P625 - PROFITABLE MANAGEMENT OF HEALTH PORTFOLIO (NON-LIFE)

Background

The share of health insurance in the total general insurance business has increased from 24.11% in FY 2014-15 to 26.76% in FY 2018-19 growing at a CAGR of 16.47%.  With the introduction of PMJAY the segment is expected to grow at an even higher rate in the future. The other factors which have fuelled the growth in the segment includes entry of more standalone health insurers, innovation in products with an increasing focus on wellness, introduction of new distribution channels and increasing role of technology in customer service.

 

Though the health insurance business is a large portfolio it is also one of the largest contributor to underwriting losses.  The issues and challenges that the Health Insurance is facing must be holistically addressed to make it a sustainable portfolio.  Handling of the subject requires knowledge and skills in various fields including developments in the health industry, market dynamics, products, Government schemes, innovation, distribution, regulations, medical underwriting, TPA management, PPN management, claims management

 

Objectives 

This programme aims to equip participants with knowledge and understanding of 

   Portfolio trends and its implication

   Regulations and its implications

   Understanding challenges in health insurance

   Innovation in health

   Framework of medical underwriting

   Effective Claims management

 Contents

   Introduction to Health Insurance: History, Business and Trends

   Health Insurance Regulations

   Innovations in Health Insurance products

   Mass Health Insurance Scheme and its Management

   PMJAY (Ayushman Bharat) and its management

   Framework for Medical Underwriting of Retail health insurance

   Travel Insurance

   Personal Accident Insurance

   Managed Health Care & Provider Management

   Retail & Group Health insurance Claims Management

   Fraud Management in Health Insurance

   TPAs and Preferred Provider Network Management

Participants Profile:  Officials handling Health Insurance underwriting & claims in Head Office, Regional Offices, Operating Offices of Indian and foreign public & private sector General Insurance Companies.   

Duration:       3 days (Online)

Dates:             20.12.2021-22.12.2021