“India is a ‘do-it-for-me’ market”

How does Beshak help customers who are looking to buy insurance?

There are two essential problems that customers have when they are buying a complicated product like health insurance. One is that they find it very difficult to find the right information, independent of vested interest or broker commissions. And the second is to be able to find the right kind of expert to guide policyholders at the time of claims.

Beshak is a 100 per cent independent research platform in India that is uninfluenced by insurer commissions. We do not have any distribution licence. We are purely focused on solving problems for customers.

The right content is provided by AI-enabled deep research that goes to the extent of actually buying policies, the process required for changing any information, the post-sales customer service and also policy cancellations.

India is also a ‘Do-it-for-me’ market, where customers need an expert to help them with solutions. They want someone to help them with the entire process. That’s where we have very senior insurance experts who not only know how to buy the right insurance, but also guide them at the time of claims — from end to end. Our advisors are people with minimum five years of experience and we also have a high rejection rate of advisors, close to 92 per cent of advisors are rejected from being onboarded into Beshak.

Do policyholders have to pay for the service?

This is a completely free service for customers. Our revenue model basically comes from being a marketplace for insurance advisors. So, insurance advisors who deal with us, pay us a platform fee, and there are around 250 advisors on the platform.

Also, the advisor job starts only after the products are recommended by the platform with its background research. This eliminates any bias the insurance advisor may have in recommending products as an incentive.

For instance, when one comes on the platform and chooses an advisor, the advisor cannot suggest products on their own. The advisor must use our research platform, generate a report on our platform which is completely tech-driven, and whatever is recommended in that report only can be suggested by that advisor to the customer.

In the health insurance marketplace, what are the primary areas of mis-selling?

The one thing that is very common is that customers are asked to not declare diseases on medical history so that a policy can be issued. This happens when you have advisors who are focused on sales and not claims as they do not have skin in the game.

The second is a very complicated one, but very important for people to know. It is the case of portability at the time of renewals, which sometimes leads to new policy issuance. As the database of customers is somehow available, customers get these weird calls from different insurance or their agents that their policy is up for renewal. Luring customers with lower prices or riders, policies are either ported or a new policy is issued. If instead of porting, a new policy is issued, all the benefits that have accrued to that point are lost by the customers. At the time of claims, policyholders will find out that the four-year waiting period has restarted with the new policy and the claim will be rejected. There’s a lot of people who come to us saying that this has happened with them.

Senior citizens are still left out of health insurance. Do you see any changes in that aspect?

Unfortunately, senior citizens are the ones who are at the receiving end today. They are paying very high premiums and the hike in premiums has happened significantly in this space. A visibility on the hikes can at least reassure them of the increase in the future. Then there is the question of claim servicing post issuance, which is decided on a case-by-case basis.

The safe way to deal with senior citizen insurance is to start early. By opting for a health insurance plan at least by late-30s, one can be certain of having health insurance in later age without worrying if the policy will be issued and about the waiting periods. The moratorium period should have smoothened the claims experience by then as well. Early insurance is also recommended, considering the early onset of diseases currently. Contrary to popular opinion, a patient with a chronic disease at 55 is likely to have a higher acceptance rate than a patient with the same condition but developed at the age of 35-40.

Claims getting rejected is another primary concern for policyholders. What are the two major reasons for rejection, and how does Beshak help overcome this?

Yes, policyholders’ concern is that after paying high premiums, they should not have any hassle at the time of claims, and claims should pass smoothly and without any uncertainty. Despite India being a price-conscious market, policyholders are willing to pay higher amounts if there is no volatility at the time of claims.

Claim rejection happens primarily because of two reasons. Customers are not aware of waiting periods, limits or other conditions. So they apply for a disease which has not completed its waiting period; let’s say slip disc will have a waiting for three years, or say piles which may have a waiting period of two years and the claim is rejected for this reason.

Second reason is not disclosing the medical history correctly. Information has to be exact and true for claims getting approved. Sometimes details of height and weight being entered incorrectly or left blank can also lead to rejection. Pin codes are also reason for rejection, though more applicable for term insurance than health insurance. When a customer pin code is not available in the drop-down list, policyholders choose the nearest pin code while filling a form and can be basis for claim rejection. Disease treated earlier, irrespective of relevance, have to be disclosed with the proper documentation.

Beshak can aid in claims process as well. Beshak advisors can interpret the terms and conditions of the policy and basically communicate what is payable with the insurer. For instance, there was a claim where the person was supposed to go through an angioplasty, but ran into complications which increased the bill. The insurer refused the claim as this was not protocol. The agent in this specific case coordinated between the insurance company, the customer and the doctor, got a letter issued by the doctor saying why this medical line of treatment is justified. Even at the Ombudsman level, the advisors have good experience, with each advisor handling 10-12 cases at any given point in time.

Despite claims being approved, customers end up paying 15-20 per cent of the bill from their pocket. What could be the reasons?

During Covid, the cost of consumables in the bill used to be around 15-20 per cent of the total bill. Now it has gone back to like being 3-4 per cent. The current reasons why claims deductions would happen are because there being limits in the policy like co-pay or there’s a room rent limit, or there is a financial limit on specific treatment.

When buying health insurance, what should policyholders look for?

The most important is to ensure that you buy the right and adequate cover. People don’t realise that when they are buying a cover at 30, they are not buying a cover for their 30s but for later ages when medical inflation will take its toll on expenses. People are not aware that a ₹5-10 lakh cover is going to be very small in 10 years. There is no cover that is going to be less in my view. Even buying a ₹2-crore cover is going to be good. It is very important to cover for tail events as well. Meaning very large hospitalisation claim, which could cost lakhs of rupees like a transplant or a cancer treatment. Especially since, the premiums delta is not high, let’s say ₹10 lakh costs ₹10,000, a ₹1-crore cover will cost ₹20,000 and not run into lakhs.

Second, free limits. A room rent limit is one thing which is very common and now many people understand, but co-pays and limits around modern surgeries should be checked. Also, an exhaustive list of day-care treatments should be covered since most treatments are now moving to day care because of technological advancements.

Third, ensuring that you’re buying from a health insurance company which has at least four-five years of track record. In health insurance, the real test of meeting claims being from the fourth year. Apart from claim ratios, measures such as claims paid in 30 days or amount of claim paid are also critical measures and these can be found on Beshak.