With the escalating healthcare costs in India and the heightened health uncertainties triggered by the COVID pandemic, it has become even more necessary to have comprehensive health insurance coverages and stay protected.

Recognising this pressing need, HDFC ERGO General Insurance has introduced a suite of new products and services. These innovations aim to redefine the health insurance landscape, offering customers enhanced access to healthcare not only within India but also abroad.

Parthanil Ghosh, President - Retail Business at HDFC ERGO General Insurance Company Limited, sheds light on how the company is spearheading a transformation in the health insurance sector.

1. What initiatives have you taken to enhance the convenience and affordability of health insurance in India

As a leading general insurer in India, HDFC ERGO General Insurance has consistently introduced innovative, tech-enabled health insurance products and solutions to enhance customer convenience and affordability.

Here are some of the distinctive product features which we introduced first time in India’s health insurance sector:

• Age point pricing to ensure no drastic premium hike
• Protect benefit to cover non-medical expenses during hospitalisation
• Interest-free instalment-based health insurance to facilitate premium payment and ease the financial burden on policyholders

Beyond product innovation, we have also introduced two new initiatives to ease the claims process for cashless treatments, so that the family members of the policyholders do not have to go through additional hassle of cumbersome documentation, and can rather focus on the recovery of the patient –

• Early Discharge: Customers need not wait for long approval procedures during their discharge, and can be released as soon as the hospital signs the discharge summary for patients undergoing cashless hospitalisation. In the first phase this facility isd available across 25 large hospitals across the country.
• Pre-approved cashless for chronic diseases: Patients undergoing cashless hospitalisation for chronic diseases like chemotherapy, dialysis and radiotherapy can now avail single approval to avail cashless hospitalisation for multiple times for the same ailment at the same health care facility.

We understand the importance of swift claim settlement and thus, for our cashless claim, we take around 35 minute with 90% of the requests are responded decisively within 66 minutes. Similarly, our average Turn Around Time (TAT) for reimbursement claims is 2.4 days, as compared to the max stipulated TAT of 30 days mandated by the regulator.

Recently, we enhanced our Optima Secure health insurance plan with features like discounts for NRIs, an OPD Plan with unlimited tele and physical consultations with free sample collection, and a global treatment plan for worldwide hospitalisation.
Recognising the need for credible health information and privacy, we developed India’s first insurer-led ecosystem, ‘here’. This platform revolves around the pillars of convenience, anxiety, and savings, featuring a unique patient-to-patient platform where individuals can connect with volunteers who have undergone similar medical procedures, and thus, proves to be ‘Seriously Helpful’ during the times of need.

2. What are the existing barriers in cashless health insurance and how do you intend to bridge those gaps?

The primary barriers in cashless health insurance revolve around lack of robust mechanism of information exchange between policyholders, networked healthcare providers, and insurers. At HDFC ERGO, we have adopted a multifaceted approach. and are actively aligning ourselves to the National Health Claims Exchange (NHCX) initiative, which aims to create a standardised and efficient channel for sharing data between all stakeholders, ensuring that information flows seamlessly and quickly, thus, enabling efficient claim processing.

Additionally, we are working closely with the General Insurance Council alongwith all other insurers to provide 100% cashless treatment to all policyholders by sharing the hospital network tie ups between the insurers.

As a digital-first company with a human heart, we are also leveraging digital and artificial intelligence to improve our claim processes, and upgrading the experience of our customers. Our self-help portals and mobile applications, linked with core processing systems, make it easy for customers to stay updated about their claims and reach out to us through various touch points. We have also partnered with insurtech firms and developed tools to help customers fill out specific claim and documentation forms based on their ailments, which has resulted in quicker turnarounds and increased customer satisfaction. We launched multilingual support across digital platforms, such as our self-help chatbot 'DIA,' which is available in both English and Hindi and our AI-enabled WhatsApp bot 'MyRA,' which offers assistance to customers in 12 languages.

Recently, we have introduced the 'Pre-Approvals' feature, which enables patients undergoing cashless hospitalisation for chronic diseases like chemotherapy, dialysis, and radiotherapy to obtain a single approval for multiple treatments for the same ailment at the same healthcare facility. Also our early discharge feature for cashless allows patients to be released as soon as the hospital signs the discharge summary without waiting for our approval. These innovations, unique in India, offer peace of mind to policyholders and families, especially those dealing with chronic diseases.

3. You talked about offering special discounts to NRI’s, what was the thought process behind that?

The current available health insurance plans for NRIs often require them to pay the same premiums as those individuals who live in India permanently. It doesn’t align with the specific needs of NRIs, who spend a significant amount of time abroad and may already have health insurance in their country of residence. To address this concern, we are offering special discount up to 40% to NRIs under the Optima Secure health insurance global coverage so that they can enjoy comprehensive and affordable coverage.

4. How is HDFC ERGO upgrading its health insurance category to meet growing needs of customers?

We have introduced new products and services to enhance accessibility to healthcare, both in India and abroad.

Key Additions:

Optima Secure: Enhancements

• Worldwide treatment coverage
• An industry first initiative, providing an option to cover travel expenses of a person supporting the insured at the time of need
• Higher deductibles up to INR 5 lakhs with a reinstatement feature
• Individual Personal Accident Rider
• Special discounts up to 40% for Non-Resident Indians (NRIs)

Optima Wellbeing

• An industry first initiative to provide unlimited tele & in-person consultations, and free home sample collections
• Discounts up to 40% on diagnostics and medicines
• Cashless ecosystem

My: Health Koti Suraksha

• An enhanced personal accident insurance with up to INR 5 crores sum insured
• Coverage against accidental death, permanent total disablement and permanent partial disablement

Explorer: A revamped travel insurance

• Coverage for health emergencies, flight mishaps and various in-trip crisis
• Coverage for wide target segments from value seekers to premium buyers
• Family coverage in a single policy

First-of-its-kind services

• Early discharge from hospitals
• Single approval for chronic diseases like chemotherapy, dialysis and radiotherapy to avail cashless hospitalisation for multiple visits

5. What is the unique preposition in your OPD subscription plan?

Our OPD (Out Patient Expenses) subscription plan is designed to provide unlimited access to tele & physical consultation with physicians and free home collection of samples for diagnostic test. Most of the OPD plans available today are restrictive in terms of either doctor fees or number of visits , and in this area we have tried to provide full flexibility to the customer to have a peace of mind on medical expenses related to pharmacy, diagnostics, and preventive care, which are typically not covered under health insurance. It comes with the following key features:

• An industry first initiative to avail unlimited tele & in-person consultations, and free home sample collections
• Discounts up to 40% on diagnostics and medicines
• Cashless ecosystem

6. What does future hold for you?

The active involvement of the government and IRDAI in shaping a robust health infrastructure, fuelled by the country’s low health insurance penetration, is set to propel health insurance market in the near future. As an important stakeholder in building a ‘Healthy India’ , our focus will remain on proactively addressing customer needs, embracing cutting-edge technology and further deepening our distribution footprint With the nation's economic progress and growing awareness of health insurance, we, as a digital-first and customer-centric insurer are taking all steps to increase awareness, accessibility and affordability of health insurance products in India so that all fellow citizens do have sufficient health insurance coverage in the near future.