HDFC ERGO Processes Its First Health Claim On NHCX Platform

~ It reinstates insurer's commitment to promote transparency and make health insurance available, accessible, affordable

HDFC ERGO General Insurance Company, India’s leading private sector general insurer, successfully processed its first-ever health claim through the National Health Claims Exchange (NHCX) platform. This groundbreaking achievement marks a significant leap forward, which will help streamline health claims processing, improve administrative efficiencies, and enhance customer experience by building a cohesive technology-driven system.

Based on the directive from Insurance Regulatory and Development Authority of India (IRDAI), General Insurance Council has been working on bringing the various stakeholders together to ensure the entire process of health Insurance is done in more simplified and transparent manner.

Developed by the National Health Authority (NHA), the NHCX platform is a single window interface which provides secure and efficient exchange of health insurance claims data. The platform is poised to revolutionise India's health insurance landscape by setting a new standard for efficiency and transparency in claims processing.

As a digital health claims portal, National Health Claims Exchange (NHCX) is a significant leap towards ensuring interoperability of health claims and fostering transparency within the industry. HDFC ERGO becomes one of the lead insurers to process health claim on NHCX platform. This marks a significant step forward in India's health insurance landscape and attests the commitment of the Company in propelling financial inclusion in India

Parthanil Ghosh, Director and Chief Business Officer, HDFC ERGO General Insurance, said, “In alignment with IRDAI's vision of 'Insurance for All by 2047’, we are committed to provide innovative solutions thereby making insurance accessible and affordable and continue to work towards improving insurance penetration across the country. In alignment to the Government's flagship ‘Ayushman Bharat Digital Mission’, we are proud to successfully process our first health claim through the NHCX platform. This further underscores our commitment to leverage cutting-edge technology and bring in better transparency and claims efficiency in health insurance. As a crucial stakeholder in building a 'Healthy India, we are confident that the NHCX platform will play a significant role by ensuring the interoperability of health claims, democratising insurance and fostering transparency within the industry.”

The NHCX is a critical gateway for exchanging claims-related information within the healthcare and insurance ecosystem. It is designed to streamline and enhance health insurance claims processing by integrating insurers, healthcare providers, and policyholders into a cohesive, technology-driven system. This platform leverages advanced digital technologies to ensure efficient, transparent, and expedited claims settlements, thereby improving the overall health insurance ecosystem.

The process begins with the hospital generating a bill through their Hospital Information System (HIS), which is then uploaded to a Third-Party Administrator (TPA) app. The Health Claim System (HCS) of HDFC ERGO then processes the claims in their claim processing queue.

As a customer experience focused organisation, HDFC ERGO is continuously disrupting technologies to offer hyperpersonalised services to build a fair and robust claims management system. Being a multi-channel organisation, the company offers a host of options and customers can check their claim status via 24X7 contact center, dedicated customer service email, WhatsApp, website, email, customer service app etc. Policyholders can also track the status of their claims on a real-time basis through Here app, one of a kind insurer led ecosystem or simply through the bitly links which is sent to them as soon as they register any claim. With 100% claim settlement ratio in health insurance, the company's average time to settle a cashless health claim is less than 40 minutes. These moves indicate a shift towards the HDFC ERGO’s digital-first customer service as 70%+  health claims are now being intimated digitally, resulting in swift claim processing.

About HDFC ERGO:

HDFC ERGO General Insurance Company Limited was promoted by erstwhile Housing Development Finance Corporation Ltd. (HDFC), India’s premier Housing Finance Institution and ERGO International AG, the primary insurance entity of Munich Re Group. Consequent to the implementation of the Scheme of Amalgamation of HDFC with and into HDFC Bank Limited (Bank), one of India’s leading private sector bank, the Company has become a subsidiary of the Bank. HDFC ERO is one of India’s leading non-life insurance company in the private sector. A digital-first company, transforming into an AI-first company, HDFC ERGO is a leader in implementing technology to offer customers the best-in-class service experience.

The company has created a stream of innovative & new products as well as services using technologies like Artificial Intelligence (AI), Machine Learning (ML), Natural Processing Language (NLP), and Robotics. HDFC ERGO offers a range of general insurance products and has a completely digital sales process with ~94% of retail policies issued digitally. HDFC ERGO’s technology platform has empowered the customers to avail 75% of the services digitally on a 24x7 basis with ~17% of the customer requests serviced by Artificial Intelligence-based tools. The Company has one of the best claims payout ratios in the General Insurance industry.

The Company offers a complete range of General Insurance products including Health, Motor, Home, Agriculture, Travel, Credit, Cyber and Personal Accident in the retail space along with Property, Marine, Engineering, Marine Cargo, Group Health and Liability Insurance in the corporate space. Be it unique insurance products, integrated customer service models, top-in-class claim processes or a host of technologically innovative solutions, HDFC ERGO has been able to delight its customers at every touch-point and milestone to ensure consumers are serviced in real-time.

Log on to www.hdfcergo.com or stay connected on the following social media handles to get more information on HDFC ERGO and the products and services offered by the company.