A glance at the annual data released by the Insurance Regulatory and Development Authority of India reveals that the health insurance business has consistently seen its Net Incurred Claims Ratio (Net ICR) jump over the past few years. Net ICR, which is the ratio of the net claims settled by an insurer to the net premiums that it collected in any given year, has spiked from 94 per cent in 2012-13 to 106 per cent in 2016-17.
Significantly, claims for workplace-related health issues are on the rise, be it for waterborne illnesses or lifestyle diseases. So, according to The Economic Times, insurance companies have started conducting audits of workplace cafeterias and are proposing changes to reduce claims related to gastroenteritis, colitis and heart-related ailments under the group mediclaim policies. Citing industry executives, the report added that these audits are being conducted as part of wellness programmes.
Consider ICICI Lombard General Insurance Company, for instance. The country's largest private sector general insurer had reportedly conducted a wellness audit at an iron and steel pipe products company recently after a worker suffered a heart attack on the premises. The check subsequently revealed low oxygen levels in the work area, the daily reported.
"We have carried out audits of workplaces and found that the particulate matter was high and oxygen levels poor, leading to higher instance of respiratory and heart-related ailments," said Amitabh Jain, head of motor and health - underwriting at ICICI Lombard General Insurance. "We propose certain changes in the office upkeep and ventilation in such instances."
Similar audits by other players in the business have thrown up a host of problems ranging from poor posture related ailments to hygiene issues. Sources told the daily that companies are focusing on cafeteria audits to help corporates evaluate issues like food safety and the nutritional value of the food served at the workplace.Apart from the sanitary conditions in cafeterias, during these audits insurers reportedly check whether they adhere to the guidelines of the Food Safety and Standards Authority of India (Fssai) on prevention of cross-contamination while preparing, cooking, storing and serving food. The sources added that insurers not only test the water used for cooking but also evaluate the process for procuring raw foods and ingredients. In addition, they regularly test food and kitchen surfaces to check for growth of fungus and bacteria that can contaminate food.
In offices where people work in shifts, especially IT and ITeS companies, insurers focus on training cafeteria staff, especially on storage techniques, servicing skills and hygiene standards.
"Our analysis of claim trends shows that over 8 per cent of employee claims are from digestive disorders, and the average claim in this disease category is around Rs 42,000," Prawal Kalita, director-benefit solutions, JLT Independent Insurance Brokers, told the daily. He added that once such an audit is done, most companies revamp their menu and look into hygiene issues. "They incorporate it in their wellness programme and take corrective measures," he explained.
Ergonomics-related audits are also gaining steam, which look into the positioning of computers, quality of chairs and their positions to ferret out musculoskeletal issues at the workplace. This follows a rising trend in claims for injuries and disorders associated with bad posture and spending long hours sitting in front of a computer.These efforts should translate to significant savings for insurers since group health - including government mass schemes - generated Rs 18,387 crore in premium in 2017-18. This accounted for a whopping 40 per cent of the health insurance industry's total premium of Rs 37,897 crore.