fragmented, unorganised healthcare industry in India. In the West, customers of insurance companies get better-negotiated costs of treatment, than people without insurance. However, in India, this is exactly the reverse. This is a great challenge which the insurers are aiming to overcome.
Apart from these, the industry is plagued with major frauds every year. Some reports attributed that around 9% of total claims have different degrees of fraudulent elements in them.
What potential do you see for the industry in general and your company in particular?
More than 80% of hospital bills are still paid out-of-pocket, than through a health insurance. Moreover, the public healthcare system in India is not really great. Health insurance is the only route, which can help spread such high costs into a larger population, making quality healthcare affordable for everyone.
What’s more, with healthcare inflation estimated at 18% to 25%, quality treatment is increasingly becoming a big cause of worry for the middle and upper-middle class. The average middle class Indian is increasingly getting aware that one big treatment in hospital could leave him in major debts today. Health insurance is getting into the mind space of people, and therefore does have extremely good potential.
With more than 12 years of experience being a specialist in health and health insurance in India, we definitely see great potential for us to expand into more cities, reaching more customers and delivering value.
How do you ensure efficient processing of claims for customers?
We ensure efficient processing of claims in three ways. First, we create strong awareness about the documentation process and time-bound rules with our customers, through e-mailers, blogs and more, to ensure they comply with the same.
Secondly, all our claims are passed through stringent proprietary checklists by our experienced claims team. We are able to foresee and inform gaps in the claim file, much in advance, hence saving valuable time.
Finally, we act as representative of our customers. We have an efficient follow-up mechanism with insurers or TPAs (third-party administrators); to ensure the claims process moves on track.
In the exposure draft (Health Insurance Regulations, 2012), IRDA (Insurance Regulatory and Development Authority) has asked health insurers to provide insurance to citizens up to the age of 65 and settle all claims in 30 days. What are your views?
Things are finally looking up for the health insurance consumer. The draft regulation is a great step to iron out a lot of grey area in health insurance services and claims. Customers can expect better and clearer delivery in the coming future.
In our own experience, we have observed that, if processes are efficient it is not difficult to settle claims in 30 days. We are happy to see that insurers are now bound by timelines of IRDA, just like customers were bound to their timelines. I am sure insurers will take these regulations in the right spirit and deliver.
Do you think there is a need to encourage TPAs to transform themselves into claim administrators, from their current role as only claims processors?
Absolutely yes! A part of controlling claims ratios would need TPAs to graduate to a larger role. TPAs, being a third-party specialist, can actually play the role of a gate-keeper for the insured customers, helping them get affordable quality medical services.
They can also get into medical management by implementing clinical protocols with network hospitals. TPAs can also work on a larger economy of scale by consolidating claims of multiple insurers, and prove more cost-effective than in-house TPAs of insurers.
However, the recent exposure draft wants the insurer (and not the TPA) to be responsible for creation and management of the provider network and protocols. We are actually puzzled, as to what would be the future role of TPAs, given this regulation taking effect.
Many health insurers are in the process of launching insurance policies that cover alternative forms of treatments? Do you think it will help the policyholders?
Yes, there are companies, like Oriental, Tata AIG, HDFC Ergo and Chola MS General, which are now covering ayush treatments, subject to certain limits and conditions. We hear from doctors, that there are some diseases, proven, to be better treated by ayurveda, unani, sidha and homeopathy. The inclusion of these treatments would give the customer wider choice in the line of treatments.
What are the trends that you are witnessing in premium and service levels in the health segment?
With rising healthcare inflation and bleeding bottom lines of health insurers, premiums are expected to increase for a couple of years, specially for people above 35, after which they could stabilise.
IRDA is taking serious steps to make sure that insurers are responding to grievances of the customers. The regulator is taking active efforts to get things in line with respect to quality and timeliness of service. Thus, service levels are bound to improve in the coming years.
How are you competing with other players in the market?
However clichéd this may sound, we being a specialist in health insurance, are not in the race with anyone. The entire team at Medimanage only strives to meet and exceed customer expectations.