New Insurance Offers Unlimited Access To Healthcare Facilities

Jayata Sharma

Deepak Mendiratta, MD, HII

The New Delhi-based Health & Insurance Integrated (HII) has crafted a unique health insurance plan for Privat Healthcare Group of New Delhi called — Privat Health Plans (PHP), which was launched recently at the capital. Through PHP, the consumer is benefited by lowering the barrier to usage of medical facilities due to the availability of unlimited access to a doctor, diagnostics, pharmacy and a regular health check-up. The cost of the scheme is designed to suit all sections of people. The price range for outpatients ranges from Rs 1,050 for an individual per year to Rs 9,000 per annum for a family package.

When asked why have a new health insurance plan, Deepak Mendiratta, MD, HII, replied, "I had a long-standing dream to design a product that will truly be an end-to-end cover for the customer with the promise of low cost coverage. Why provide treatment to people only when they are sick? Why not promise them a healthy life instead?" He further added, "PHP took me almost one and a half years to bring it up in its current state and I made sure it provides advantage to every stake holder," says Mendiratta. Privat Healthcare is a part of Asia Medical Assistance, a company having offices in India and Thailand and representative offices in Middle East and Japan. The marketing, advertising and promotion of PHP is entirely handled by HII.

Through this scheme, hospitals get a constant flow of patients due to increased customer usage and the insurance company gets to reduce its claim ratios by having increased percentage of its insured healthy and keeping them away from falling sick. "The most attractive feature of this plan is the unlimited access to a doctor as well as unlimited pharmacy usage, if recommended by the patient’s GP," informs Mendiratta. However, variations of this plan provide limited access to a specialist. This cover also has the option for taking an evacuation membership in case the patient is travelling outside his/her home city. In this case, the benefits will ensure that, if required, the insured will be evacuated through road or air to the nearest place of medical excellence in a matter of hours. "This feature is extremely useful in medical emergencies, which are currently lacking in India," adds Mendiratta.

The introduction of any product or scheme involves a lot of research work and market feasibility studies. And PHP is no different. Before designing the product, HII did a comprehensive study of international health benefits and the various models that are used in health insurance markets worldwide. In India, they conducted a study of the consumers' perception of such a product and their expectations, the barriers to adoption and HII's options in distribution. "We then came up with critical factors that will ensure the success of this scheme," states Mendiratta.

According to him, the insurance market is excited about this product since it gets to use the capitation model to transfer the risk on the outpatient benefit. This is important as insurance companies do not have much data or capability for effectively controlling claim costs. "They appreciate that this is the next wave of health insurance benefits and by promoting PHP they will be better able to manage their claim ratios on the inpatient claims," says Mendiratta. In addition, the availability of comprehensive outpatient benefits will substantially reduce the morbidity leading to hospitalisation.