Indian health insurance sector is in the throes of a massive transformation. Companies are actively innovating products to meet the cashless outpatient requirements, said Prashant Jhaveri, chief business officer, Medi Assist.

Even as the outpatient policy benefits kick in, it is in the interest of every insurance provider to ensure access to quality healthcare through the ‘illness-to-wellness’ continuum at affordable prices. This is the next evolution of medical insurance players in India, Jhaveri told Pharmabiz in a telecon.

A visible trend on the medical insurance landscape is the demand for least-priced and comprehensive products in the OPD space to curtail the huge out-of-pocket expenses. On an average the medical spend for OPD is Rs.30,000 annually. Therefore a ‘right value and all-inclusive’ offering will significantly see an uptake in this health insurance space, he added.

The big challenge for medical insurance providers is to sieve the chaff from the wheat. It is an ordeal to identify the trusted choice of providers to come under the ambit of medical insurance. “India has around 50,000 healthcare providers. Medi Assist Group has empanelled only 5,000 healthcare providers for in-patient care and has consciously stayed away from the rest,” he said.

Medi Assist has already been saving 20 million corporate lives including their families. Out of these, 6 million are primary beneficiaries. Now MediBuddy Infiniti, the country’s first outpatient enabling cashless platform will widen the scope of healthcare access has empanelled 10,000 hospitals, diagnostics centres, medical clinics and authorized pharmacy partners into its network. “Our strategy is to largely reimburse the expenses online. In this regard, we are creating a massive awareness to ensure meaningful access to accredited care,” said Jhaveri.

In India, health insurance was introduced in 1986 with Mediclaim being among the first policies issued by the General Insurance Company (GIC). In 2000, the Union government liberalised the sector permitting entry of private players. This brought in offerings like family floater plans, critical illness plans, hospital cash and top-up policies. In 2002, Insurance Regulatory Development Authority (IRDA) notified the concept of Third Party Administrators (TPAs). In 2014, medical inflation in the country touched 12-15 per cent as against a global average of 6-7 per cent. Around 4 per cent of Indians were covered under group medication and 2 per cent subscribed to retail health insurance policies. In 2015, the healthcare providers moved on to online platform of cashless claims management.

As per the IRDA report 2014-15, the market size of the health insurance sector is around Rs.20,000 crore in premium. The growth rate is 14 per cent CAGR from 2013 to 2015. There are currently 27 licensed TPAs in the industry today listed with the IRDA.