Understanding gaps within the medical health insurance ecosystem and role of technology in bridging them


Medical health insurance is extremely underpenetrated in India, despite the extensive need for health protection across the country. Within the last two years, people have realised the importance of medical health insurance, amid the Covid pandemic. Nonetheless, there remains to be an enormous demand-supply gap within the medical health insurance penetration. While there’s a necessity for awareness, most consumers face challenges with accessibility of medical health insurance policies. Greater than half the population lives without the safety of a health coverage.

Around 50% persons are covered under government-sponsored schemes, under which consumers cannot avail the perfect medical care. Many individuals in India are covered under group medical health insurance cover and this number surpasses individual health cover. While the federal government, insurance manufacturers, distributors are working extensively towards increasing the medical health insurance penetration; there’s an increasing need for technological interventions to make insurance more accessible to consumers, across the country.

In the previous few years, technology has proved its prowess within the insurance category. The last two years especially, have witnessed a large growth within the digital insurance model, which eventually eased out the processes for insurance manufacturers, distributors and end consumers. We now have seen how digital has been successful in making the end-to-end insurance life cycle seamless.

Artificial Intelligence and Machine Learning have been assisting the insurance sector with claim processing, by decreasing human intervention and turnaround time. From offering quick, customised services and experiences to consumers, especially through the purchase process, AI/ ML has helped insurers execute quick claim turnaround cycles with claim settlements being more accurate and error-free. Processing claims through submission of documents online, claim settlement across all categories, intimation of claim incidents through WhatsApp, have modified insurance for consumers. Consumers too face lesser hassles, as a consequence of the personalised experience and quicker settlement processes, added with the indisputable fact that they’ll check their claims history and stay up-to-date on the payment schedules.

Tech based channels have made insurance a personalised experience, very similar to the e-commerce virtual platforms. Tech, through big data analytics, has helped firms understand personalised consumer behaviour, their family needs and helped them reach out with more accurate need-based insurance solutions. For instance, an insurance advisor can guide the patron with the correct medical health insurance policy, based on the health history of the patron/ his relations. Such customisation has been helping consumers select the correct sort of policy, catering to the patron’s specific needs.
Even the insurance regulatory body (IRDAI) introduced latest policies recently, to make medical health insurance process more flexible and accessible to consumers. The regulator has been flexible in allowing InsurTech firms experiment with tech-based insurance products, in order that the insurance penetration can increase within the country. The Health ID introduced by the federal government can turn into an awesome step towards improving underwriting process within the medical health insurance eco-system. IOT health devices too are playing a key role in gathering of huge data and hence helping with underwriting processes.

InsurTech is playing an enormous role in mitigating the insurance demand-supply gap, be it within the medical health insurance category or every other category. Technology is attempting to make all the system efficient with higher process and by introducing InsurTech products which can assist insurance reach to the masses. Nonetheless, all the insurance eco-system must be open to support the transformational changes and accept the brand new age of insurance distribution. Only then InsurTech can perform at its optimum efficiency.



Views expressed above are the writer’s own.


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