Anuj Gulati, Managing Director and CEO, Religare Health Insurance, on standardisation of health insurance norms -
Q. Now that there is standardisation, how do you think health insurance companies will make their products stand out?
A. The new standardisation norms in no way restricts insurers' potential for innovation. Insurance companies are free to define the coverage under products, waiting period for pre-existing conditions, sub-limits, co-pay, and even cover outpatient services and pharmacy purchases. They have ample scope to build unique propositions.
Moreover, this is a claim-intensive and, therefore, a service-intensive industry. So, while product design is an imperative for differentiation, we believe the quality of service will be a key determinant of success.
Q. The guidelines standardise clauses in the agreement between TPAs, hospitals and insurers. How will this affect the old practices?
A. With standardisation of agreements, the regulator has clearly defined the roles and responsibilities of each party. This will encourage transparency between stakeholders and place ownership of the transaction with the insurer. Moreover, it eliminates customer dissonance, when upon filing a claim he observes that the onus of his claim being serviced lies with a third party completely independent of the insurance transaction/contract. Standardisation of the agreement will ensure that major clauses are defined, while commercial aspects of the agreement remain at the discretion of both the organisations. The tripartite agreement makes the insurer the owner of the network and ensures standardisation of services levels.
Q. Will a standard agreement make life easier for all stakeholders?
A. Certainly, as it does away with variance and ambiguity in the role of each stakeholder, expressly defining the responsibility of each party to the contract, ensuring maximum value and convenience for the customer.