Health, Wellness, And Insurance: When Claim Outgo Reduces, Premiums Reduce For Everybody

Fundamentally, we look at insurance to protect us when things go wrong. However, one of our obsessions is to contribute to society and improve it. So, if somebody falls ill, we should take care of them. But how can we contribute to wellness? For this, we have a huge ecosystem around us, right from hospitals to diagnostics to putting together an entire chain of a gym, etc. Then, we have a lot of data points to figure out how to put that all into one place. So, as a company and the industry, our obsession is whether we can be a major contributor to the wellness of society. Can we raise the bar there? So, somewhere, we were considering giving discounts on the premium if a person is healthy or has a good health track record.

The simple outpatient department (OPD) cover we offer is also part of wellness. You don’t realise that a lot of times, a lot of people hesitate (consulting a doctor) when they don’t have health coverage. I have seen people, including my friends, who, if they have a headache, go to the chemist who gives them some XYZ medicine. But when they have a good OPD cover, they don’t hesitate to go to the best place. So, even an OPD cover contributes to wellness because it is pre-emptive, like a teleconsultation with a doctor. So, when you are not well, you can reach out and have a consultation from wherever you are. Those things act in a big way in prevention.

In terms of fitness, walking every day is good. Studies say it’s not about how much weight you have; it’s about how fit you are, which makes a difference in your longevity, happiness, and wellness. So, a lot of these myths about how you would look with this or that much weight have to be broken.

I think somebody should talk about wellness, or how happy you feel, or mental health, and educate people about where to go when things go wrong. So, what the company and the industry are working towards is a combination of these things.

If people are healthier, the claims should be lower. So, it looks like it’s benefiting the insurance companies. But what we don’t realise is the basics of the insurance business. It is like you collect money from many to pay a few. This is the insurance business.

When the money that goes out (the money spent on claims) reduces, the collection of money from many (policyholders) will also decrease. It’s cyclic. We need to remember that if the claim outgo reduces, the overall premium reduces for everybody. It’s a very positive cycle, and I mention from the industry perspective that our obsession is about how to contribute to society and make things better.

You must have heard about the schemes that would reduce your premium if you take care of yourself or if you have joined a gym. That will be like an incentive.

But the way I look at it is that you may get a reduction of X percentage in premium, but the premium in itself is not very expensive in the Indian context. An X percentage of that would be insignificant from that perspective. However, the benefit (from taking care of yourself) is huge, and we should consider using the ecosystem the insurance industry has created. If you get a reduction in premium, it is good; it is like an incentive for you, but think that it’s a huge benefit because the healthier you are, the happier you are, and the better your life is.

In any ancient civilisation—India being one of them—every household and every person is a health champion. As we all know, consuming ginger is a treatment in Ayurveda. Meditation, yoga, or being in the sun during winter is spoken about in modern science, but this has been happening for ages. But if you look at the insurance industry, what did we do? So, we started accepting Ayurvedic or ‘Ayush’ as we call it, as part of the reimbursement of claims. We also started accepting mental health reimbursement claims.

So, the idea is that the industry keeps encouraging you to be healthier and happier. The sector also keeps adding many things to make it, from that perspective, a perfect cover for you.

Mental health is covered in the insurance policy. We provide OPD cover and reimbursement for mental health consultations. We also have tele-calling, where you can speak to somebody about your mental health. So, the industry has put together all this as an ecosystem where you can reach out.

We also talk to the people in the mental health space, NGOs, and doctors to see how to improve it. We also have a project going on to know what more can be added but data is an issue in the mental health space. It is the biggest problem because, as an insurer, you need good data to design the product. But even without that, the industry has provided coverage for mental health. With more data, we can refine it and make it much better.

The OPD itself is a step in that direction. It takes care of it. The second issue, as you said, is hospitalisation, which has been taken care of as well. The data shows that not everybody has to visit doctors frequently. It says that for most people, a mental health issue is a one-off in a lifetime, and they would have it (mental issue) for some months.

So it is not as expensive as you would think. The recurring ones (mental health issues) that go beyond normal consulting would lead to hospitalisation and payments. So, we are trying to see the data points of the gaps left, if any, and trying to address that.

We are putting together studies. As a company, we were the first to develop an SOS button; if you press that, you immediately receive a callback. You will then have an ambulance come to you, take care of you, and take you to the hospital, even before the children can arrive.

So, first of all, look at your ecosystem. If things go wrong, how fast do you get a response, the golden hour, as you call it? That will make a difference in the quality of life.

The second thing is your social circle. How do you build a good social circle even before you hit retirement? Because loneliness causes more problems than anything else. Focus on your social circle and take good health insurance when things are going well. When you retire, when you are lonely, and if you start looking at it, it takes more time. But when you are in the pink of your health and things are good, and if you have a big (social) circle, family and friends, invest in them and walk daily. That is something that makes a huge difference. Laugh a lot. Spend time with people. Over time, digitalisation has taken people away from being with each other. So, walk every day, have a social circle, know what to do in an emergency, and ensure an ecosystem that can take care of you; this is what makes a huge difference.

As an insurer, we are trying to see how we can build that ecosystem for our people and customers with whatever learning we have, and how to keep incorporating friends and partners to put it together.