the insurer. Many companies are now offering health insurance for those below 60 on the basis of the
customers’ declarations and tele-underwriting.
After the individual fills up the proposal form online, the case moves to the tele-underwriting team.
“Based on the health declarations, a medical professional from the insurance company calls up the
customer and tries to understand the current health status and medical and family health history," said
Manish Dodeja, head, claims and underwriting, Religare Health Insurance Co. Ltd.
According to Dodeja, in case a customer declares a disease, the medical professional will seek more
details pertaining to it. If the customer, for example, declares that he has diabetes, the company
representative may enquire how long the customer has had the illness, the medicines he is taking, other
symptoms he has, precautions advised by doctors, and so on.
DO they work?
The alternative evaluation mechanism can help a customer get a policy issued faster.
Tele-underwriting reduces ambiguity: Direct consultation assures the insurers that the declarations
made are genuine. “Many times, people may not understand technical terms for the disease. They may
not know, for instance, that hypertension is the technical term for what is colloquially called blood
pressure. When a medical professional has a consultation with the customer, such ambiguities are taken
care of," said Dodeja.
Sometimes, people are not even aware that they have an ailment, and simply follow a doctor’s
prescription. The insurance medical professional can take a call on the current health condition on the
basis of the prescribed medicine.
Medical tests are not totally reliable: The purpose of pre-acceptance medical screening is to find out
whether applicants have any illness at the time of buying the insurance policy. But some insurers feel
that these tests may not give a clear picture.
Before issuing the policy, insurers typically do electrocardiogram (ECG) to understand the health of the
heart, check blood pressure, and sugar and creatinine levels to know conditions of the kidneys. “Pre-
acceptance medical screening only gives insurers a bird’s eye view of a person’s health. It does not give
detailed information. Despite all the tests, insurers still get claims in the first few months after policy
issuance," said Dr S. Prakash, managing director, Star Health and Allied Insurance.
According to him, if ECG is normal, it doesn’t mean that the person doesn’t have any heart problems.
Similarly, a person’s blood sugar may be higher or lower, but the person may still be healthy. Also, if a
customer is taking medication, his sugar or blood pressure levels would be normal.
Many insurers also find problems with laboratories to whom they outsource the tests. “We have de-
panelled a lot of laboratories for different reasons. There must be about 4,000 labs in the country. Only
10% maintain high standards and have proper accreditation. We often faced problems with labs outside
metros, in tier-2 and tier-3 cities," said Prakash.
Credit scores, income levels work for life cover: To decide on the amount of life insurance cover,
insurers now look at the credit score of the applicant as one of the parameters. According to industry
experts, there’s a correlation between credit scores and the lifestyle of an individual. Those with a
higher credit score not only have financial discipline but also have better lifestyle. If an individual is
better organized, disciplined, self-conscious, and responsible, then the assumption is that he will also
focus on keeping himself fit," said Agarwal.