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Health Insurance Customers: In Focus

Explore the evolving landscape of health insurance customers, their expectations, obstacles they face, and ways to improve the overall experience. Discover key insights to cater effectively to the demands of a discerning clientele.

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Health Insurance Customers: In Focus

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  1. Health Insurance Customers: In Focus RAMANA REDDY C.V. HELIOS Insurance Services Pvt Ltd HELIOS

  2. HELIOS Insurance Services HELIOS Insurance Services Pvt Ltd HELIOS

  3. HELIOS Insurance Services • Health Insurance Customers: • # increasing steadily • Ignorant • Apprehensive • Confused • Affordability ? • Knowledgeable • Demanding HELIOS

  4. HELIOS Insurance Services Obstacles • Lack of awareness • Illiteracy • Bad or no infrastructure • Field staff inadequately trained • Lengthy proposal forms • Access to assistance • Skepticism in claims settlement • Capacity to pay HELIOS

  5. HELIOS Insurance Services • Present Situation • Limited choice of HI products • Increased hospital billing • Fraudulent claims • Lack of control • Poor quality of Services • Reimbursement delays • Pre-existing diseases exclusion • Policy limitations (eg: OP) • Inadequate information reg: ailments, procedures etc • No medical outcomes monitoring HELIOS

  6. HELIOS Insurance Services • Customer Expectations: • OP cover • Prompt customer service • No restrictions • Pre-existing ailments cover • Access to young as well as aged • Access to info (website, toll-free tel) • Renewal notices (SMS, email etc) • Payment thru debit / credit HELIOS

  7. HELIOS Insurance Services • Customer expectations… • Info on old / new products/services • call centres • internet • mailers • consumer meets • Claim Processing to be made easier ( reimbursement) • seek ‘claim form’ • bills / documents in original • detailed discharge summary • submit & follow-up • e-Claims ? HELIOS

  8. HELIOS Insurance Services • Pre-existing diseases cover • contentious • source of heartburn • taken by surprise • difficult to understand & accept • false notion of complete cover • cause for max. rejections • OP • withdrawn by Ins. Co.s • assured utilization • losses incurred • cumbersome to administer • fraudulent claims • in future ?? HELIOS

  9. HELIOS Insurance Services Better medical care - increased lifespan - increased cost - better medical outcomes - dependence on machines - shift to pvt healthcare - need for insurance - caught in the spiral - no alternatives Health Insurance is vital HELIOS

  10. HELIOS Insurance Services • Look forward to … • Stand alone Health Insurance companies • More products to choose from • More efficient claim settlement • Rationalized hospital tariff • Graded hospital payments • PED & OP covers • Sub-limits • Co-payments • Restricted choice of Providers • Pro-active wellness programs • Incentive for no/low claims HELIOS

  11. HELIOS Insurance Services Product: • Clarity • Minimum limitations • Easy access to benefits • Preferable Cashless (medical) • Prompt reimbursement HELIOS

  12. HELIOS Insurance Services Value • Identified preferred providers • Pre-determined treatment protocols • Pre negotiated tariff • Monitor medical outcomes • Partial transfer of risk to Provider • Focus on prevention • Speedy process for access to care • Monitor utilization & billing • Monitor disease patterns HELIOS

  13. HELIOS Insurance Services THANK YOU HELIOS

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