According to the report of financial news, quoted by Dynamic Development, Roza Saeedi, the director of medical insurance of Cooperative Insurance Company, gave the following explanations in a conversation about health insurance:
What is the state of health insurance now and how is the relationship between cooperative insurance and health insurance fund?
Currently, health insurance covers a part of people’s medical expenses, which, despite the allocation of funds, unfortunately has not been very successful in the drug sector (related to Darvar plan) and people’s out-of-pocket payments for drug costs have increased.
Cooperative Insurance, as a commercial and supplementary insurance company, is responsible for paying part of the medical expenses that are not covered by basic insurance for its insured, according to the provisions of the contracts. With the activation of the communication infrastructure of the electronic health record system (SEAS), more communication will be established between supplementary insurance companies and basic insurances.
Considering the elimination of 4,200 currency and the pricing of medicines in Nimai currency, what will be the coverage of cooperative insurance for policyholders?
At the beginning of the year, the announcement of our insurance premiums for drug coverage was based on damages according to the preferred currency of 4,200 Tomans. In the middle of the year, the discussion of Darvar plan was brought up and it was decided that the difference in the price of drugs would be paid by the basic insurance companies, and finally by issuing a license to increase the price of drugs, The total cost of the drug for the consumer and finally other supplementary insurances has been more than expected. Since the medical insurance contracts are long-term (one year), the effect of the loss caused by this issue will continue to be on the performance of insurance companies and cooperative insurance.
What coverage has Cooperative Insurance provided for policyholders in its new contracts? Either in terms of the basic amount to conclude a supplementary contract or to cover the costs of treatment and the limit of obligations.
The basic and essential coverage for providing supplementary treatment insurance, reimbursement of hospitalization and surgery costs in hospitals and surgery centers is limited. According to the number of insured persons, the ability to pay insurance premiums and the request of insurers and insured persons, it is possible to determine the ceiling of obligations or to provide additional coverages, including all types of paraclinical expenses. Basically, the treatment insurance policy is a customized insurance policy, the amount of obligations and its coverages are designed according to the needs of each group.
What were the new plans and initiatives of cooperative insurance in 1401 and what are its plans for the coming years?
The main innovation of cooperative insurance in group medical insurance is to focus on increasing the quality of service. At Cooperative Insurance, we are trying to reduce the time of damage investigation by performing a part of the process of delivery and checking documents electronically.
At the same time, we have family medical insurance and small business group medical insurance in our insurance portfolio.
Cooperative travel insurance is one of the most complete and up-to-date insurance policies available in the market.
Today, the main problem of insurances is the payment of damages, which causes the dissatisfaction of different sections of the society, including insurance holders, owners of pharmacies, laboratories, imaging, etc.; How does cooperative insurance interact with them?
As we have said before, we have something to say about the quality of medical insurance services in Cooperative Insurance, and we have minimized this time by conducting the claim review process electronically. At the same time, we always listen to the criticisms and suggestions of the final insured directly in order to fix the weaknesses. In the next step, we will check our own performance with continuous surveys and try to solve existing problems. The shortening of the insured’s claim payment process is connected to the internal reward system of our organization, and there is a direct relationship between the reward of colleagues and the reduction of the duration of claims investigation.
Regarding the contracting parties, Cooperative Insurance is one of the few insurers that has no debt to these centers and fulfills its obligations as soon as possible, and this is the basis for the long-term cooperation of these centers with us. Therefore, the new centers with whom the contract is concluded are surprised by our payment speed. But later they realize that this is a fixed procedure in cooperative insurance and this did not happen just because the contract was new.