- AI in health insurance
- AI use cases in health insurance
- Benefits of AI in health insurance
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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Updated on May 05, 2025 5 min read
What is Artificial Intelligence in Health Insurance?
AI in the health insurance industry has gained widespread popularity in India in recent years. Star Health Insurance launched its AI-driven Star Health Face Scan, while Future Generali has its own AI tool, the Health Shield Advisor. An increasing number of health insurers are launching integrated AI tools every day.
AI in health insurance is rapidly transforming the insurance industry, offering numerous opportunities to enhance efficiency, personalise services, and improve overall customer experience. From underwriting and pricing to claims processing and customer engagement, AI is making its way into the insurance industry rapidly. Explore the impact of AI in insurance, its role, and benefits for customers and insurers.
What Is The Role of Artificial Intelligence (AI) in Healthcare?
Artificial Intelligence (AI) is transforming the way the insurance industry operates by improving efficiency, accuracy, and profitability. AI in healthcare can help doctors analyse your vitals with little to no chance of human error. Automating tasks like image analysis, lab reports, and more will assist doctors and patients alike in personalising treatments. AI in healthcare aims to enhance patient care, speed up treatment, and make healthcare cost-effective.
How AI Can Be Used In Insurance?
As per data, nearly two-thirds of physicians say that AI helps in efficient diagnostics. Let us understand how AI can be used in the health insurance industry
Risk Assessment Using AI
Wearable data metrics like activity levels, sleep patterns, etc., offer accurate data for efficient risk management. AI can pinpoint specific combinations of past conditions and lifestyle factors with a high predictive probability for future health risks. Additionally, critical illnesses such as cancer of any type can be spotted early on for effective treatments. Identifying a specific cancer marker through genomic analysis enables targeted preventative care and more accurate risk prediction probabilities. The data can be further used to recommend ideal health insurance plans.
Personalised Health Coverage
Artificial intelligence in the health insurance industry helps personalise health coverage. AI helps design customizable plans based on individual risk factors and needs. For example, individuals with a family history of heart disease may opt for a statistically higher coverage level for cardiovascular care.
AI-Empowered Operations
AI in health insurance will offer faster claim processing, an automated underwriting process, fraud detection, enhanced customer service, and more. Tools like AI chatbots are another source that offers to handle routine inquiries, improve response times and free up human agents.
Benefits of Artificial Intelligence in Healthcare
Let us talk about the various benefits for both customers and insurers on the integration of AI in health insurance:
- Easier and faster claim processing.
- Accurate data gathering leading to personalised health insurance plans.
- Creating a vast healthcare ecosystem for patients using optimum healthcare solutions.
- AI in health insurance analyse data from multiple sources, such as claims data, social media, and public records, to identify potential fraud, safeguard customers and insurance providers.
- AI integration in health insurance will help in scheduling, record management, faster claim processes, and more, allowing healthcare providers to focus on patient care.
Impact of AI in Health Insurance
There are multiple use cases of AI in health insurance to understand its overall impact. Health insurance in India is being revolutionised each day. Streamlining operations, reducing costs, enhancing customer experience, and improving risk management are some of the effects of artificial intelligence.
However, it is crucial to address the challenges related to data privacy, algorithmic bias, regulatory compliance, and the need for skilled professionals to ensure responsible and ethical implementation of AI in this critical sector. As AI technologies continue to advance, their integration into health insurance will likely deepen, leading to further innovations and transformations in the industry.
Challenges of AI in Health Insurance
While integrating artificial intelligence is proving to be beneficial, there are certain challenges associated with the same.
Data Privacy and Security Concerns
Handling sensitive personal and medical information requires strict security measures to avoid data breaches and misuse of data. AI in health insurance implementation requires robust data protection measures.Ethical Issues
While artificial intelligence can simplify the lives of patients, doctors, and insurance providers, the loss of human touch is a cause of concern. Additionally, there are concerns regarding who takes responsibility when AI makes incorrect decisions.AI Data Bias
AI systems rely heavily on the data that they will be fed, influencing the decisions made by the tools. This means the data, if incomplete or biased, can produce inaccurate results.Artificial Intelligence Data Bias
If the data used to train AI algorithms reflects existing biases, the AI system can amplify the biases. This can lead to unfair outcomes for certain demographic groups that are underrepresented in a certain geographical region.
AI Use Cases in Health Insurance
Let us take a look at some leading health insurance providers in India using AI tools to simplify insurance.
Star Health Insurance
A new AI-driven tool called Star Health Face Scan, introduced by Star Health Insurance, will remotely gauge 18 parameters such as blood pressure, pulse rate, heart rate, haemoglobin levels, and stress levels. The face scan will leverage artificial intelligence to analyse an individual’s face and provide real-time insights on the vital health parameters in a minute, as per the insurance provider.Future Generali Health Insurance
Future Generali health insurance introduced the ’Health Shield Advisor’, an AI-powered tool designed to help individuals determine the ideal amount of health insurance coverage based on their unique lifestyle. It is available on their official website, simplifying the process of evaluation.
Impact of AI in Healthcare
There are multiple use cases of AI in health insurance to understand its overall impact. Health insurance in India is being revolutionised each day. Streamlining operations, reducing costs, enhancing customer experience, and improving risk management are some of the effects of artificial intelligence.
However, it is crucial to address the challenges related to data privacy, algorithmic bias, regulatory compliance, and the need for skilled professionals to ensure responsible and ethical implementation of AI in this critical sector. As AI technologies continue to advance, their integration into health insurance will likely deepen, leading to further innovations and transformations in the industry.
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AI In Health Insurance: FAQS
1. What is artificial intelligence in health insurance?
Artificial intelligence refers to the application of advanced algorithms and machine learning to analyse complex medical data. It helps diagnose symptoms and also recommends accurate health plans for patients.
2. How is artificial intelligence used in health insurance?
AI in health insurance is used in many tools like chatbots, for the underwriting process, personalised health plan selection, and more.
3. What are the benefits of AI in health insurance?
AI offers numerous benefits to the health insurance industry, impacting various aspects of operations, cost efficiency, customer experience, and risk management.
4. Can artificial intelligence predict the cost of health insurance for policyholders?
Yes, artificial intelligence (AI) can be used to predict the cost of health insurance for policyholders. AI and machine learning algorithms can analyse vast datasets to forecast individual health risks and, consequently, the potential cost of health insurance. This allows insurers to offer more precise and personalised pricing models to health policy buyers.
5. How does AI make the claim process quicker?
AI streamlines the claims processing through automation and faster turnaround, enhancing fraud detection with anomaly analysis, enabling personalised coverage and pricing based on individual risk factors, improving customer experience with AI-powered support, accelerating underwriting with better risk prediction, reducing administrative costs by automating repetitive tasks, and providing predictive analytics for informed decision-making.
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Written By: Simran Kaur Vij
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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