Segar Sampathkumar, director, Health Insurance, GI Council

Such a system, which currently serves 52 per cent of health policies, will create a seamless technological mechanism for all the insurers to settle policy holders’ claims cashless without any manual interventions, has been one of the main agenda of Debasish Panda, chairman, IRDAI, to increase insurance penetration in the country

Mumbai:

The general insurance council, the office representative body of the domestic general insurers, have roped in Segar Sampathkumar as director of health insurance for three years,  to plan and implement the comprehensive changes paving the way for a 100 per cent cashless payment in the segment.

Such a system, which currently serves 52 per cent of the industry’s health policies, will create a seamless technological mechanism for all the insurers to settle policy holders’ claims cashless without any manual interventions, has been one of the main agenda of Debasish Panda, chairman, IRDAI, to increase insurance penetration in the country.    

Kumar, 67, who was an Insurance Ombudsman, Chennai, for almost last two years, has quit his job to take up his new assignment from Oct 1 and will be based in Chennai.

Kumar was earlier also a general manager, handling health insurance portfolio at the country’s largest non-life general insurer New India Assurance.

The council, which is headed by a secretary general, has for the first time created such a senior level  post, by paying even a higher salary than the secretary general, to drive changes in the sector, which needs a robust technological  platform and a deeper coordination with all the stake holders of the nationwide healthcare sector involving hospitals, doctors and pharmacists.

The council has also formed another committee under, S Prakash, former MD, Star Health, along with other industry officials, to oversee the the implementation of the  project on cashless claims.

The new system of cashless payment, apart from needing a technological platform, also needs a lot of standardization of rates, services, and empanelment of more hospitals to cover every nook and corners of the country.

Panda, earlier had said in a bid to achieve full cashless payment in the health insurance sector, both General Insurance Councils and Life Insurance Councils are working with National Health Authority for on-boarding of insurers on National Health Claims Exchange (NHCX).They are playing a very prominent and active role for enabling common empanelment and interoperability with hospitals.

“This will make claim processing of health insurance seamless and frictionless for the policyholders.I am happy to inform that all general and health insurers and four TPAs have already on-boarded on NHCX sandbox and are in the process of full integration. it will be an important milestone in democratizing insurance access and ensuring sufficient coverage,” he had said.

The NHCX employs technology in uniting hospitals, insurers, service providers, and TPAs on one platform. This synergy expedites claims, reduces fraud, and standardizes processes, streamlining the entire healthcare system. It represents a transformative leap towards equitable, efficient, and digitized healthcare services for all, he had explained.

Post Covid-19, health Insurance has already become the largest portfolio of the general insurance industry and with a growth of  23 per cent, it has contributed Rs 90,600  crore of premium in FY2022-23.