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India InsurTech Thought Leadership

Thought Leadership – Exegesis Infotech

In most instances, an individual’s first encounter with Insurance is the insurance provided by the company they start their first job with, and most of us take this insurance for granted. As you read this statement, I’m sure you are trying to summarize the benefits offered by your employer & realize that you are probably not aware of the exact nature of benefits offered in your corporate insurance policy.

Planning Employee Benefits for a corporate of less than 50 employees (appx 200 lives including dependents) is not really a challenge. But when the size of the organization becomes large (1000+ lives) this is when challenges confront all the entities involved:

  1. Insurance companies

  2. Third Party Administrators

  3. Insurance Brokers

  4. Corporates

What are the challenges?

  1. Data integrity – The lives covered have to be in sync across all the above entities at any point in time. This is easier said than done for organizations where lives run into thousands, with constant addition & deletion throughout the one year span of the insurance policy (new joinees, resignations, mid term additions/ deletions of existing employees).

For data integrity to be maintained, not only is the timely smooth exchange of data necessary, but it must also be ensured that Underwriting guidelines are followed before enrolling employees & their dependents. This becomes more complicated when on an average 10 policies are administered by the corporate to meet the demands of its employees. These include the standard Group Mediclaim (GMC), Group Personal Accident (GPA) & Group Term Life (GTL). In addition, there are mandatory / non mandatory Addons to each policy, Top-Ups & various forms of Voluntary policies.

  1. Premium calculation – in addition to so many policies offered for enrollment, multiple modes of premium payment adds to the complication.

  2. Fully sponsored – the corporate will bear the premium cost

  3. Partly sponsored – some percentage will be borne by the corporate, rest will be deducted from employee payroll

  4. Paid by employee – these are voluntary policies where employee pays the entire premium to the insurance company

Accurate calculation of premium to enable corporates to pay a single consolidated premium to the insurance company becomes key – as based on this, endorsements are done by insurance companies to confirm lives covered, and the commissions of Insurance Brokers & TPA’s are also based on these calculations. As mentioned earlier, constant joining & resignations of employees from the organization also has an impact on monthly payroll & Full/Final settlements.

  1. Data Exchange – All this data need to flow in a particular sequence to respective stakeholders for smooth functioning of the program. Once successfully enrolled & insurance company endorsement are done, Ecards (cashless cards) have to be issued to all members who have enrolled in the above policies. Along with this, the list of cashless Network hospitals needs to be provided by the Insurer/ TPA as applicable.

  2. Secure web services with Insurers / TPA’s allow this data to be exchanged

  3. Single Sign-on integrations with Insurers / TPA’s is another option

  4. In case of reimbursement claims, tracking of claim status would also be available through the above options.

  1. Data Security – with data flowing through so many entities & since this data holds Personal Identifiable Information (PII) like name, email, mobile number etc, it’s critical that data should be exchanged securely at all touch points.

  2. From corporates to intermediaries or Insurers

  3. SFTP

  4. Secure integration with Payroll / HR systems

  5. Password protected excel sheets

  6. From intermediaries to Insurers / TPA’s

  7. Secure web services using encryption

  8. Single Sign-On wherever possible

Access to data at all touch points should be restricted by access control policies. It would be an added advantage if the entities involved have stringent information security policies or are certified (e.g. ISO 27001 ISMS). These certifications will ensure proper user access control & device control to prevent data leakage.

  1. Grievance resolution – with such huge volumes of data flowing across multiple entities there are bound to be grievances at multiple levels. Use of standard communication tools like bulk Email, bulk SMS, Whatsapp along with a ticketing system will help employees of the corporate to raise grievance & the intermediatory / insurer to resolve them in a time bound manner. Enabling Employee benefits on mobile apps (in addition to web portal) would also be a good addition to above mentioned options.

  1. Looking forward – up until now the HR / Employee Benefits team at the corporate has been designing the Employee benefits program based on employee’s benefit category i.e. Grade of the employee, geo location, number of years in the organization etc. However, as people get accustomed to personalization across other aspects, we expect Personalization of Employee Benefits (wallets, flex insurance & non-insurance components) is the way ahead as well. This will entail HR topping up individual wallets of the employees & the employee being able to choose benefits from available options.

Additionally, the employee can also have option to add points (leave encashment, other benefits) to the already topped up wallet by HR. This will enable the employee to pick and choose insurance & non insurance (health checkup, Gym / Yoga memberships, Wellness programs) components, thus personalizing Employee Benefits based on individual needs.

In conclusion, the important question is – Is this enough in today’s dynamic environment? Not really. With uncertain work environments, it is important that yourself & your near / dear ones are always covered. Hence always make sure that in addition to the insurance benefits offered by your employer, you also have personal health & life insurance covers which will help you navigate emergencies in between jobs.

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