Safety net: Covid-19 cases up, check if policy covers at-home care

Sum insured must be adequate, include consumables like PPE kits – The resurgence of Covid-19 has reignited fears of infection and the financial burden of medical treatment. The importance of assessing one’s health insurance policy covers and financial preparedness can’t be overstated.

Inadequate coverage – The previous waves offer a few lessons. “Medical costs tend to shoot up in a crisis. During Covid, hospitalisation was two-three times more expensive than normal. The frequency of hospitalisation also rose,” says Kapil Mehta, co-founder, SecureNow. Many either did not have health insurance or had policies with insufficient sum insured, which was inadequate to meet the expenses of multiple hospitalisations.

Many also had disease-specific plans. “It is better to have a comprehensive health insurance plan rather than a disease-specific one. We don’t know the nature of the next pandemic. Broader covers offer more security,” says Mehta.
Expenses not covered – Even those who had comprehensive policies discovered that they did not cover many Covid-related expenses. They had to pay for them out of their own pockets. “Many policies offered limited coverage for at-home (domiciliary) treatment. Many also offered inadequate coverage for personal protective equipment (PPE),” says Rahul M Mishra, co-founder & director, Policy Ensure.
He adds that many policies had co-payment requirements and high deductibles, which again translated into out-of-pocket expenses (OOPE).
Fill in gaps – Check if your health policy will pay for these expenses. If not, port to a better policy or fill in the gaps with riders.
“Your policy covers should provide comprehensive coverage, which includes hospitalisation, day care procedures, domiciliary hospitalisation, and treatment of common critical illnesses,” says Naval Goel, chief executive officer (CEO) and founder, PolicyX.
He adds that the policy should offer the option to increase the sum insured and pay a no-claim bonus.

Says Siddharth Singhal, business head-health insurance, “By paying 5-7 per cent extra premium, you can buy a rider that will cover the cost of consumables.”
If the sum assured is inadequate, enhance it or buy a super top-up policy. “Take a basic cover of ~5-10 lakh and then buy a super top-up cover. Opt for a deductible equivalent to the basic policy. This will make the super top-up cover affordable,” says Mishra.

Also consider purchasing a daily cash benefit rider or a standalone daily cash benefit policy covers. This pays a fixed sum for each day of hospitalisation, which can be used to meet OOPE.
Remember a key point about making a claim for domiciliary treatment. “A registered MBBS doctor must recommend that hospitalisation is a must but can’t be done due to non-availability of beds at a nearby hospital or because the patient is not in a condition to be moved,” says Singhal.
Health care fund – You must also have a health care fund.
“In most claims, about 85 per cent of costs are paid and 15 per cent are outside the ambit of coverage. A health care fund can take care of this. Keep this fund independent of other investments. Put this money in a bank deposit or a short-term debt fund,” says Mehta. He adds that one needs to top this up over time as medical inflation is above 10 per cent.
Systematic investment plans (SIPs) can help. While the amount required in the fund will vary from person to person, ~10 lakh should suffice in most cases.

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How can insurance companies leverage AI to penetrate Tier 2 and 3 markets and satisfy customer needs?

Reportedly, insurers have been adopting AI technology to enhance the customer experience

By Rahul M Mishra

While gaining ground in India, the insurance market is expected to become one of the fastest-growing markets in the world. Currently, the Indian insurance market is the 10th largest in the world; however, it is anticipated to become the 6th largest by 2032, according to a report by Swiss Re.

In order to meet this aim, the insurance companies in India need to tap into new markets, such as Tier 2 and Tier 3 cities. These cities have become hotbeds of business growth owing to several developmental factors. However, to target this market efficiently, the insurers need to adapt new-age technologies such as AI. As AI technology has advanced, it has become an integral part of the insurance sector.

The insurers have been adopting AI technology to enhance the customer experience, streamline operations, and make faster and more accurate decisions. As growth in Tier 2 and Tier 3 cities has become necessary for the insurers, AI will aid them in penetrating these markets.

Aiding in personalised marketing

People residing in Tier 2 and Tier 3 cities have different purchasing habits and considerations when compared to those in metropolitan areas. Hence, the strategies that insurers would have used in developed areas might not work in the minor cities. Therefore, insurers need to understand the market and then cultivate their strategies in order to be successful there. One way to do this is by leveraging AI technology in order to provide personalised experiences. According to a previous Epsilon study, brands that offer personalised experiences increase the likelihood that 80% of consumers will make a purchase.

Based on the customer data, including behavioural patterns, demographic information, and location, the marketing strategies can be tweaked. The individualised approach will help target specific cohorts residing in Tier 2 and Tier 3 cities with relevant messaging. Another way is to form alliances with micro-FinTech companies in these areas that have a better understanding of people’s financial wellbeing.

Round-the-clock support with chatbots

Pandemic acted as a catalyst for the growth of conversational AI along with the rise of digitalization. The technology disrupted almost every sector in operation, and the insurance sector is not an exception. Insurance is a 24/7 industry, and since mishaps can occur at any time, so can the claims. Manually catering to the needs of customers can be daunting owing to the number of claims an insurer receives every day. Therefore, AI with bots can improve efficiency, improve processes, and satisfy customer needs.

An insurance chatbot makes sure that every query and claim receives a real-time response. A conversational AI can initiate quotes, carry on conversations, ascertain the customer’s intent, recommend products, and even respond to follow-up queries. A Statista statistic claims that one-third of customers found chatbots to be “very effective” in answering their questions. Chatbots can also be customised in local languages to provide 24/7 support. This guarantees that no customer will go unanswered and gives them the option to connect to a live agent if necessary, keeping customers of Tier 2 and Tier 3 cities satisfied.

Identifying potential customers

Businesses continue to benefit from AI and predictive analytics in terms of identifying consumer trends, creating customer profiles, and creating more precise potential target audiences. But it’s also doing much more, both in terms of gathering data and using it to provide customers with the individualised service they require. All marketing initiatives must include target group segmentation, and insurance companies are no exception. If businesses don’t know whom to persuade, convincing consumers in Tier 2 and Tier 3 cities is challenging.

Today’s marketers can accurately identify the best target audience thanks to AI and predictive analytics. It also helps identify new subgroups of this group that share characteristics with insurance in a quicker and more accurate manner. With the help of these data sources, insurers can make ex ante decisions about pricing and underwriting, enabling proactive contact with a bindable quote for a product bundle customised to the customer’s risk profile and coverage requirements.

Facilitating fraud detection

Insurance companies found it challenging to expedite the claims processing process under the previous traditional model because of the daily claim volume. It can be difficult to identify specific patterns in the claim data that might call for closer examination under human supervision. But with AI, it only takes a few minutes and skilful programming for digital tools to detect particular claim patterns that happen arbitrarily or in large quantities. And all of this is accomplished without unnecessarily raising operating costs or adding to the workload.

Therefore, it is in the best interests of the insurance companies and the claimants for the claims to be resolved as soon as possible. The entire claims process has been streamlined and expedited as a result of technology like artificial intelligence (AI), data analytics, and other related tools. AI and other technological advancements have not only significantly sped up the processes, from data capture to settlement initiation, approval, and authorization to tracking payment and recovery and managing communication but also aided in improvising fraud detection.

All things considered

Along with AI, insurance companies also require a well-coordinated strategy that involves re-evaluating the company’s capabilities. This can be accomplished by living up to each company’s value proposition and thinking creatively about how to best meet the needs of customers in Tier 2 and Tier 3 cities. Then they can finally understand how to leverage AI and learn how to create value for their products. With the advancement of AI technology and its accessibility, modern insurers are tapping Tier 2 and Tier 3 at an astonishingly rapid rate and expect to soon modify their priorities according to their customers.  As they leverage the power of AI, they can extend their reach, find potential customers, efficiently detect fraud, and cater to the needs of the customers in these minor cities.

The author is co-founder and director, Policy Ensure

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What you need to know before opting for home insurance

Home insurance is an important investment for homeowners. It will come in handy if there is any damage to property. However, choosing the right policy can be a daunting affair. Here are some factors for buyers to consider before purchasing home insurance.

The risks: Firstly, it’s crucial to understand the scope of the policy’s coverage. While most policies typically cover damage to the physical structure and any personal property inside it, there may be some exclusions or limitations.

For instance, the policy may not cover natural calamities like earthquakes, floods, and landslides. It is crucial to consider the risks of such events to your property. Also, Rahul M. Mishra, co-founder and director of Policy Ensure, said, “Home insurance policies typically have limited liability for personal injury or damage caused to a third party on the premises of the property.”

Coverage level: You must consider factors such as the home’s value, the cost of rebuilding, and the value of other personal property, etc. Mishra said, “It’s essential to consider a worst-case scenarios and ensure adequate coverage for rebuilding your home and replacing valuables, if required. For instance, the Bharat Grih Raksha Policy provides additional benefits such as coverage for buildings, furniture, fixtures, fittings, and contents at home, etc, besides renovation.”

Deductibles: Several insurers offer comprehensive coverage without deductibles. “For instance, the Bharat Grih Raksha Policy has no deductible and provides coverage for flood and earthquake damage, architect fees, alternative accommodation, and debris removal to a specified limit. It also imposes no penalty for underinsurance claims of less than 15%,” said Mishra.

The claims process: You must know how to file a claim, the type of documentation required, and the typical time taken for claim settlement. You should also be aware of any limitations or exclusions to the coverage and any applicable deductibles. Also, you must check the claim settlement ratio from the website of Irdai while choosing the insurance company.

Additionally, Sudhish Ramteke, associate director–head of Property Practice at Anand Rathi Insurance Brokers, said, “ You must ensure the correctness of particulars. For instance, property description, content description, location address etc., should be complete. Any mismatch in these areas can cause problems in the event of claims.”

For the records: Maintaining a record of your personal property is vital. This includes ownership deeds, with visuals of the exteriors and interiors of the property, and receipts for expensive items such as electronics and jewellery. These records can be helpful in the event of loss or damage, as they can provide proof of ownership and help expedite the claims process.

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Will policyholders benefit from IRDAI’s nudge on ‘direct plans’?

The regulator has asked companies to disclose the discounts they can offer on direct purchases since they involve no commission. Direct modes exist even now. All that IRDAI has now mandated is a bit more transparency. That doesn’t mean insurers and policyholders are mandated to offer direct plans, unlike MFs

Some insurers have been offering direct plan-like insurance policies on their websites, with lower premiums.

The Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers recently to disclose to policyholders the probable discounts on premiums, if those policy sales do not involve agents, and, therefore, commissions.

Since no commission is to be paid, the savings on such policies, available directly on an insurance company’s website, can be passed on to policyholders as lower premiums.

“Every insurer shall have a well-documented policy approved by its board on an annual basis, which shall, at the minimum, specify the measures to bring cost-effectiveness in the conduct of business and reduction of expenses of management (EoM) on an annual basis, manner of transfer of benefits arising from reduction of expenses and/or from directly sourced business to the policyholders by way of reduction in premium,” says IRDAI’s notification on EoM caps for life, general and health insurance companies.

Also read | Beyond health cover: How employers can widen their insurance bouquet for employees

A direct mutual fund plan moment? 

To be clear, IRDAI has merely mandated a bit more transparency on insurance companies. This does not mean that they have to mandatorily offer direct plans or policies to policyholders.

Mutual funds (MF) are mandated to offer direct plans to unit holders. These plans are called direct plans and do not come embedded with distributor commission, unlike the regular plans. The difference between the expense ratio of a direct MF plan and a regular plan is a distributor’s commission.

Investors, who buy plans directly from a fund house’s branch or from its website, can save on distributor’s commission.

Insurance companies, on the other hand, are not mandated to offer direct plans. However some insurers like Acko General Insurance and Aegon Life Insurance have been offering direct plan-like insurance policies on their websites, with lower premiums.

IRDAI’s latest notifications take a small step forward. Now, insurers who offer such direct policies must state the quantum of discounts they offer, clearly in their board-approved policies. The quantum of discounts, though, has been left entirely to insurance companies.

Besides, even the commission and EoM structure in force until March 31, 2023, did not prevent companies from charging lower premiums to policyholders buying policies directly.

“The circular does not make any specific mention of direct plans. Technically, insurers could pay lower commissions and pass on the benefit to policyholders even when commission caps existed (the new rules effective April 1 allow insurers to pay commissions as per board-approved policies, while adhering to the overall EoM ceilings. It is up to the life insurers to decide how or whether to offer differential pricing),” says Kamlesh Rao, MD and CEO, Aditya Birla Life Insurance.

The new payment of commission and EoM rules, effective April 1, have mandated insurers to specify board-approved policies on commissions, clearly. They include any reduction in premium benefit that can be passed on to policyholders.

Also read | A health insurance policy that locks your premiums till you make a claim

Move unlikely to herald changes in the distributor-reliant industry  

However, insurance is still a push-product in India. Even today, companies rely heavily on agents to sell policies. Any move to cut costs here and pass on the savings to policyholders, experts say, can upset the agents’ lobby.

“If I were to offer lower premiums on commission-free, direct products, my distributors are bound to demand the same pricing while keeping the commission payout intact, which will be difficult. This is what has prevented life insurance companies from offering lower premiums on direct policies so far,” says the CEO of a leading private life insurance company who spoke on condition of anonymity.

This will continue to be the case unless IRDAI issues an unambiguous diktat mandating differential pricing for direct and distributor-sourced policies, he adds.

Companies like Acko General Insurance and Aegon Life Insurance have promoted their direct models as their USPs and all insurance companies, including the Life Insurance Corporation of India (LIC), sell policies through direct and online modes.

“Every company is free to offer differential pricing, but the challenge for most companies is that they operate with agents. So, those distribution channels are bound to object if they offer discounts on policies sold through, say, online channels,” explains Animesh Das, Chief Underwriting Officer, Acko General Insurance.

“Every company understands that there is a saving for the customer. It depends on the provisions in the product filed. If the company decides to offer a 30 percent discount while selling online, it can (which was the case even prior to the new EoM rules).”

Then, there are industry players who believe that IRDAI’s rules will pave the way for savings, if any, to be passed on to all policyholders, not just direct customers, and over a period of time.

“The clause has to be read in conjunction with the first one, which says that insurers have to review their EoM every year and strive to bring them down annually. So, if you (insurers) source the policy directly and it leads to a reduction in cost, it should be passed on to policyholders. However, it is a broad guideline. The reduction in premium could be passed at the portfolio level to all policyholders and not restricted only to those who buy directly,” says Abhishek Bondia, Managing Director and Principal Officer, SecureNow Insurance Brokers.

A nudge to insurers  

While rules did not prevent insurance companies from offering discounts to policyholders reaching out through direct channels, IRDAI’s latest notification could act as the much-needed nudge towards passing on the savings on commissions to policyholders.

Overall, IRDAI’s move is positive as it will act as a guide to companies to reach out to customers directly. It is more like a guidance as not all companies are utilising it (the existing flexibility to offer discounts), while some companies, like ours, were already making use of it. It will be beneficial to customers as the direct route is a transparent, cheaper one,” says Das.

However, others believe direct route does not automatically translate into savings for insurers. “Even to sell policies through the direct mode, the insurer will have to incur advertising and sales expenses, which the intermediary would have borne. Then, there is claim servicing, which, otherwise, the agent would take care of,” says Hari Radhakrishnan, Regional Director, First Policy Insurance Brokers.

The quantum of discounts, too, will be a critical factor in determining whether policyholders make a switch to low-commission policies. “The objective of the government and the IRDAI is to encourage insurance penetration and there is a feeling that higher pricing (due to higher commissions) is one of the barriers. However, the under-penetration is not due to the price points. It is because people see insurance as merely an expense and do not appreciate the value it can add. Now, insurance companies can start direct verticals, but this, too, involves costs. If they offer discounts of just 5-6 percent, policyholders might still prefer agents as insurance is a complex product that necessitates hand-holding,” says Rahul Mishra, Co-founder and Director, PolicyEnsure, an insurance broking firm.

Put simply, it remains to be seen if insurers take a cue from IRDAI’s nudge to move to offer worthwhile discounts on policies purchased through online and direct platforms.

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Role of AI and ML in the insurance industry

Reportedly, Ai and ML are also being used to improve risk management in the insurance sector

By Pankaj Vashishtha

Every industrial landscape has been rapidly changing due to the expanding reach of automation, and the insurance industry is no exception. Due to its significant role in increasing productivity and lowering costs, this industry is swiftly catching up to the AI bandwagon. AI and ML are revolutionizing the industry, transforming the way insurers operate and interact with customers. These technologies enable insurers to streamline processes, reduce costs, and improve customer experience.

AI and ML have the potential to transform the insurance industry completely. The conventional approaches to risk analysis, fraud detection, and claims processing are time-consuming, ineffective, and often inefficient. However, with the help of AI and ML, insurers can analyze massive volumes of data in real-time, spot trends and anomalies, and create more complex models for fraud detection, risk assessment, and claims processing.

Additionally, AI and ML enhance consumer engagement and experience by allowing insurers to customize goods and services to meet specific customer needs and preferences, offer real-time assistance, and respond to customer questions via chatbots and virtual assistants. As these technologies continue to evolve, we can expect to see even more innovative applications in the insurance industry.

Fraud Detection and Prevention

Insurance fraud is a major concern that costs insurers billions of dollars every year. Manual reviews are one of the more time-consuming and frequently inefficient traditional fraud detection techniques. In order to evaluate huge amounts of data in real-time, increasingly advanced fraud detection and prevention systems are being developed using AI and ML. With these tools, insurers can see trends and anomalies in the claims data and stop fraudulent claims before they are paid out.

Risk Assessment and Underwriting

The methods for risk evaluation and underwriting in the insurance industry are changing thanks to AI and ML. In the past, insurers have calculated premiums and assessed risk using manual procedures. But in order to effectively evaluate risk and determine rates, AI and ML systems can now examine massive amounts of data, including demographic data, claims history, and behavioural data. Additionally, insurers use AI and ML to automate the underwriting process, which saves time and money when processing applications. As a result, customers may receive their orders more quickly, and insurance costs may go down.

Customer Service and Engagement

Customer service and engagement in the insurance industry are improved with the use of AI and ML. Artificial intelligence-powered chatbots and virtual assistants can offer customers immediate assistance and responses to their queries. These chatbots can answer basic questions, freeing up human agents to handle more complex problems. Additionally, by customizing goods and services to suit each client’s requirements and preferences, AI and ML can be utilized to enhance consumer experiences. This can raise customer retention rates and promote customer satisfaction and loyalty.

Claims Processing and Management

Another area where AI and machine learning are transforming the insurance industry is claim processing and management. Insurance companies use AI and machine learning algorithms to automate claims processing, saving time and money. As a result, customers will receive their payments faster, and insurance costs may decrease. Furthermore, data on claims can be analyzed using AI and Ml to discover patterns and trends. This can help to reduce the likelihood of claims being denied, and insurers can use this data to identify areas where their claims procedures can be improved.

Predictive Analytics and Risk Management

Ai and ML are also being used to improve risk management in the insurance sector. Predictive analytics algorithms can analyze vast amounts of data to identify potential risks and predict future events. This can help insurers to develop more effective risk management strategies and reduce the likelihood of losses. For instance, insurers can use predictive analytics to identify customers who are at a higher risk of making a claim and develop targeted interventions to reduce the likelihood of a claim being made. This can lead to lower costs for insurers and better outcomes for customers.

Future of the Insurance Industry!

The insurance industry is evolving due to the advent of AI and ML, which enable insurers to improve customer experience, cut costs, and streamline operations. AI and ML are employed in various applications in the insurance industry, including fraud detection and prevention, risk assessment and underwriting, customer service and engagement, claims processing and management, as well as predictive analytics and risk management. Hence, one can anticipate even more cutting-edge applications in the insurance sector as AI and ML develop. As a result, it is evident that the insurance industry is poised to prosper in the coming years if it adopts these technologies and changes with the times.

The author is co-founder and CEO, Policy Ensure

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