Bathwal explained that conventional health insurance has historically focused on hospitalisation, leaving everyday healthcare expenses—including outpatient consultations, diagnostics, medicines, and chronic disease management—largely uncovered.
“Insurance has not effectively addressed the costs households face most often. Expanding coverage to outpatient and preventive care helps manage expenses more predictably and reduces avoidable, high-cost hospitalisations over time,” he said.
Affordability, he added, is another challenge that cannot be solved by pricing alone.
Reducing healthcare costs through better coordination, promoting preventive care, and improving the health profile of insured customers are key levers.
Platforms such as Bima Sugam, which aim to simplify policy onboarding and servicing, also help lower distribution costs, making insurance more accessible without compromising long-term sustainability.
Innovation in product design and distribution is essential to engage first-time buyers, particularly younger consumers.
Bathwal said young customers increasingly value clarity, relevance, and ease of use.
While younger policyholders may prioritise outpatient access, wellness benefits, and instant services, senior citizens tend to prefer products that provide ongoing medical support, chronic disease coverage, and defined benefits.
AI-enabled tools and assisted-digital models can simplify discovery and onboarding, while also enabling insurers to provide faster, consistent service.
Bathwal also emphasised the importance of trust and retention.
ABHI’s HealthReturns programme, for example, rewards policyholders for healthy behaviour, allowing eligible customers to earn back up to 100% of their
premium through wellness-linked benefits, he said.
“When customers experience insurance as a service that supports everyday health, it shifts from a reluctant purchase to a valued product,” he said.
Collaboration across insurers, healthcare providers, and policymakers is also critical. Digital infrastructure such as ABHA, Bima Sugam, and the National Health Claims Exchange (NHCX) is creating transparency, improving claims processing, and enabling more predictable pricing.
Sustained dialogue between providers and insurers helps align treatment protocols and pricing, ultimately benefiting both customers and the insurance ecosystem.
Bathwal said ABHI’s broader vision is to move from a reactive, hospital-focused model to a comprehensive health ecosystem. Chronic condition management programmes for diabetes, hypertension, and asthma focus on consistent monitoring and adherence, while digital tools allow customers to track their health and participate in wellness initiatives.
This approach, he added, aligns customer health outcomes with the insurer’s sustainability goals and marks a significant shift in the role of health insurance in India.
