Health claim approvals should be instant like credit cards: Apollo Munich Health CEO

When asked about targets, most insurance CEOs talk about scale. Antony Jacob, 52, CEO of Apollo Munich Health — a joint venture between Apollo Hospitals and Munich Re — has a different approach.

His dream is to have a system where it would be possible for a policyholder to swipe a health insurance card at a hospital and get instant online authorization for any medical procedure, specifying the extent of coverage. “Today, we have a turnaround time of 65 minutes for a cashless claim. I ask: Why should it be more than one minute? We have seen how credit cards have evolved and health insurance can also work the same way,” says Jacob. He feels the customer can live with exclusions in the policy but what is distressing is the uncertainty over whether his claim is covered or not.

It is with this kind of innovative thinking that Jacob seeks to differentiate his company from three other health insurers and close to 20 general insurers providing health cover.

The company is on the verge of a breakthrough in health insurance, having now designed the first ever health insurance for diabetics. This is a policy that will cover diabetics from day one and will charge a premium of 20-25% over standard products.

Despite India having the highest incidence of diabetes in the world, this is one cover that has eluded the market for the nearly three decades that health insurance has been in existence in the country. Apollo Munich has filed this product with the regulator and hopes to start selling it in FY14.

The other advantage Apollo Munich has over rivals is having a group that specializes in healthcare as a parent. It is feedback from its parent that has helped Apollo Munich to come out with its earlier product Optima Restore — a reinstatement policy that brings the sum insured to the original level even after a claim during the year.

When Antony Jacob quit his job as finance director of UK insurer Royal Sun Alliance for Middle East and Asia to join a start-up health insurance firm floated by Apollo and Germany’s Munich Re in 2009, his acquaintances in the industry were taken by surprise. Health was a business in which no insurer made money. Jacob himself had earlier headed Royal Sun Alliance, a general insurer that he had taken to the top five positions. Today, Apollo Munich is expected to generate around Rs 630 crore of premium for FY13 — up from Rs 475 crore last year.

Another differentiator for Apollo’s is its stringent underwriting standards. It also takes a long-term approach to costs by advising companies to promote wellness by encouraging clients to live a healthier life. Within his own company, Jacob practices what he preaches. A recent programme that rewarded employees who improved their health parameters saw one of the executives taking home an iPad for improving his body-mass index ratio.

The stringent underwriting standards leads to more drop-outs at the application stage, but leads to more efficient underwriting. The company has managed to turn profitable in the second quarter of FY13 and is likely to turn in a profit this year.

“Today, most corporates view group health insurance as a cost. What we try to do is to explain to them the cost of ill-health. How muchtually lose on absenteeism due to sickness and show them how health costs can be reduced through preventives such as home diagnostics,” said Jacob.

There is also a conscious effort to focus on strong underwriting so there is no distress at the claims stage. “To do proper underwriting, it is crucial that we get the right information in the proposal form. An individual may be extremely diligent in filling a US visa application, which is only one trip, but careless when it comes to filling a health insurance proposal that will be the basis of a contract for decades,” says Jacob. He points out that the more questions a prospect answers, his chances of getting a better deal improves.

Health insurance, which was non-existent 30 years ago, is today is a Rs 13,000-crore market — almost a fifth of the non-life industry. Increasing medical costs are expected to drive demand for health insurance, but given that only 5% of the population is covered, the industry has a long way to go and will need to look at innovation to bring health insurance within reach of most of the population.

Apollo is moving with caution on the mass segment, which is today served under the Rashtriya Swasthya Bima Yojana. According to Jacob, the biggest challenge is distribution as branches take very long to break even. “Bank branches are best placed to distribute, but they are still not available for us,” he says, adding that he still hopes for the best.

A chartered accountant by profession, Jacob has been in non-life insurance for most of his career. An alumnus of Loyola College, Chennai, he received the ‘Achiever’ award on the occasion of ‘World Loyola Alumni Congress 2010’. He is an avid golfer and tennis player and loves travelling to new destinations.