Sub-Limits in Health Insurance Scrapped

Pertaining to group insurance, the standard industry claim ratio for retail health insurance was nearly 60-70 percent. In other words, there was an industry pay claim of Rs.60-70 for every Rs.100. In case of group insurance, the insurance seeker had to pay over Rs.110 as compared to Rs.100 earned.

Rahul Agarwal, CEO and MD of Optima Insurance Broker, quotes, "Companies are trying different price points. Premium charged on products without sub-limits and co-pay is 15 percent higher than those which have limits across the country." He further says, "Retail health market is very lucrative. Also, fraud management has become better with monitoring of claims online." Some insurance firms have also introduced ‘in-house third-party’ administration systems to examine various claims and lower instances losses and claims.

As retail health insurance is growing at the rate of 25-30 percent on a year-on-year basis, it contributes roughly about Rs.5,000 crore each year. As group insurance holds the lion’s share of health insurance, insurance firms are also providing covers for alternative modes of healing, like - homoeopathy, ayurveda and unani. A health insurance forum has also been formed to talk about various insurance related issues brought forth by stakeholders.