Upgrading technology, increasing the business from the four public sector general insurers, an d following the current market practices are some of the measures that are being thought of to strengthen the Health Insurance TPA of India Ltd (HITPA), said top industry officials.
The HITPA is promoted by five government-owned insurers – National Insurance Company Ltd, The New India Assurance Company Ltd, The Oriental Insurance Company Ltd, United India Insurance Company Ltd, and General Insurance Corporation of India (GIC) – to process health insurance claims.
“The central government wants HITPA to be strengthened. A committee to recommend measures for that has submitted its report,” Oriental Insurance’s Chairman-cum-Managing Director R.R.Singh told IANS.
Singh said HITPA has to upgrade its technology as it is not able to generate the required management information system (MIS) reports.
Already, the promoter companies have taken steps to make HITPA market-oriented by stopping deputation of their Deputy General Managers to the latter. And now, only the Managing Director of HITPA is selected from one of the promoter companies which in turn give the person the necessary experience for a larger role in his/her parent company.
It is learnt from sources, the draft report of the committee headed by Oriental’s former CMD Anjan Dey has recommended adopting current market practices like hiring from outside, revamping the IT systems, having fraud detection systems, and improving the service levels as some of the means to strengthen HITPA.
“The process to upgrade the IT systems has begun with the appointment of a consultant. The technology or the software is not a major one and there are some plug and play softwares available in the market,” a senior official of HITPA told IANS preferring anonymity.
The four government-owned general insurers should also increase the number of policies given to HITPA for claims handling. There needs to be some organisational changes in HITPA and more people from the market to be hired.
Though HITPA is co-promoted by the government-owned four primary insurers, not all the health insurance policies sold by them are handled by it. The company handles only a part of the retail policies sold by the insurers as the remaining goes to other private players.
In the case of major corporate group health insurance policies, the client chooses the claims processing agency called a third party administrator (TPA). As per the sectoral regulator’s stipulation, HITPA cannot handle the claims of private insurers, said the official.
“In the case of group health policies, the primary insurers have started insisting on having its own TPA to have a control on the claim cost. Last year, HITPA processed about 2.70 lakh health insurance claims out of the policies covering about 70 lakh lives and the claims settlement ratio was 96 per cent. During the first half of FY24, HITPA handled 2.21 lakh health insurance policies covering about 10 lakh lives and processed 88,000 claims.
“If the claim papers are in line, then the sanction for cashless takes a maximum of 20-30 minutes. In case where some queries are raised, then the time taken will be about two hours,” the company official said.
“The HITPA is now present in all the branch offices of the four primary insurers. Also the company is marketing its services with the insurance intermediaries,” the HITPA official added.
Queried about how HITPA is helping in reducing the claims outgo for the primary insurers, the official said: “The incurred claims ratio (ICR) on the policies on which health insurance claims are lodged is about 92 per cent, the best in the 18 member TPA industry. Last year the ICR was 94 per cent.”
According to the official, the company has a process to check for fraud claims lodged on health insurance policies bought online.
The HITPA is also in the process of hiring qualified doctors-allopathy and traditional healing systems like ayurveda, yoga, unani, siddha, and homoeopathy.
For HITPA, its revenue stream is only the handling fee from the primary insurers whereas the private TPAs get revenue from other services like medical examination and other non-insurance schemes.