GI Council Appoints Health Insurance Expert to Implement 100% Cashless Payment System


The General Insurance Council in India has taken a significant step towards enhancing the efficiency and accessibility of health insurance services by appointing Segar Sampathkumar as the director of health insurance for a three-year tenure. This move aims to implement comprehensive changes within the sector, ultimately leading to the establishment of a 100% cashless payment system. Currently, this system serves 52% of the industry's health policies, and its expansion aligns with the vision of Mr Debasish Panda, Chairman of the Insurance Regulatory and Development Authority of India (IRDAI), to boost insurance penetration across the country.

Segar Sampathkumar, who previously held the position of Insurance Ombudsman in Chennai for nearly two years, has resigned from his post to undertake this new assignment. His experience also includes serving as a general manager responsible for the health insurance portfolio at New India Assurance, the largest non-life general insurer in India.

The General Insurance Council, under the leadership of a secretary-general, has introduced a senior-level position dedicated to driving sectoral changes. This strategic initiative acknowledges the need for a robust technological platform and enhanced coordination with the nationwide healthcare sector, including hospitals, doctors, and pharmacists.

In addition to appointing Segar Sampathkumar, the council has formed a committee, led by S Prakash, former MD of Star Health, and composed of industry experts, to oversee the implementation of the cashless claims project.

The transition to a cashless payment system entails not only the adoption of a sophisticated technological framework but also the standardization of rates, services, and the empanelment of more hospitals to ensure coverage across the entire country.

Mr Debasish Panda, Chairman IRDAI has emphasized the cooperation between the General Insurance Council, Life Insurance Council, and the National Health Authority in onboarding insurers onto the National Health Claims Exchange (NHCX). This collaborative effort will facilitate common empanelment and interoperability with hospitals, streamlining the claim processing of health insurance and making it seamless and frictionless for policyholders.

The NHCX leverages technology to unite hospitals, insurers, service providers, and third-party administrators on a single platform. This synergy expedites claims, reduces fraud, and standardizes processes, ultimately contributing to an equitable, efficient, and digitized healthcare ecosystem accessible to all.

Post-COVID-19, health insurance has emerged as the largest portfolio within the general insurance industry, experiencing a remarkable growth of 23%. In the fiscal year 2022-2023, it contributed an impressive Rs 90,600 crore in premium, highlighting the sector's increasing importance and the potential for further advancements in the Indian insurance landscape.