Health Insurance, Cashless 'Juggernaut'!

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This case study was compiled from published sources, and is intended to be used as a basis for class discussion. It is not intended to illustrate either effective or ineffective handling of a management situation. Nor is it a primary information source.

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Case Details:


Case Code : INS054 For delivery in electronic format: Rs. 400 ;
For delivery through courier (within India): Rs. 400 + Shipping & Handling Charges extra


Case Length : 10 Pages
Period : 2010-2011
Pub Date : 2011
Teaching Note : Not Available
Organization : -
Industry : -
Countries : India


Health insurance in India was promulgated initially by social health insurance schemes of central and state governments. It was more a group policy and was not designed either for specific medical conditions or for any individual/family coverage. Penetration of health insurance picked up only after private insurance companies players introduced individual/family health insurance policies with flexibility and additional features. Cashless Claim facility was one of such product which nullified the need of 'initial spending and claiming later' aspect and had became instantly popular among customers. Boosted by the popularity of cashless claim policies, health insurance grew at a brisk pace in India.

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Though the health insurance industry was growing, insurers complained that they were constrained by losses owing to factors like higher administration expenses, adverse claims ratio, high hospital charges and improper risk assessment. To contain the losses, apart from other corrective measures, insurance companies proposed deduction and standardization of hospital charges. When most of the network hospitals refused the proposal, insurers went ahead and announced delisting those hospitals which rejected proposal and scrapping cashless hospitalization facility. This raised alarm in customer and industry groups attracting action from all bodies involved for an amicable solution.


Health insurance concepts and health insurance industry growth in India.
Health insurance supply chain and relation as well as contention among the involved parties.
Cashless Claim feature supremacy in health insurance plans.
Cashless feature restrictions and its implications on market and negotiations process for amicable settlement.


  Page No.
Introduction 1
Insurance Industry in India: Prior Liberalization 2
Insurance in India Post Liberalization 2
Cashless Claim Facility 2
Policy Restricted, Customer Victimized 3
Negotiations for Settlement 4
Exhibits 6


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