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Health insurance most relevant

Health insurance most relevant


Akif Zia Malik, HOD Business Solutions, TPL Insurance

Having a degree of Mechanical Engineering and MBA, both from the UK, Akif Malik has a diversified experience working within Manufacturing as well as Services Industry of more than 20 years.
Akif has an insurance industry experience of 15 years, both in Non-Life and Life Insurance Industry, where he has led Agency Distribution Channel, Banca Channel as well as corporate sector and is well versed with the developments happening within the insurance industry.

Mr. Akif Zia Malik, Head of Corporate Business Solutions at TPL Insurance Limited, shares his opinion and thoughts on the importance of healthcare as well as conventional and Takaful coverage

PAGE: Explain the categories in business and corporate insurance. What makes them different from other claims?

Akif Zia Malik: Business and corporate health insurance claims have some unique aspects compared to individual health insurance claims:

  1. Group Nature: Business health insurance is provided to a group of employees, and claims are often processed collectively. This can sometimes provide the advantage of better rates and terms due to the larger risk pool.
  2. Employer Contributions: In many cases, employers contribute to the cost of health insurance premiums, making it more affordable for employees. This is different from individual plans where individuals bear the full premium cost.
  3. Customization: Employers can tailor health insurance plans to suit the needs of their employees. They might offer multiple plan options, such as HMO, PPO, or HDHP, allowing employees to choose what best fits their circumstances.
  4. Regulations and Compliance: Business health insurance plans are subject to specific regulations and compliance standards, including those outlined by the Affordable Care Act (ACA) in the United States. These regulations impact plan design, coverage requirements, and reporting obligations.

Overall, the categories of business and corporate health insurance plans offer a range of options for employers to provide healthcare coverage to their employees. These plans aim to balance cost, coverage, and flexibility while addressing the unique needs of a group of individuals.

PAGE: Explain the terms and conditions of pension and health insurance claims in your company? What type of covers in the company, clients usually prefer?

Akif Zia Malik: Health insurance product are broadly categorised under:

OPD is offered by insurance companies on an Admin Services Only (ASO) / Pool Basis. This means that the client provides a certain amount of pool to the insurance company. The insurance companies provide the admin services for managing the OPD claims for the client and charge a certain fee on it.

IPD is based on the risk assessment of each corporate client, including their number of employees, age brackets, hospital benchmarks, claim history, hospitalisation limits etc. and a separate quote including the terms and conditions is shared with the client. Hospitalisation is a Mandatory Benefit whereas Maternity, OPD, Dental, Optical and others are optional under Health Insurance Policy.

At TPL Insurance, we also offer pre-underwritten (i.e., everything is defined / off the shelf product) individual and family health insurance plans along with global offering where an individual can opt for elective surgery anywhere in the world.

Health insurance claims are either settled on a direct settlement with hospital or on a reimbursement basis. When a client goes to a hospital which is on the panel list of the insurer, the hospital sends the bill to the insurer and the insurer settles the bill with the hospital. On a reimbursement basis, if the client goes to a non-panel hospital, they send the bill to the insurer and the insurer makes the payment to the client. All this is done in accordance with the policy.

PAGE: How you will handle an irate client, who has some issues with services or products?

Akif Zia Malik: Health insurance is always sensitive as it can happen to anyone at any time. It is crucial to approach these situations with patience, empathy, and professionalism. The goal is to address their concerns, provide accurate information, and ensure they feel supported throughout the process.

Health insurance companies provide 24/7 access to their clients via a helpline to ensure timely delivery of their services.

PAGE: What is the level of competition in the insurance sector?

Akif Zia Malik: Insurance companies are licensed as either Life Insurance Companies or Non-Life Insurance Companies. Health insurance is a segment in which Life Insurance Companies as well as Non-Life Insurance Companies can operate so it is highly competitive. Within the insurance industry, health insurance is a segment which does not usually add to the bottom line of the insurance company but contributes to the top line. If the insurance company’s growth strategy is top line focused, they become aggressive in terms of their pricing resulting in higher competition. While the client may benefit in the short term because of the competition, it is not sustainable for either the insurance company or the insured company.

PAGE: Your views on progress of Takaful in Pakistan:

Akif Zia Malik: Takaful segment has been gradually rising in Pakistan; although not at the pace of Islamic Banking. The basic reason is the lack of capacity in the international market for Takaful and because of that most insurance companies still write a bigger share of their business in conventional mode of insurance.

When it comes to health insurance; there is no Reinsurance arrangement hence the health insurance business is kept on the net book of the insurance company. For this reason, the percentage of Takaful vs Conventional in health insurance is bigger but at the end, it comes down to the client’s preference as there is no difference in the product offering.

PAGE: Tell us about the government’s support to the insurance sector?

Akif Zia Malik: Insurance, as an industry, requires a lot more support than what is being granted by the government. There was a time when life insurance premiums were entitled for tax breaks, but it is no longer the case.

Recently, Group Health Insurance has been subjected to Sindh Sales Tax of 13%. This will create another hurdle for SMEs as their input cost will go up.

While the insurance industry is taking up this matter but during these times of high inflation, where the medical/hospitalisation cost is increasing, government should be incentivizing companies to avail private health insurance for their employees.

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