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

Published byAmberlynn Hodges Modified over 8 years ago

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Presentation on theme: "Health Insurance Customers: In Focus RAMANA REDDY C.V. HELIOS Insurance Services Pvt Ltd HELIOS."— Presentation transcript:

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

2 HELIOS Insurance Services Pvt Ltd HELIOS Insurance Services

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

4 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 Obstacles HELIOS HELIOS Insurance Services

5 HELIOS 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 Insurance Services

6 HELIOS 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 Insurance Services

7 HELIOS 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 Insurance Services

8 HELIOS 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 rejections OP withdrawn by Ins.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 Insurance Services

9 HELIOS 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 Insurance Services

10 HELIOS 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

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

12 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 Value HELIOS HELIOS Insurance Services

13 HELIOS THANK YOU HELIOS Insurance Services

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