Health insurance products in the country are expected to witness a revolutionary change in the near future as General Insurance Corporation (GIC) and its four subsidiaries are currently initiating steps to introduce a comprehensive `preventive, curative and follow-through' approach for the health insurance schemes, expected to hit the market shortly.

In a bid to take advantage of the huge healthcare potential in the country, the non-life insurance major is currently redefining its heathcare plans in the form of managed care packages.

Health Insurance in India is a growth sector with considerable future potential. Although the lower middle class 20% population with per capital real Gross Domestic Product (GDP) of $527 may not be able to afford much insurance coverage, the middle and upper middle class population (around 180 million) with per capita real GDP of $2641 gives an indication of the tremendous market potential for health insurance in the country.

Framing the managed care package on the basis of similar offerings prevalent in counties like the UK and US, the managed care products developed by GIC and its subsidiaries, will be operated through `third party administrators' (TPAs), who will be the mediating channel between the health care service providers and the insurers. The TPA networks will be established on a commission basis by the insurer.

Under the TPA system, policyholders will get enrolled with the TPA located at regional levels and they will sign a memorandum of understanding with the service providers. These providers will be directly paid by the TPAs on the basis of the policy amount.

The TPA will get reimbursed from the insurer. This will serve as a boon for the policyholders as they will be able to avail the insurance cover immediately .

At present, under the various indemnity and healthcare schemes, the policyholders undertake medical treatments at their expense and get the reimbursement to the maximum limit of the insured amount. Apart from the processing delays involved in compensation under such schemes, more often the policyholders are under or over treated.

Companies such as Paramount Healthcare and Sedjwick Parikh in Mumbai, and Medicare and Faith Healthcare of the Appllo group in Calcutta offer insurance cover to their patients. These managed care companies have shown keen interest in becoming certified TPAs. The companies are currently working on setting up countrywide TPA network.

According to industry sources, the managed care package will be a premium product and will be initially offered in metros. Establishing a full-fledged TPA network will involve accreditation of the administrators and benchmarking of the service providers. The TPA networks, if established will revolutionaries the concept of healthcare in India and make the sector more organised and efficient.

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