Livemint came up with the article on 25/12/2018 , “Insurance sector turns focus on product structures” according to which a lot of changes have been and will be witnessed across life, health and motor insurance.

Policy structures once designed and approved, continues to be used for years with minor changes in inclusions and exclusions. These changes many a times are attributed to the experience of the insurer with regards to the loss-making factors, changing regulations of the IRDAI and changing scenarios of healthcare availability, consumer longevity and newer ways of fraud and abuse. The most significant factor is having lost some cases at legal fora only because the policy terms/ wording were not ironclad.

Further, there have been various discussions in the past for inclusion of mental health, dental treatments and many more such, currently excluded, medical conditions in the health insurance policy. And these discussions have now gained some momentum with a change of guard in the IRDAI. Subsequent to Mr. Subhash Khuntania having taken the throne, a lot of changes are being witnessed in the life, health and motor insurance products. The significance of prudent policy wording cannot be emphasized more if dental, mental health; also if bariatric surgery and LASIK (or similar) are covered.

With the changes in the policy terms and exact wording designed towards a much more mature market (both in consumer awareness as well propensity to decipher for self-gain), a lot of Insurance companies may face the challenges to modify their documents both to satisfy the regulator as well as ensure self-protection as these modifications need to be legally and medically compliant, be risk free (to the insurer) and ethical towards the consumer.

Pre-issuance medicals form an integral part of policy structure – and our experience suggests major changes are called for with SA going higher and higher. A special word of caution here for being extra cautious when it comes to offering Critical Illness (CI) cover and accident protection.

An inhouse analysis done revealed:

Fraud in life insurance is for the family.
Fraud in health insurance is for the provider, whereas
Fraud in CI/ Personal Accident (PA) is for the insured to enjoy
The fact that it is much easier to obtain a large sum CI & PA policy with much less premium – INCHES anticipates CI/ PA fraud to be fraud of next decade. With CI policies of INR 10 million (1.49 million USD) being available with ease – why bother of similar sum life/ health cover?

We at INCHES Healthcare Pvt. Ltd have over 18 years of unparalleled experience in delivering medically exact and legally compliant inputs for the insurance industry.

We help in designing new product and refining the existing policy documents. Our services include (but not limited to):

De-risking ideas/ concepts before one invests time and money into their development.
Convert assumptions into knowledge of riders.
Help refine existing products w.r.t. client pain points.
Help in formulating policy terms, pre-issuance medicals and UW matrix and claim guidelines. We also refine the same, if client has already invested in creating the same.
This solution is assisted with many other services provided by INCHES Healthcare Pvt. Ltd:

Claims support.
Legal support.
Medical Audit.
Field Investigations.
Training.
With a one stop solution and providing quality opinions, INCHES Healthcare Pvt. Ltd strives to eliminate all pain points of the Insurance companies.

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