Top 5 companies in claim settlement 764 Star Health & Allied 759 TATA AIG 748 Reliance Gen Insurance 745 ICICI Lombard 735 National Insurance Top 5 companies in customer service 758 758 752 750 748 Star Health & Allied TATA AIG Reliance Gen Insurance ICICI Lombard National Insurance Arnab Mitra ■ [email protected]NEW DELHI: Blame it on advertisements. Every medical insurer claims it is the best. And the truth is that almost every insurer does offer something that oth- ers do not. So, how do you decide which is the best for you? To help you make the choice, we bring you the most definitive answer — the Hindustan Times-MaRS Survey of India’s Best Medical Insurers — which rated 15 top insurers on customer sat- isfaction on settlement and satisfaction on customer servicing. The first which included six param- eters like claim settlement, TPA respon- siveness, speed of service, delivery of promised services, etc., while the sec- ond included parameters like ease of product enquiry, levels of transparen- cy, quality and spread of hospital net- work, attitude of company agents, clar- ity of diseases covered and excluded, etc. A word of caution will be neces- sary here. The final results were very close — meaning there isn’t a lot sep- arating the best from the rest. Our survey shows that Tata AIG and ICICI Lombard are the (joint) highest ranked medical insurers on customer service, while Star Health & Allied Insurance Co. comes out on top in claim settlements. But the leaders don’t lead by a lot — a few points more on one or two param- eters and less on a few others could have altered the results quite dramat- ically. Another caveat — overall, satis- faction levels aren’t very high, imply- ing that all companies need to focus more on serving the customer. Says Raghu Roy, managing director of MaRS, HT’s knowledge partner for this survey: “An industry average of 740 (out of a maximum possible score of 1,000) on claim settlement satisfaction is definitely not a great score. And that the highest score by any company is 765, only a few points above the indus- try average, also suggests that the claim settlement process may never make the customer fully satisfied. This is, per- haps, to be expected.” This scenario is repeated in satis- faction with customer servicing. “Customers are not happy — the indus- try average is 746 (out of a maximum possible score of 1,000). One fact stands out: that companies do not exhibit high differentials from each other on this measure.” An interesting finding is that the industry as a whole seems to be serv- icing customers better in Bangalore, Lucknow, Kolkata and Mumbai. Respondents in these cities gave the industry scores that are higher than the all-India average, both on customer satisfaction as well as satisfaction with claim settlements. Bangalore is the only city to give scores of more than 800 on both these parameters (respondents gave scores of 811 on customer service and 810 on claim settlement). Obviously, companies aren’t being able to replicate the Bangalore model elsewhere. This is most obvious in Chennai, Hyderabad, Delhi and Ahmedabad, which gave the industry scores less than the national average. One fact that stands out is that pri- vate insurers have stolen a clear march over their public sector counterparts. Except for Delhi, which ranked United India Insurance Co. first, none of the cities ranked any public sec- tor insurer on top. Clearly, every single com- pany has a long way to go. HT Correspondent ■ [email protected]NEW DELHI: In the HT-MaRS survey, cus- tomer satisfaction on customer serv- icing and interaction was measured using six parameters — product enquiry stage, purchase transaction, policy issuance, hospital network, renewal, and transparency. And the public sector National Insurance Company (NIC) ranked third, coming after private sector Tata AIG and ICICI Lombard. There was also that little matter about it being the only state-owned company to feature at all among the top five in terms of customer satisfac- tion. The survey was carried out among 2074 medical insurance policy holders in eight major cities of India — Delhi, Lucknow, Kolkata, Mumbai, Ahmedabad, Chennai, Bangalore and Hyderabad. While industry analysts said that the insurer had resorted to reasonable pric- ing, which went in its favour, insurance sector experts pointed out that claims settlement takes longer in NIC com- pared to its competitors, which might explain the third position. “It takes about one to one-and-a-half months for settlement of claims in NIC,” said a leading third party administra- tor (TPA), on conditions of anonymity. So what can public sector insurers do to get better in the area of customer satisfaction? The four PSU insurers — National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance — which togeth- er manage about R6,000 crore of health insurance business, complain about being saddled with a commercially unvi- able claims settlement ratio of 115%. They have to say that the way TPAs function also has a major bearing on customer satisfaction, and forming a common TPA is one way of cutting down on costs. “The four state-owned general insur- ance companies are looking to engage a third party administrator to ensure that customers are not put through any major trouble especially when we have no health regulator, the process is on track and we hope to have one soon,” said NIC chairman and managing direc- tor NSR Chandra Prasad. TPAs are intermediaries between patients and insurance firms. Typically stationed at hospitals, TPAs take care of the administrative process of mediclaim policies. “This arrangement will provide economies of scale to the four insurers,” said Prasad. NIC has set a claim settlement target for 2010-11 at 90%. And as Prasad lets in, “We are focused on customer service more than profits and business models.” As Amit Mitra, secretary general of industry body Federation of Indian Chambers of Commerce and Industry puts it, “The emphasis has to be on con- sumer awareness and satisfaction, pro- vision of quality health care, improved insurance services and greater collab- oration and trust between insurers and healthcare providers.” INDIA’S BEST MEDICAL INSURERS user’schoice THE INDUSTRY AS A WHOLE SEEMS TO BE SERVICING CUSTOMERS BETTER IN BANGALORE, LUCKNOW, KOLKATA AND MUMBAI. RESPONDENTS HERE GAVE THE INDUSTRY SCORES HIGHER THAN THE ALL-INDIA AVERAGE. Still room for improvement SPECTRE OF UNCERTAINTY The Hindustan Times-MaRS Survey of India’s Best Medical Insurers reveals that overall, customer satisfaction levels aren’t very high, implying that all companies need to focus more on serving the customer What makes National Insurance third best ■ Doctors looks on as Dr Ross Crawford (not in picture) operates on a cadaver during a two-day specialised course on Cadaver Hip Arthoplasty at AIIMS in New Delhi. The photograph has been used here for repre- sentational purposes, gesturing at the need for insurance players to take a lesson or two in taking caring of their customers. ARIJIT SEN / HT PHOTO ■ A World Bank study claims that 99% of Indians will face financial crunch in case of any critical illness, underlining the need for health insurance. THINKSTOCK CUSTOMERS’ VERDICT: THE BEST COMPANIES ( ) The four state-owned general insurance companies are looking to engage a third party administrator to ensure that customers are not put through any major trouble NSR CHANDRA PRASAD Emphasis has to be on consumer awareness and satisfaction, provision of quality health care, improved insurance services and greater collaboration between insurers and healthcare providers AMIT MITRA TIME LAG Experts say that claims settlement takes longer in NIC compared to its competitors SAMPLE SIZE: A TOTAL OF 2074 MEDICAL INSURANCE HOLDERS FROM 8 CITIES SATISFACTION WITH CUSTOMER SERVICING WAS MEASURED USING 6 DIMENSIONS GRAPHICS: PRASHANT CHAUDHARY Higher figure indicates greater satisfaction level 14 | business | HINDUSTAN TIMES, MUMBAI MONDAY, MARCH 28, 2011
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NEWDELHI:Blame it on advertisements.Every medical insurer claims it is thebest.And the truth is that almost everyinsurer does offer something that oth-ers donot. So, howdoyoudecidewhichis the best for you?Tohelpyoumake thechoice,webring
you the most definitive answer — theHindustan Times-MaRS Survey ofIndia’s BestMedical Insurers—whichrated 15 top insurers on customer sat-isfaction on settlement and satisfactionon customer servicing.The first which included six param-
eters like claimsettlement,TPArespon-siveness, speed of service, delivery ofpromised services, etc., while the sec-ond included parameters like ease ofproduct enquiry, levels of transparen-cy, quality and spread of hospital net-work, attitude of company agents, clar-ity of diseases covered and excluded,etc. A word of caution will be neces-sary here. The final results were veryclose — meaning there isn’t a lot sep-arating the best from the rest.Our survey shows thatTataAIGand
ICICI Lombard are the (joint) highestranked medical insurers on customerservice, while Star Health & AlliedInsuranceCo. comesout on top in claimsettlements.But the leaders don’t lead by a lot—
a fewpointsmoreononeor twoparam-eters and less on a few others couldhave altered the results quite dramat-ically. Another caveat— overall, satis-faction levels aren’t very high, imply-ing that all companies need to focusmore on serving the customer.Says Raghu Roy, managing director
of MaRS, HT’s knowledge partner forthis survey: “An industry averageof 740(out of a maximum possible score of1,000) on claim settlement satisfactionis definitely not a great score. And thatthe highest score by any company is765, only a few points above the indus-try average, also suggests that the claimsettlement process may never makethe customer fully satisfied.This is, per-haps, to be expected.”This scenario is repeated in satis-
faction with customer servicing.“Customers arenot happy—the indus-try average is 746 (out of a maximumpossible score of 1,000).One fact standsout: that companies donot exhibit highdifferentials from each other on thismeasure.”An interesting finding is that the
industry as a whole seems to be serv-icing customers better in Bangalore,Lucknow, Kolkata and Mumbai.Respondents in these cities gave theindustry scores that are higher thanthe all-India average, both on customersatisfaction aswell as satisfactionwithclaim settlements.Bangalore is the only city to give
scores ofmore than 800 on both theseparameters (respondents gave scores
of 811 on customer service and 810 onclaim settlement).Obviously, companies aren’t being
able to replicate the Bangalore modelelsewhere. This is most obvious inChennai, Hyderabad, Delhi andAhmedabad, which gave the industryscores less than the national average.One fact that stands out is that pri-
vate insurers have stolen a clearmarchover their public sector counterparts.Except forDelhi,which rankedUnitedIndia Insurance Co. first, none ofthe cities ranked any public sec-tor insurer on top.Clearly, every single com-
NEWDELHI: In theHT-MaRSsurvey, cus-tomer satisfaction on customer serv-icing and interaction was measuredusingsixparameters—productenquirystage, purchase transaction, policyissuance, hospital network, renewal,and transparency.And the public sector National
InsuranceCompany (NIC) ranked third,coming after private sector Tata AIGand ICICI Lombard.There was also that little matter
about it being the only state-ownedcompany to feature at all among thetop five in terms of customer satisfac-tion.The surveywas carriedout among2074medical insurance policy holdersin eight major cities of India — Delhi,Lucknow, Kolkata, Mumbai,Ahmedabad, Chennai, Bangalore andHyderabad.While industry analysts said that the
insurerhadresorted to reasonablepric-
ing,whichwent in its favour, insurancesector experts pointed out that claimssettlement takes longer in NIC com-pared to its competitors, which mightexplain the third position.“It takes about one to one-and-a-half
months for settlementof claims inNIC,”said a leading third party administra-tor (TPA), on conditions of anonymity.So what can public sector insurers
do to get better in the area of customersatisfaction?The four PSU insurers — National
Insurance Company, New India
Assurance, Oriental Insurance andUnited India Insurance—which togeth-ermanage about R6,000 crore of healthinsurance business, complain aboutbeing saddledwithacommerciallyunvi-able claims settlement ratio of 115%.They have to say that the way TPAsfunction also has a major bearing oncustomer satisfaction, and forming acommon TPA is one way of cuttingdown on costs.“The four state-ownedgeneral insur-
ance companies are looking to engagea third party administrator to ensure
that customers arenot put throughanymajor trouble especiallywhenwehaveno health regulator, the process is ontrack and we hope to have one soon,”saidNICchairmanandmanagingdirec-tor NSR Chandra Prasad.TPAs are intermediaries between
patients and insurance firms.Typicallystationed at hospitals, TPAs take careof the administrative process ofmediclaimpolicies. “This arrangementwill provide economies of scale to thefour insurers,” saidPrasad.NIChas seta claim settlement target for 2010-11 at90%. And as Prasad lets in, “We arefocusedoncustomer servicemore thanprofits and business models.”As Amit Mitra, secretary general of
industry body Federation of IndianChambers of Commerce and Industryputs it, “The emphasis has to be oncon-sumer awareness and satisfaction, pro-vision of quality health care, improvedinsurance services and greater collab-oration and trust between insurers andhealthcare providers.”
INDIA’SBESTMEDICALINSURERSuser’schoice
THE INDUSTRY AS A WHOLESEEMS TO BE SERVICINGCUSTOMERS BETTER INBANGALORE, LUCKNOW, KOLKATAAND MUMBAI. RESPONDENTSHERE GAVE THE INDUSTRYSCORES HIGHER THAN THEALL-INDIA AVERAGE.
Still room for improvementSPECTRE OF UNCERTAINTY The Hindustan Times-MaRS Survey of India’s Best Medical Insurers reveals that overall, customersatisfaction levels aren’t very high, implying that all companies need to focus more on serving the customer
Whatmakes National Insurance third best
■ Doctors looks on as Dr Ross Crawford (not in picture) operates on a cadaver during a two-day specialised course on Cadaver Hip Arthoplasty at AIIMS in New Delhi. The photograph has been used here for repre-sentational purposes, gesturing at the need for insurance players to take a lesson or two in taking caring of their customers. ARIJIT SEN / HT PHOTO
■ A World Bank study claims that 99% of Indians will face financial crunch in caseof any critical illness, underlining the need for health insurance. THINKSTOCK
CUSTOMERS’ VERDICT: THE BEST COMPANIES
( )The four state-owned
general insurance companiesare looking to engage a thirdparty administrator to ensure
that customers are not put throughany major trouble
NSR CHANDRA PRASAD
Emphasis has to be on consumerawareness and satisfaction,
provision of quality health care,improved insurance services andgreater collaboration between
insurers and healthcare providersAM I T M I T RA
TIME LAG Experts say that claims settlement takes longer in NIC compared to its competitors
SAMPLE SIZE: A TOTAL OF 2074 MEDICAL INSURANCE HOLDERS FROM 8 CITIES SATISFACTION WITH CUSTOMER SERVICING WAS MEASURED USING 6 DIMENSIONS
NEWDELHI:While the to-go-or-not-to-go-the-cashless-way debate continues torock the insuranceboat, choppywatersnotwithstanding, a few insurance firmshave managed to ensure steady claimprocessing for their clients.Tata AIG bagged second place in
claim settlement satisfaction, accord-ing to a Hindustan Times-MaRS sur-vey of health insurance firms.“We had not stopped accepting
claims evenwhen the controversy overcashless hospitalisation was on lastyear,” explained Gaurav Garg, manag-ing director, Tata AIG.The impasse over cashless hospital-
isation began in July last year whenalleging over-billing byhospitals, state-owned general insurance companieswithdrew the facility of cashless treat-ment.Now, this step would have made lit-
tle difference even in 2006, when theinsured revenue was less than 10% ofhospital billing.But since then thehealthinsurance market has consistentlygrownat a 40%CAGR, as stated by theConfederationof Indian Industry report,andnaturally the implications arehuge.According to the industry average,
settlement ratio of the industry is about65-75% for individual policies and 100%for group insurance policies.Many companies offer group health
insurance policies to their employees.Group insurance premium comes at afractionof individual policies, anddress-
es up the package nicely while beingeasy on the employer’s pocket.While an individual policy of a cover
of R2 lakhcould cost about R3,000annu-ally for a 30-year old person, a groupinsurance cover for the same personwould barely cost his employer a fewhundred rupees.Lately, insurance companies have
quietly raised premium rates allegingthat hospitals have been inflating billshurting their bottomlines.Non-life insurance companies have
also started charginghigher premiumsfromcorporationsofferinggrouphealthinsurance to their employees. In thelast fewmonths, group insurance pre-miums have gone up by about 25%.To keep costs under control some
companieshavealreadystartedrestruc-turing health insurance benefits, suchas curtailing benefits for dependants,offered to employees.“To keep costs in control from this
year onwards any cover for additionalbenefits to dependent parentswill haveto be borne by the employee,” saidthe human resources director of oneof India’s largest information technol-ogy companies, who did not wish tobe identified. In fact, not being presentin group insurance may have helpedTata AIG.AlthoughGarg says, “Thoughweare
not present in group insurance at themoment,wemay consider entering thesegment inwakeof the free pricingpol-icy.” But for all the insurance playersout there, the expert advice seems tobe: ironout outstanding issuesbetweenhospitals and insurance firmsandworkonbetter servicedeliveryandcustomersatisfaction.Gopal Verma, director, e-Meditek, a
third party administrator, says, “Insu-rance firmsmustwork towards havinga framework to settle claims within aweek to ensure that customers do nothave to go through uncertainty.”Like they say, healthy, wealthy and
NEW DELHI: As public sector insurerspow-wowedwith hospitals, private sec-torplayersmadehay.Most of themcon-tinuedwith cashless claims andgainedsteadily, at least in terms of customerperception.ICICI Lombard was rated the best
in the area of customer satisfaction bythe HT-Mars survey. “We did not dis-continue with cashless hospitalisationat any point,” said Sanjay Datta, head,customer service, ICICI Lombard.The company’s premium fromhealth
insurance in 2010-11 was R1,000 crore,an increase of about 20% over the pre-vious fiscal.According to a report by the
Comptroller and Auditor General ofIndia, the private sector general insur-ance players are estimated to garner
health insurance premium of R30,000crorewithin 2015, almost thrice the cur-rent premium.The same report also suggested that
though the health portfolio was grow-ing at a phenomenal rate, PSU insur-ers were losing their market share toprivate sector companies.Despite growth in the volumeof busi-
ness PSUs continued to incur losses.And the losses incurred had much todowith the lack ofmonitoring in groupmediclaim policies.What especially seems tohave tipped
the scales in favour of ICICI Lombardis the speedof settlement—sevendaysin all.Says Datta, “We settle claims with-
in a defined period of time andbesides,we keep the customer informed aboutthe status of the claim settlementprocess and naturally our customerswant to stay with us.”
ICICI’s USP: Speedydisbursement of claims
Star shines brighestin claim settlementHT Correspondents■ [email protected]
NEWDELHI :When it comes to claim set-tlement, private insurance companiesare perceived to be better than theirpublic sector counterparts, reveals thefindings of theHindustanTimes-MaRSsurvey.Respondents to the survey ranked
India’s first stand-alone health insur-ance company, Star Health & AlliedInsurance Company, as the best interms of settlement of mediclaim poli-cies.Health insurance in India covers
around 11% of the population, accord-ing to the latest Comptroller andAuditor General (CAG) report.But low penetration notwithstand-
ing, health insurance is themost soughtafter portfolio next only to motor
insurance.And as Gopal Verma, director, e-
Meditek, a third-party administrator(TPA) points out; stand-alone healthinsurance companies will play a criti-cal role in the domestic market toincrease penetration.“Star Health & Allied Insurance
Company along with a few other com-panies have a singlewindow clearancemechanism which reduces the settle-ment to less than aweek,” said Verma.Industry experts said that once the
regulatory issues including the foreigndirect investment (FDI) norms areaddressed, several more standalonehealth insurance companies will forayinto India.
The Insurance Amendment Bill,that is pending in Rajya Sabha, seeksto enhance the cap on FDI in privateinsurers from the current 26% to 49%.
WHAT HAPPENED In July 2010, PSU insurers stoppedcashless treatment alleging over-billing by hospitals
Cashless offerhelpedTataAIG score
The study was carriedout in eight major citiesof India — Delhi,Lucknow, Kolkata,Mumbai, Ahmedabad,Chennai, Bangalore andHyderabad.The study team was ledby Vishal Ramchandani([email protected]).A total of 2074 medicalinsurance holdersconstituted the totalsample size across 8cities for 15 medicalinsurance companies.The sample spread bythe insurance compa-nies are given below.
CCuussttoommeerr ssaattiissffaaccttiioonn oonn ccllaaiimmsseettttlleemmeenntt was measured using sixattribute parameters — contactibility ofsurveyor/TPA, surveyor/TPA respon-siveness, surveyor claim processknowledge, procedure/paperwork forclaim settlement, speed of service/timetaken in claim settlement, and deliveryof promised services in the policy.
CCuussttoommeerr ssaattiissffaaccttiioonn oonn ccuussttoommeerrsseerrvviicciinngg aanndd iinntteerraaccttiioonn was carriedout using six dimensions — productenquiry stage, purchase transaction,policy issuance, hospital network,renewal, and transparency.Weights used for each of the sixdimensions to arrive at the aggregatescore on customer interaction was:Product enquiry stage 12%
Purchase transaction 15%Policy Issuance 16%Hospital Network 21%Renewal Process 12%Transparency 24%
Each customer interaction dimensionwas measured using a 2-6 attributeparameters, for a total of 27 attributeparameters, as given below.PRODUCT ENQUIRY — Five attributes:Detailed information provided, specifi-cation of documentation, process ofpurchasing explained, and speed ofservice.PURCHASE TRANSACTION — Sixattributes: Ease of purchasing thepolicy, detailed product information,transparency in transaction, courtesyand politeness, willingness of staff to
answer queries, Speed of service/transaction.POLICY ISSUANCE — Five attributes:Timely receipt of documents, intimationof policy status, speed of service, sim-plicity of procedure for issue of policy,and attitude of company’s agents.NETWORK — Two attributes: Hospitalnetwork - quality of hospitals,hospital network - number of tie-upsRENEWAL— Five attributes: Timely inti-mation of renewal, timely receipt ofrenewal notice, ease of renewing thepolicy, timely renewal, receipt of policydocuments, and speed of service.TRANSPARENCY— Four attributes:Clarity on diseases covered, clearlystated policy wordings, regular productupdates, transparent no claim bonuscredits.
METHODOLOGY
FOR ALL INSURANCE PLAYERSTHE EXPERT ADVICE IS: IRONOUT OUTSTANDING ISSUESBETWEEN HOSPITALS ANDINSURANCE FIRMS ANDWORKON BETTER SERVICE DELIVERY
Brand Sample sizeApollo Munich 106Bajaj Allianz 191Bharti AXA 112Cholamandalam MS 41HDFC Ergo 145ICICI Lombard 198Max Buppa 23National Insurance 206New India Assurance 181Oriental Insurance 168Reliance Gen Insurance 174Royal Sundaram 71Star Health & Allied 135TATA AIG 158United India 165
2074
KolkataDelhi Mumbai Chennai
760
762 756 756 754 751
760 760 758 754 752
756
754
752
750
Star Health& Allied
Star Health& Allied
TATAAIG
TATAAIG
TATAAIG
Reliance GenInsurance
Reliance GenInsurance
Reliance GenInsurance
ICICILombard
ICICILombard
ICICILombard
NationalInsurance
NationalInsurance
768
746
737
724
722
United India
United India
United India
United India
OrientalInsurance
OrientalInsurance
OrientalInsurance
TATA AIG
TATA AIG
TATA AIG
TATA AIG
TATA AIG Star Health
Star Health& Allied
HDFC Ergo
HDFC Ergo
ICICILombard
TATA AIG
BajajAlliance
BajajAlliance
BajajAlliance
BajajAlliance
HDFC Ergo
Reliance GenInsurance
Reliance GenInsurance
Reliance GenInsurance
Reliance GenInsurance
NationalInsurance
NationalInsurance
NationalInsurance
New IndiaInsurance
New IndiaInsurance
New IndiaAssurance
New IndiaAssurance
New IndiaAssurance
New IndiaAssurance
New IndiaAssurance
ICICILombard
ICICILombard
ICICILombard
BhartiAXA
820
783
782
779
757
822
784
784
778
759
723
717
698
694
687
842
835
831
828
819
Star Health& Allied
Star Health& Allied
Star Health& Allied
735
735
713
710
709
736
729
704
702
677
870
818
815
794
782
HyderabadBangalore Ahmedabad Lucknow
Star Health& Allied
TATA AIG
Reliance GenInsurance
ICICILombard
NationalInsurance
766
763
762
755
754
Star Health& Allied
TATA AIG TATA AIG
Reliance GenInsurance
ICICILombard
ICICILombard
NationalInsurance
NationalInsurance
756
751
748
741
737
755
757
750
746
744
CUSTOMERS’ VERDICT: THE DEFINITIVE GUIDE TO THE BEST SERVICE PROVIDERS ACROSS INDIA
Eight cities give their verdict on the best medical insurers
Customer satisfaction oninteraction at productenquiry level — Top5 companies
Customersatisfactionon interactionat purchasetransaction— Top 5companies