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Health Insurance Customers: In Focus

Health Insurance Customers: In Focus. RAMANA REDDY C.V. HELIOS Insurance Services Pvt Ltd. HELIOS. HELIOS Insurance Services. HELIOS Insurance Services Pvt Ltd. HELIOS. HELIOS Insurance Services. Health Insurance Customers: # increasing steadily Ignorant Apprehensive Confused

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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 rejections • OP • withdrawn by Ins.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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