Why an Insurance Broker ?

India has traditionally been an extremely price sensitive market across industries. While price sensitivity keeps the Insurers on their toes, it also pushes them into undercutting each other, to get a foothold into new businesses; this undercutting (while it might seem like a sweet deal for the Insured, especially in the present) has disastrous long term ramifications.

Over the last decade Organizations have had a fairly good ride, because they were able to pass on the risk of health insurance to the Insurers because of the cut throat undercutting. The industry standards were driven largely by expiring premiums, when a more appropriate metric to decide the renewal premium is the claims experience - defined as the quantum of claims (different from the number of claims) settled by the Insurer as a percentage of the premium borne (without tax) for the policy.

We have already started our steep ascent to a place where mediclaim premiums aren’t sustainable and Insurers have started pushing back on the costs. Read More....

• The public sector general insurers kept losing market share, owing to mismanagement and entry of new digital players. Finally, when the realization of an eventual doom dawned, the public insurers tried to make up, by entering the undercutting game in order to acquire new businesses, particularly in the Health portfolio. Things got so messed up that many a times, two or three of the four public insurers were competing with each other for the same business. But, all of this worked in favor of the Employers. Health policies with an average claim ratio of over 120% were underwritten at premiums that were discounted over last years premiums.
• The last decade also saw a lot of easy money flow into the Insurance industry. Deep pocketed venture capitalist trying to find that one Unicorn, kept throwing in more money to increase footfalls. This in turn, led deep pocketed new age insurers, wreck the market with discounted unsustainable premiums.
• Technology can be an enabler only when you reach scale. The new age Insurers realized this and kept increasing their investment in technology but undercutting premium.

We have just about reached the inflection point where premiums will start rationalizing; you will soon start looking at a scenario where the Insurers will either start increasing premiums or reducing benefits, and if you are extremely unlucky, both.

Understanding technicalities of your benefit policies was never as important as today. Your Insurance Broker has the arsenal that can equip you with tools to understand and thereby negotiate on technical grounds. Some parameters for negotiations could be -

• Your ability to show business growth projections like
  • ramping up of operations,
  • acquisition of assets,
  • addition of younger demography to the employee base

  All of these translate into increased topline for the Insurer and therefore an opportunity for you to bargain on the premium.

• Add-on coverages and sub-limits for policies are going to be THE parameters on which most battles would be fought. Your ability therefore, to prune through the current add-ons that aren’t as widely utilized as opposed to one’s that would be beneficial for the entire employee base, will seal you a better deal.
• A common saying in the Benefit policy circles is - your policy is only as good as it is perceived to be. Perception in turn is a communication game. The success of your policy is therefore largely dependent on how well are the nitty-gritties of the policy communicated. A Broker who has experience in managing such communication can minimize friction and maximize perception value for the policy.
• Your Benefits policy should integrate seamlessly with the Human Resource Departments vision to keep your employees healthy. To that end, a Broker's experience of having implemented a Benefits program can come in handy.
• The Broker should be a master liaising agent. They should know who to escalate matters to and when, to ensure resolution within the shortest frame.

One of the most critical jobs for a Brokers is to find you a partner who would best suit your needs. While this is easier said than done, in our experience, exclusivity (of mandate) breeds a sense of trust. It not only shoulders the Broker with the total responsibility of the Benefits program but also reduces the Insurers overheads; thereby fostering a sense of mutual trust.
As a policy, Ethika does not work with companies that involve multiple insurance brokers. Trust and complete transparency are important to us.

Putting together a generous Benefits Program that will profoundly impact the life and loyalty of your employees requires legal and financial counsel. There is no one solution, and as any HR manager will testify, the demands of each workplace differ significantly.

Our discussion on structuring Benefits policies over the years has helped us evolve parameters that need due consideration, some of these are

• Gap Analysis
  While obvious, Gap Analysis can be a tricky issue. What you think is covered under your Benefits package might not necessarily be the same as what is actually covered; for eg : you might think baby care expense under maternity are covered upto the Sum Insured, but they might be capped upto the maternity cover sublimit. A lot of times, Employers keep bearing cost for some benefits that no one has ever claimed for; the likelihood of a claim arising for such benefits is also zero and yet they are being carried forward as a legacy. Identification of such gaps is critical.
  As a general rule, a Benefits policy must be overhauled every two to three years, new market standards should be incorporated, old ones discarded.
• Claims Control Measures
  The end goal of a Benefits package, the one objective parameter it is judged on (ofcourse without compromising on quality) is your control on the claims outgo. The trick is to control the claims outgo without reducing the perceived benefits. Right use of Co-payments, Deductibles, Preferred provider Network, Room Rent cap, Disease wise cap, Second opinion from Specialist doctors can help in controlling the claims outgo, thereby decreasing renewal premium.
• Benchmarking
  This can be the one field where comparing Apples to Oranges can actually help improve your Benefits package. Benchmarking your practices against the right industries and industry leaders can help get you greater bang for your buck.
• Scientific Claim Projections for employees
  A quarterly projection of how the Organization has fared, on the claims outgo as also projections based on where we are at and the premium implications at renewal, if the trajectory continues, can help sensitize Employees. It should be clear though, that the intention behind this exercise is not to dissuade Employees from preferring claims but to ensure transparent communication as to where we are, and where we are headed.
• Cost Benefit Analysis
  Once the benefits are frozen, your Insurance Broker should float a detailed Request For Proposal (RFP) with leading insurers and fetch the most competitive premiums. This can be considered the point where the Broker is in charge of bringing together two parties for atleast a year. They should be able to get you atleast three options with a detailed cost-benefit analysis and comparison reports.
• Merger And Acquisitions
  The most intricate issues after an M & A are the people issues. More often than not, it is the people issues that decide the success or failure of an M & A. In case of an M & A, the appropriate departments of both the Employers need to sit with the Broker to work on the way ahead. The most important aspect of the M & A though remains the amalgamation of the two policies and the employee communication thereafter.
• Employee Funded Group Policies
  As an Orient nation, we are used to the concept of a joint family and are sensitive about the subject. Most Employers accordingly include parents in the Employee Benefits policy. But even when they don’t, they do they to facilitate a platform for their Employees to form a Group for a parent policy. The Broker understands this balance that needs to be maintained and can work with the Insurer to explore the best possible alternative for the Employer. This alternative could be including parents in the Employee policy or getting them a different policy or a Super Top-Up policy. The Broker also liaises with the Insurer to ensure benefits of migration and/ or portability are made available to the Employees.
• Suggesting new benefits
  We have entered the era of neo-healthcare. Insurers accordingly are adapting by providing benefits that were previously unheard of - Outpatient consultations, diagnostic tests, health check ups, nutrition consultations, pharmacy discounts, unlimited access to doctor on video or phone, Negotiating Discounts with preferred hospitals, long term ( more than 1 year) Group health insurance policies, Employee assistance program, Employee wellness programs, Flexi Benefits etc. Your Brokers ability to identify such Insurers and match them with you is key to the foundation of a successful relationship.
• Compliance
  Your Broker should be aware of benefits mandated by law and ensure there is no overlap between such benefits unless it is by discretion of the Employer. Some mandated benefits include EDLI, ESI, Gratuity, Workmen Compensation etc.,.

Technology is reshaping how Employers select and offer Employee Benefits, put access to information at the fingertips of the Employees and create a seamless and interactive experience; that said, the ability to interact with a human being acquires a lot of significance when our loved one are at a Hospital and our claim processing is taking longer than usual - understanding this difference between which processes to automate and which ones to leave be for human intervention is going to differentiate the good from the great Insurers.

Technological advances ensure connectivity and information flow between appropriate parties at appropriate times. Acting as a facilitator, technology can ensure the Employers intervention is at a minimum. Employers can thereby divert their attention and energies to core business activities. The new age insurance technology is reducing risk, improving visibility, and increasing profitability. A picture perfect scenario has your Insurance Brokers optimize the use of technology to ensure repetitive tasks are dealt with while intervening whenever manual intervention is needed.

One such tool designed by Ethika automates simple, repetitive tasks and doesn't need constant supervision either by Employers or Agents.

To support employees during enrollment, Employers can adopt online platforms designed to personalize and simplify the experience. All the information related to their benefits is always available to them. The platform can also offer many tools to support the well-being of employees. Most of the insurance brokers including Ethika offer you a complimentary enrollment tool so that the employer or HR can manage the enrollment period online seamlessly and conveniently. With an online platform, the new employee can be onboarded, instantly. The additions and deletions of employees can be easily done. This facility is particularly enabling when your new joiner needs to avail of hospitalization benefits, a week into her job.

The premium for additions and deletions is generally calculated on a prorated basis and the credit or debit is made in the CD account, maintained with the Insurer. This tool also helps the Employer to see the balance anytime online for their policies. Online tool helps in managing the policies, adding or deleting members without any hassle, with just a click!

Employers, especially with the right employee benefits insurance, need to become experience-led and make their employees’ lives easier and better with technology. Partnering with technology is a necessity for growth.

As an Employer you may have created a great Benefits package for your Employees but do your Employees truly know or understand what is available to them? Our experience says less than 16% of employees avail the insurance benefits. Many of them may not even be aware of the full range of benefits available. That makes appropriate employee communication extremely important. It increases the overall perceived benefit score of an Employer. We have come across cases where Employees with two different Companies with the same benefits program had different perception of their Benefits policy.

Can we insert a picture art here - two colleagues communicating with each other
Colleague 1 - Dude, I heard Ashwin, our batch topper is looking for a job change, only because his Benefits program is a dud.
Colleague 2 - I think he will be a very good fit with us, moreover our EB program is world class.

The importance of communicating a well-structured and planned Employee Benefit Communication program cannot be over-emphasized.
The Employees should be aware of the overall compensation (this includes the premium the Employer is bearing for their mediclaim) and not just the cash value of their salary!

That’s where benefits communication plays its part by helping the employees to understand the value of their employment. A good, thought through employee benefits communication program tells the employees what options are available to them, what to choose wisely, what mistakes to avoid, like not selecting the plans that will later lead to increased out of pocket costs putting a burden on their pockets.

Ethika also designs and implements Comprehensive & Functional communications Programs for its clients to ensure the Employees are made aware of all the benefits our clients offer to them. With frequent communication you can ensure employees remain engaged and up-to-date about the various benefits and facilities available for them. Gamification of Benefits knowledge, Structured promotional mailers and Posters, Quizzes at well-planned intervals can ensure appropriate communication reaches and registers with the intended recipient. It is also important to ensure that the language used for communication is the one that Employees understand and can connect with.

Choose a partner who can provide the best support to your employees during their claims settlement process which is generally an unpleasant and stressful experience. Most Insurance Brokers act as forwarding agents with little to zero technical knowledge - when the Employee has questions about claims, the Broker directs them to the Third Party Administrator or the Insurer. There is absolutely zero value addition when information is flowing from either party to the other.

Your Broker should understand you and work by your side, they should be by the side of the Employees to achieve the best outcome for their claims. The Broker should provide Red Carpet Support Service to your employees, extending support to them at every step, from medical emergencies to claims settlement. Your Broker should be able to clear up billing disputes and reduce turn around times wherever possible.

Outsourcing the management of your Benefits program to an Insurance Broker has several advantages. Burdening crucial personnel with additional, unfamiliar responsibilities when their core competence lies somewhere else can be a heavy cost to bear.

Ethika believes in 'serving to care and serving with compassion’. We are sensitive to the claimant's losses and their expectations from an Insurer. Our exposure to diverse cases of claims redressal has shown us that each claim is unique in terms of conditions and requirements, and should therefore be dealt with uniquely. We take up the responsibility to address all concerns of the Employees during claims settlements; over the years we have fine tuned this entire architecture to an extent that it is seamless.

Employee Health Risk Management is important in the workplace because employees need to be healthy to be happy and productive.

Here are some interesting stats

Health care is usually thought of as a way to treat sickness- leading to high Mediclaim utilization. This is what we call “Reactive approach”- There is a problem with this approach!

With an alarming increase in the price of health insurance, employers seek to reduce premium costs, they limit coverage or impose measures such as copayments on employees to shift healthcare costs to them, resulting in a negative perception of the company. We have analysed that the main causes of this increase are unhealthy lifestyle choices such as lack of exercise and irregular eating habits

In order to effectively manage and limit escalating premiums, our Wellness Team works with the client to protect employee benefits without compromising management's objectives- The "Preventive approach”. Preventive approach reduces the risk for diseases, disabilities, and death!

We use encourages corporates to include wellness in their employee benefit programmes. A systematic and scientific approach ensures qualitative results and brings about a positive change in the overall organisational health.

We're all about wellness

Since corporate health requirements differ, each wellness programme has to be tailored to the organization's needs. It takes careful planning and thought to make an employee wellness program work.

There's no denying that employee wellness is a fast-growing practice in corporations and will play a crucial role in the future. Absenteeism, turnover, and healthcare costs have been reduced through wellness programs, which also raise employee morale, resulting in higher productivity and higher profits.

One Size Does Not Fit All is a strong belief that we hold here at Ethika!

Wellness Programme Design

The proof is in the pudding and pudding is made of data. Our wellness program is designed by identifying health risk patterns by digging deep into the claims data. Data helps our wellness experts to detect health trends and formulate wellness plans based on those trends.

Besides that we customize engagements based on the organizational health trends! Online sessions- personal growth, health, nutrition, physical health as well as mental health sessions conducted by renowned and best on industry trainers.

In order to ensure employee participation, we choose topics that are relevant to the masses and are engaging, as no matter what is offered, there would be no value without voluntary employee involvement.

Wellness Service

Our 7 step approach follows a scientifically proven framework designed to deliver results.

With our 7 step approach, we have changed the health quotient of many organizations!