What steps would you suggest for minimization of losses in Health Sector?

CS Professional · Insurance - Law & Practice · PYQS · June 2023
What steps would you suggest for minimization of losses in Health Sector?

Answer & Explanation:

There is robust growth of business in "Health Sector" and this trend is expected to continue in future also. Unfortunately, Ratio of Loss in this sector has increased with the business growth. Hence, there exists urgency of minimizing losses. Aggressive Marketing of Health Policies to the people of Younger Age by introducing new products, training to the Agents and Greater incentives for procuring this Business. Loading of Premium on Group Policies based on their Past Claim Experiences. Careful Selection of Third Party Administrators (TPA) having Professionals and favorable past records. Monitoring the working of TPAs on regular basis as the loss ratio in the Health Sector increases considerable after the introduction of TPA. The benefits under various heads like Room Rent, Doctors fees and Diagnostic materials etc. should have individual limits instead of overall Sum Insured without any Sub Limits. Maximum Limits of compensation may be fixed for treatment of common diseases like Cataract, Kidney Stone, and Heart Ailments etc. While empaneling Hospitals for cashless service, insurance companies may negotiate for discounts. Prompt investigation of doubtful cases to detect fraud. Blacklisting of hospitals and third party administrators found resorting to fraudulent means.

Topics: Health Insurance

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