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How technological innovation is disrupting Group Medical Cover (GMC) for good

Team AckoJan 17, 2024

The combination of the internet, smartphones, and a tech-based infrastructure has led to the modern-day digital avatar of insurance. As Corporate Healthcare or Group Medical Cover (GMC) is a part of this rapidly changing landscape, it has also been significantly disrupted by technological innovation and advancements. It’s time to ride the wave of change or perish under it; and this article will highlight why.

The ensuing sections will highlight the following:

Challenges faced by traditional GMCs
How the tech-based GMCs overcome the challenges
Prominent ways in which tech is causing disruption in the industry

Contents

Part One: Challenges of traditional GMCs

Just as the mobile phone replaced the landline, group medical cover also needed an upgrade. Resorting to traditional non-tech GMCs in the current era may bring the following challenges to the forefront for organisations that are keen on providing the best health benefits to their employees.

Standard policy

Each person has a unique health profile. Therefore, their health challenges are also unique. As a result, covering a group of individuals under a standard health insurance policy is unlikely to prove productive.

Mostly, traditional GMCs do not allow employers and employees to customise the health cover.
This leads to inadequate coverage, which needs to be addressed by the employees by buying an individual health insurance cover.

Here’s an example. Suppose Mr. A is an employee serving an organisation that provides standard medical coverage as per a traditional GMC. Most probably, Mr. A won’t be able to get personalised coverage with respect to inclusions and the sum insured. This would force Mr. A to either get a separate policy suiting his needs or be under insured. In either case, the organisation’s purpose of providing optimum healthcare benefits to its employees is defeated.

Lack of services

Simply issuing a health insurance policy without offering timely and quality services is not rewarding. Traditional GMCs often fail to recognise this.

In 2021 and beyond, GMCs need to incorporate wellness.
The inclusion of various wellness measures like teleconsultation, fitness tracking etc., can do wonders for the overall health of employees and eventually boost bottom-line numbers for the organisations.

Continuing the above example, if Mr. A’s GMC offers services like fitness tracking and proper nutrition consultations to monitor calorie intake, then the chances of him being unwell and hospitalised due to lifestyle issues can reduce significantly.

Non-utilisation of policies

Often, the employees might not utilise the traditional GMC. This can happen because of:

a lack of awareness about the policy’s benefits
a lack of understanding of how to benefit from the policy

Traditional GMCs can find it difficult to spread awareness about the benefits and educate the employees about the GMC due to lack of tech support.

Difficulty in raising claims

Most of the traditional GMCs rely on manual claim management.

Physical documents need to be submitted to the insurer or the Third-party Administrator (TPA) for lodging and settlement of claims.
This is a tedious and time-consuming process which in turn delays the release of the claim amount.

Increase in admin costs

Employers with traditional GMCs have to assign dedicated staff to handle administration tasks related to managing the policy regularly. An employer’s hardships are increased as they have to manage:

recruiting new employees
handle overall paperwork

Part two: Overcoming the challenges with technology

The following approach of tech-based GMCs has alleviated the above-mentioned challenges posed by traditional GMCs.

Personalisation of the policies

Tech-based GMCs offer employers and employees to personalise the policies.

Organisations can provide the employees with a base policy covering the essentials with an option for the employees to add covers, riders, and top-ups specific to their needs and requirements.
It can include an option to cover family members of the employees as well.

Efficient services

In the Wharton University column, Sangita Reddy, Joint Managing Director of Apollo Hospitals, stated, “Care is shifting from the hospital to the clinic, from the clinic to the home and from the home to a 24/7, ubiquitous access to care, driven by the mobile phone.”

Employees are receiving improved and efficient services due to tech-based GMCs entering the space, shifting everything from physical to digital.

For example, here are some of the efficient services associated with the employee-centric ACKO Health cover.

Free online doctor consultations
Discounts on lab tests and medicine
Fitness tracking

Increased policy utilisation

With modern policies covering health check-ups and outpatient department expenses as well, there can be an increase in the utilisation of policy benefits without hospitalisation.

Organisations now can provide additional facilities in terms of full-body check-ups, preliminary health care, etc., within the ambit of the GMCs.
Also, a tech-based infrastructure helps in educating the policyholders about their policy’s benefits. Often, this is achieved via webinars, ebooks, newsletters, infographics, and blogs.

Ease of filing claims

Thanks to websites, apps, and supporting mechanisms, employees can file claims against the GMC in a hassle-free manner.

Employees can raise a claim by accessing the insurer’s app and uploading necessary documents such as hospital bills.
Within days, the claim amount is credited into the employee’s bank account (assuming the claim was accepted).

Reduction in admin costs

Tech-based GMCs can integrate with the organisation’s Human Resource Management Systems (HRMS) and relieve the employer of handling GMC-related menial tasks.

Whether an employee enters or leaves the organisation, insurance-related details can be easily managed.
This type of tech-based solution can lead to a considerable reduction in the organisation’s admin costs.

Part three: How technology is disrupting GMC

Here are the tech-based solutions that ensure GMCs by digital-first insurers score over their traditional counterparts.

Telemedicine

As telemedicine has eliminated the geographical boundaries, consultation, diagnosis, and treatment from some of the best doctors can be accessed from remote places.

Some of the major advantages of telemedicine via GMC are as follows.

Timely medical intervention
Free consultations
Access to best doctors without geographical restrictions

Chatbot query resolution

Tech-based GMCs often have a chatbot feature for quick query resolution. Major benefits of this AI-based solution include the following.

Query resolution without any manual intervention
Guidance with the procedural aspects of various issues
24x7 assistance

Digital processes

One of the primary benefits of tech-based policies is the paperless and contactless processes. Due to digitalisation, it has become easier for:

employers to buy the GMC online
employees to lodge and settle the claim directly through the insurer’s website or mobile applications
employees to avail various services offered by the GMC

PAN India network

Tech-based GMCs have the capability to operate on a PAN-India basis. A large network benefits the organisations in terms of the following.

To receive GMC services for multiple office locations through a single insurer
Especially beneficial in the cases of employee transfers from one location to the other
Avail of cashless claims at network hospitals

Order medicines online

Ordering medicines online at any time and getting them delivered at home without a surcharge is a boon. And this is one of the key advantages of a tech-based GMC. Its benefits include the following.

Relief from the effort required to visit pharmacies in search of the required medicines
Receive authentic medicine
Exclusive discounts can be availed on prescribed medicines

Discounts on lab tests

Insurers that offer a tech-based GMC often have tie-ups with top pathological laboratories across the country. These tie-ups result in certain benefits to the organisations and their employees in terms of:

discounts on preventive health check-ups
wide range of tests at affordable prices
the facility of booking diagnostic lab tests online from home itself

Fitness tracking for preventive care

Preventive healthcare can lead to a paradigm shift from a cure-based approach to a wellness-based approach. Nowadays, fitness tracking for preventive care is easier than ever with the availability of various gadgets and applications. With a tech-based GMC, employees can benefit from the following.

They can track their fitness activities (for example, distance walked) via a mobile application and get rewarded for achieving fitness goals.
They can monitor their real-time health status and plan the workout accordingly.

Employees = Assets

As Richard Branson tweeted, “Take care of your employees, and they will take care of your business. It’s as simple as that”.

And tech-based GMCs are the right tool for people-centric organisations to ensure their most important assets stay insured, avail of the policy’s services and benefits, and receive hassle-free claim settlement.

All this without escalating admin costs and with receiving value for every penny spent.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.