ICICI Lombard Introduces Solution to Transform OPD Health Insurance

ICICI Lombard General Insurance has launched a health insurance app — ‘IL TakeCare’ in collaboration with Practo, the leading healthcare platform. This one-of-its-kind solution covers Outpatient (OPD) expenses of all its customers.

The app meets key customer requirements with respect to their primary healthcare needs. This includes hassle-free, real-time claim authentication of expenses such as doctor consultation, medical tests, pharmacy spends etc.

It also empowers the user to access a cashless network comprising of specialized doctors. The app thus addresses a key problem of customers wherein they were hitherto required to pay for OPD expenses from their own pocket.

The ‘IL TakeCare’ application works in sync with Practo’s ‘Trinity’ technology to allow customers to make cashless visits with doctors including those who operate stand-alone clinics.

The IL TakeCare app also allows users to book a network diagnostics centre for medical tests and receive the results on the app, which automatically becomes an online repository of medical records. They can also buy medicines at discounted rates and pick them from a medical store or get delivery at their home.

Consumer OPD journey through the app

The app facilitates real-time view of personal health records (PHRs) as well as benefits, billings and transactions for service providers. It comes with a one-time password (OTP) for all transactions via mobile or email and provides multiple access points for family members. The solution will be made available to customers with due consent of the regulator.

Trinity technology of Practo

Practo’s new Trinity technology will help patients get a paperless and cashless experience for everyday healthcare needs such as doctor visits, medicine purchase, online consultations as well as diagnostic tests.

With Trinity’s integration into IL TakeCare, customers can visit ICICI Lombard empaneled clinics on Practo’s provider network by booking appointments through the app or just walking into a clinic. The system will recognize them automatically and verify the transaction to improve transparency.

Trinity enables seamless transfer of structured digital prescriptions from the doctors to help ICICI Lombard identify prescribed tests, treatments and medicines which facilitates real-time adjudication of claims and would ensure periodic settlement for doctors. With Trinity, doctors and clinics across the country can now accept ICICI Lombard Insurance via Practo’s software platform.

A growing healthcare market, increased penetration and new models of service delivery are driving the Indian health insurance industry, which is poised to reach Rs 500 billion by 2021 at a CAGR of 20 per cent. Having said this, lack of outpatient coverage is a major inhibiting factor for growth, with two-third of medical expenses classified as out of pocket.

As per estimates, standalone outpatient care in terms of size would be 6 times of the current health insurance market. Drugs, diagnostics, consultations and tests primarily constitute out-of-pocket-expenses. In India, outpatient expenses are met through personal income and savings, raising the issue of ability of OPD patients to pay for various medical services. In fact, as per experts, about 3.5 per cent of population is below the poverty line because of out-of-pocket expenses, which can decline to 0.5 per cent if out-of-pocket payments on outpatient care are excluded.