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 29.35% in FY 2020-21. The portfolio has registered a CAGR of 20% over the last decade. With the introduction of PMJAY, the Health Insurance segment is expected to grow at a higher rate in the future. The other factors which have fuelled the growth include pandemic, new medical procedures, entry of more standalone health insurers, product innovation , an increasing focus on OPD, 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 care 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

   Health Innovation in

   Framework of medical underwriting

   Effective Claims management

Contents

  Health Care Scenario in India

   Introduction to Health Insurance: Business and Trends

   Health Insurance Regulations

   Framework Medical Underwriting

   Health Insurance products

   OPD, Wellness

   Handling Corporate Health Accounts

   Ayushman Bharat: PMJAY and its management

   Provider Management

   Claims Management

   Fraud Management

   Management of TPAs

   Enhancement of Engagement with Health Insurance Customers

   Profitability in Health Insurance

 Participants Profile:  Officials handling Health Insurance Underwriting & Claims in Head Office, Regional Offices, Operational Offices, Officials of Product Department and Internal Audit Operating Offices of Indian and foreign public & private sector General Insurance Companies.   

Duration:      3 days

Dates:             12.09.2022-14.09.2022