Health Insurance - A Fast Growing Segment in India

Introduction

The modern age - a mix of daily adventures, hectic work schedules, and whatnot. But one thing that accompanies all this is the underlying health concerns.

The world has, over the years, witnessed unprecedented growth in various spheres - from the standard of living to technology. This growth also has and further led to an increase in the cost of availability too.

This increased cost is not restricted to any one sector but is spread evenly across all the sectors. Healthcare is no exception making it India’s largest segment in terms of revenue as well as employment.

Nowadays, the cost of treatment is exceeding the cost of being healthy. Therefore, various measures have been taken to ensure that these healthcare expenses don’t burn a hole in our pockets.

One of those measures is the Royal Sundaram Network Hospitals. With over a dedicated chain of over 3000 specialized hospitals, Royal Sundaram aims to provide the best medical care available.

What makes the health sector in India different and largely successful is the ease of not only purchasing a plan but also of claiming. With a claim management system having an efficiency of over 80%, healthcare insurance provider Royal Sundaram earned the Celent Model Insurer Asia Award 2013, literally.

Royal Sundaram General Insurance also received an ISO 9001-2008 certification for the successful delivery of unparalleled customer services.

The Network of the Healers

For proper medical care and effective claim processing, there are several network hospitals linked together which each client is free to choose. Apart from seamless healthcare and top-notch treatment, Royal Sundaram Network Hospitals also provide cashless treatment.

Additionally, if a client chooses not to go for a network hospital, they ensure that all the charges incurred during the treatment are taken care of.

From a simple blood test to complex surgical procedures, healthcare insurance providers ensure that every requirement for a client’s healthy future is taken care of.

Hiccups? Got you covered!

Okay then! Read the papers, signed the policy and paid the premium. But that’s just not it! What if a client decides to claim his/her health insurance and the treatment costs him/her more than what he paid for?

Such situations do come in the process of medical eventuality now and then. But that’s not the end! In an event where the costs are greater than the sum insured, the client has an option to just top-up his/her plan.

Top-up plans provide additional coverage and act as the spare tank for your vehicle while also ensuring that the clients’ do no face a financial crisis. These plans are meant to provide greater flexibility and act as a backup.

Getting a top-up plan is not restricted to having existing health insurance or to the company from where the existing plan has been purchased.

These plans are very flexible and include several members of the family. Additionally, these plans can also be converted to a basic plan.

Features of Healthcare Plans

Health Insurance plans today target a wide number or groups of people. Be it children, students, parents or senior citizens; there are plans to suit everybody.

Few basic features covered by healthcare plans are:

Out-patient Services
Accident and Emergency Services
Neonatal and Maternity Services
Hospitalization
Behavioural Health Treatment
Prescription Medicines
Rehabilitation Services
Laboratory Services
Chronic Disease Management
Paediatric Services

In addition to the above-mentioned features, healthcare plans also provide the following benefits, to name a few:

Wide Coverage
Long-term Coverage
In-Patient Hospitalization
Pre and Post Hospitalization Care
Day-Care
Domiciliary Treatment
Organ Donor Expenses
Cash Benefits
Ambulance Cover
Critical Illness Cover

These features and benefits act as a honeypot for the people, making them purchase the healthcare plans at nominal and competitive prices.

Claim Settlement Process

As easy the process of purchase of a healthcare plan is, the same must be true for the claim settlement process also. After all, who would want to get stuck in the tedious process when already suffering from a health issue.

To obtain the services covered in the healthcare plan, healthcare policyholder needs to submit a request with the healthcare provider. This can be achieved in two ways:

Direct Claim Settlement (Cashless Treatment)
Reimbursement of Expenses

When a policyholder submits a request, the network hospitals such as the Royal Sundaram Network Hospitals contact the healthcare provider, which in this case is Royal Sundaram Health Insurance, and the healthcare provider verifies the claim documents and establishes the authenticity of the case. A field doctor may also be assigned to verify the treatment prescribed.

After the completion of the verification process, the concerned medical team approves the claim request.

However, even if the claim request is legit, the claim request may be denied in the following cases:

Incorrect filling of details
Untimely request for claim settlement
Lack of relevant documents
Forged claim
Previous health issues not covered in the policy document

Proper documentation and disclosure of the facts lead to a smooth and convenient claim settlement. Incorrect facts and wrong intents usually add to the grievances one is already facing.

Reasons Behind the Growth

According to the latest report by IRDAI, the healthcare industry can see a boom and is expecting an increase to INR 8.6 trillion. Medical tourism also is not far behind with predictions of up to 25 percent growth.

One of the main factors behind such exponential growth of this segment is the never-ending demand. The healthcare industry in India provides medical care at competitive prices as compared to its western counterparts.

Another significant reason for the growth of the healthcare industry is the rebate provided under Section 80(D) of the Income Tax Act.

There has also been an increase in various diseases, which has led to a rise in medical costs. This rise in medical costs has convinced people from all groups to purchase a healthcare plan suiting their needs.

Additionally, the rise in medical costs and cost of treatment has led to inequity in access to healthcare services.

Also, the per capita expenditure on public health increased to INR 1,112 in 2015-16 from INR 621 in 2009-10. The center to state ratio of the expenditure on public health in 2015-16 was 31:69.

Various health programs launched by the government on a national level have also played a vital role in handling most of the serious health concerns, and several communicable and non-communicable diseases.

The Final Words

Concluding the facts presented, it is evident that healthcare industry indeed plays a vital role in today’s world. However, the current healthcare infrastructure indeed paves the way for betterment in services and care.

Disclaimer : *Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.