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MUMBAI: Non-life insurance companies are coming together under the General Insurance Council to create a platform for onboarding hospitals for cashless claims settlement. The platform will make it easier for hospitals to tie up with insurers and enable the industry check leakages by identifying bad players in the healthcare sector.
“The platform will address a key pain point of the healthcare industry of having to deal with 30 insurance companies separately. It would also help the industry check leakages due to fraud, waste and abuse and help bring down costs,” said S Prakash, MD, Star Health and Allied Insurance, and executive committee member of General Insurance Council.
According to Prakash, the objective is to increase the share of cashless claims to close to 100% from 55%. He said that the industry has grown at a compounded annual growth rate of 20.3% to Rs 73,000 crore in FY22 and was expected to touch Rs 90,000 crore this year. If the growth rate is accelerated to 30%, the size of the health insurance industry would be Rs 4.5-5 lakh crore. This would make health, more than 40% of the non-life industry.
The industry would also take action against errant hospitals based on alert from members with the nature of action depending on the intensity of the alert. The action would range from warning to suspension from the health insurance network. Nearly 30 hospitals have been identified against which the council plans to take action.
“Nearly 40% of the treatments in many hospitals are covered under insurance. The Rs 73,000-crore top line of the health insurance companies is going towards the bottom line of hospitals,” said Prakash. Besides taking action against errant hospitals the industry will look at rewarding ethical players by paying not only for the medical activity but also the outcome.
“The platform will address a key pain point of the healthcare industry of having to deal with 30 insurance companies separately. It would also help the industry check leakages due to fraud, waste and abuse and help bring down costs,” said S Prakash, MD, Star Health and Allied Insurance, and executive committee member of General Insurance Council.
According to Prakash, the objective is to increase the share of cashless claims to close to 100% from 55%. He said that the industry has grown at a compounded annual growth rate of 20.3% to Rs 73,000 crore in FY22 and was expected to touch Rs 90,000 crore this year. If the growth rate is accelerated to 30%, the size of the health insurance industry would be Rs 4.5-5 lakh crore. This would make health, more than 40% of the non-life industry.
The industry would also take action against errant hospitals based on alert from members with the nature of action depending on the intensity of the alert. The action would range from warning to suspension from the health insurance network. Nearly 30 hospitals have been identified against which the council plans to take action.
“Nearly 40% of the treatments in many hospitals are covered under insurance. The Rs 73,000-crore top line of the health insurance companies is going towards the bottom line of hospitals,” said Prakash. Besides taking action against errant hospitals the industry will look at rewarding ethical players by paying not only for the medical activity but also the outcome.
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