Q1 2027 Narayana Hrudayalaya Ltd Earnings Call

August 3, 2026

Operator: Good afternoon everyone, welcome to the Q1 FY27 earnings call of Narayana Hrudayalaya Limited. We thank you for joining us today. On the call from the management team we have with us Dr. Emmanuel Rupert, CEO and MD, Ms. Sandhya Jayaraman, Group CFO, Mr. Venkatesh, Group COO, Dr. Anesh Shetty, MD of the International Business, Mr. Ravi Viswanathan, CEO of NHIC, Mr. Nishant Singh, Head of Investor Relations, and Mr. Vivek Agarwal, Deputy General Manager, Finance and Investor Relations. The results presentation and financial statements have already been uploaded on the stock exchanges and are also available on the company's website.

Operator: Good afternoon everyone, welcome to the Q1 FY27 earnings call of Narayana Hrudayalaya Limited. We thank you for joining us today. On the call from the management team we have with us Dr. Emmanuel Rupert, CEO and MD, Ms. Sandhya Jayaraman, Group CFO, Mr. Venkatesh, Group COO, Dr. Anesh Shetty, MD of the International Business, Mr. Ravi Vishwanath, CEO of NHIC, Mr. Nishant Singh, Head of Investor Relations, and Mr. Vivek Agarwal, Deputy General Manager, Finance and Investor Relations. The results presentation and financial statements have already been uploaded on the stock exchanges and are also available on the company's website.

Speaker #1: Good morning, everyone.

Speaker #2: And welcome to the Q1 FY27 earnings call of Narayana Hrudayalaya Limited. We thank you for joining us today. On the call from the management team, we have with us Dr. Emmanuel Rupert, CEO and MD; Ms. Sandhya Jayaraman, Group CFO; Mr. Venkatesh, Group COO; Dr. Aneesh Shetty, MD of the International Business; Mr. Ravi Vishwanathan, CEO of NHIC; Mr. Nishant Singh, Vice President, Finance and Investor Relations; and Mr. Vivek Agarwal, Deputy General Manager, Finance and Investor Relations.

Speaker #2: The results presentation and financial statements have already been uploaded on the stock exchanges and are also available on the company's website. Before we proceed with this call, we would like to remind everyone that anything being said on this call that reflects any outlook for the future or can be construed as a forward-looking statement must be viewed in conjunction with the uncertainties and risks that we face.

Operator: Before we proceed with this call, we would like to remind everyone that everything that is being said on this call that reflects any outlook for the future, or which can be construed as a forward-looking statement, must be viewed in conjunction with the uncertainties and the risks that they face. Please note that this call is for the duration of 1 hour. We will address questions pertaining to the India business first 30 minutes, followed by international business. Given the limited time available, participants are requested to ask maximum two questions at a time and join the queue for any follow-up questions. With that, now we would like to start the Q&A. I request everyone to use the raise hand icon to go ahead with your question. Participants, you may click on the raise hand icon to proceed with your question. First question is from Prithwiraj.

Operator: Before we proceed with this call, we would like to remind everyone that everything that is being said on this call that reflects any outlook for the future, or which can be construed as a forward-looking statement, must be viewed in conjunction with the uncertainties and the risks that they face. Please note that this call is for the duration of one hour. We will address questions pertaining to the India business first 30 minutes, followed by international business. Given the limited time available, participants are requested to ask maximum two questions at a time and join the queue for any follow-up questions. With that, now we would like to start the Q&A. I request everyone to use the raise hand icon to go ahead with your question. Participants, you may click on the raise hand icon to proceed with your question. First question is from Prithviraj.

Speaker #2: Please note that this call is scheduled for 1 hour. We will address questions pertaining to the India business for the first 30 minutes, followed by international business.

Speaker #2: Given the limited time available, participants are requested to ask a maximum of two questions at a time and join the queue for any follow-up questions. With that, we would now like to start the Q&A.

Speaker #2: I request everyone to use the Raise Hand icon to go ahead with your question. Participants may click on the Raise Hand icon to proceed with your question.

Speaker #2: First question is from Prithviraj. Kindly announce your company name and proceed with your question.

Operator: Kindly announce your company name and proceed with your question.

Speaker #3: Hi, this is Prithviraj from Unifi Capital. Let me begin with the domestic hospital space first. I think the EBITDA of 40%, despite not adding any beds in the last 7 to 8 years, is quite remarkable.

[Analyst] (Unifi Capital): Hi. This is Prithwiraj from Unifi Capital. Let me begin with the domestic hospital space first. I think the EBITDA growth of 40%, despite not adding any base in the last 7 to 8 years is quite remarkable. In this context, my first question is with respect to the revenue growth. I think till last few quarters, the entire revenue growth for India hospitals came from ARPOB, but this time, surprisingly, even the footfalls went up. Could you explain that, and how should we look at it going forward? Will it be a combination of ARPOB plus footfalls, or it will be predominantly ARPOB till you commission the new hospitals?

[Analyst] (Unifi Capital): Hi. This is Prithviraj from Unifi Capital. Let me begin with the domestic hospital space first. I think the EBITDA growth of 40%, despite not adding any base in the last 7 to 8 years is quite remarkable. In this context, my first question is with respect to the revenue growth. I think till last few quarters, the entire revenue growth for India hospitals came from ARPOB, but this time, surprisingly, even the footfalls went up. Could you explain that, and how should we look at it going forward? Will it be a combination of ARPOB plus footfalls, or it will be predominantly ARPOB till you commission the new hospitals?

Speaker #3: In this context, my first question is with respect to the revenue growth. I think till the last few quarters, the entire revenue growth for India hospitals came from RPOP, but this time, surprisingly, even the footfalls went up.

Speaker #3: So, you know, could you explain that, and how should we look at it going forward? Will it be a combination of RPOP plus footfalls, or will it be predominantly RPOP till you commission the new hospitals?

Speaker #4: Hi, Prithviraj. I'll take this up. We've lately been doing a lot of high-end procedures, and also, the robotic work has gone up substantially.

R. Venkatesh: Hi, Prithwiraj. I'll take this up. We've been obviously doing a lot of high-end procedures, and also the robotic work has gone up substantially. If you see the margin improvement over the last 2 to 3 quarters, they are basically on account of high volume of high-end procedures and also increased use of technology and robotics. If you see the presence of our clinic across the network in mainly around Bangalore, has actually strengthened the brand reputation of the hospital network, resulting in increased footfall. If you look at the data of Clinics, we do more or less the total footfalls of patients in clinic is approximately 30% of the total overall footfalls in the hospital. That is also the level of contribution clinics are doing. That is also complemented towards increasing of the footfall.

R. Venkatesh: Hi, Prithwiraj. I'll take this up. We've been obviously doing a lot of high-end procedures, and also the robotic work has gone up substantially. If you see the margin improvement over the last two to 3 quarters, they are basically on account of high volume of high-end procedures and also increased use of technology and robotics. If you see the presence of our clinic across the network in mainly around Bangalore, has actually strengthened the brand reputation of the hospital network, resulting in increased footfall. If you look at the data of Clinics, we do more or less the total footfalls of patients in clinic is approximately 30% of the total overall footfalls in the hospital. That is also the level of contribution clinics are doing. That is also complemented towards increasing of the footfall.

Speaker #4: So if you see the margin improvement over the last two to three quarters, they are basically on account of a high volume of high-end procedures and also increased use of technology and robotics.

Speaker #4: And also, if you see, the presence of our clinic across the network, mainly around Bangalore, has actually strengthened the brand reputation of the hospital network, resulting in increased footfall.

Speaker #4: If you look at the data of clinics, we do more or less, the total footfalls of patients in clinics is approximately 30% of the total OPD footfalls.

Speaker #4: In the hospital, so that is also the level of contribution clinics are making. That is also contributing towards increasing footfall. And overall, general demand is also strong as far as healthcare is concerned.

R. Venkatesh: Overall general demand is also strong as far as healthcare is concerned. We have seen a good traction in terms of volumes coming across the network, across all the regions. It has been a good combination of volumes as well as realizations. Going forward, we would strive towards continuing with such a combination in the quarters to come. Obviously we will not be able to boil down to any specific numbers. We would always work towards getting a combination of both volumes and realizations in the quarters to come. Yeah.

Speaker #4: So we have seen a good traction in terms of volumes coming across the network across all the regions. And it has been a good combination of volumes as well as realizations and going forward, we would strive towards continuing with such a combination in the quarters to come, but obviously we will not be able to boil down to any specific numbers but we would always work towards getting a combination of both volumes and realizations in the quarters to come.

Speaker #3: Fantastic. Yeah, just on the margin front, you made the point about the 24% EBITDA margin. So, if you compare your RPOP with other competitors, it is significantly lower; however, your margins are largely on par with the competitors.

[Analyst] (Unifi Capital): That's clear. Just on margin front, you made a point of the 24% EBITDA margin. If you compare your ARPOB with the other competitors, it is significantly lower. However, your margins are largely on par with your competitors. I understand you have taken several initiatives on efficiency, et cetera. You think, is there a further scope for hospitals margins to go up or it should stabilize at these levels?

Speaker #3: And you know, you have taken several initiatives on efficiency, etc. But do you think there is further scope for hospital margins to go up, or should they stabilize at these levels?

Speaker #4: And I want to take that.

R. Venkatesh: Sandhya, you want to take that?

Speaker #5: Yes, sure, Venkatesh. If you look at how our margin journey—like you had acknowledged—we haven't added any beds, but we've been able to deliver incremental revenue and throughput.

Sandhya Jayaraman: Yes, sure, Venkatesh. If you look at how our margin journey, like you had acknowledged that we haven't added any beds, but we've been able to deliver incremental revenue and throughput. That is what is giving us the expansion that we are seeing in margins in addition to footfalls, as you call that. This will continue because we don't have any meaningful bed addition coming in for the next two to three years. Having said that, we have to make a choice on the leverage benefits. We are an operator that works with an affordable care philosophy. We will continue to make that choice on how much do we pull back into cash flows and thereby fueling our expansion initiatives, how much we are going to continue to invest into our new growth verticals, like integrated care, and how much we will pass back to the customers.

Speaker #5: And that is what is giving us the expansion we are seeing in margins, in addition to the footfalls that you called out. This will continue because we don't have any meaningful bed additions coming in for the next two to three years.

Speaker #5: Having said that, we have to make a choice on the leverage benefit. We are an operator that works within the affordable care philosophy, so we will continue to make that choice on how much we pull back into cash flows and thereby fuel our expansion initiatives.

Speaker #5: How much are we going to continue to invest into our new growth verticals, like integrated care, and how much will we pass back to the customers?

Speaker #5: And those operational decisions, we will make as we go through this journey. It is not possible to give a projection on that, but what we can definitely see is that we will see expansion in the core operating margin of the business, given the leverage benefit that we will enjoy.

Sandhya Jayaraman: Those operational decisions we will make as we go through this journey. It is not possible to give a prediction on that, what we can definitely see is that we will see expansion in the core operating margin of the business, given the leverage benefit that we will enjoy.

Speaker #3: One final question on the domestic business. If you look at the insurance space, I think the losses shot up significantly during the quarter. Just trying to understand, you know, what has changed so much in one quarter that the losses spiked up in a big way.

[Analyst] (Unifi Capital): One final question on domestic business. If you look at the insurance space, I think the losses shot up significantly during the quarter. Just trying to understand, what has changed so much in one quarter that the losses spiked up in a big way. Should we expect these losses to sustain for the next few quarters, or is it more of a one-off quarter? What explains this domestic insurance losses?

Speaker #3: And should we expect these losses to sustain for the next few quarters, or is it more of a one-off quarter? So, what explains these domestic insurance losses?

Speaker #4: Ravi, can you just take this up next?

R. Venkatesh: Ravi, can you just take this up, please?

Speaker #1: Sure. Hi, Prithviraj. No, I mean, absolutely right. I think a few things here to kind of keep in mind in this—it is still a relatively small book, and so a few large claims sometimes can have a disproportionate impact.

Ravi Viswanathan: Sure. Hi, Prithvi. Absolutely right. I think a few things here to kind of keep in mind on this. It is still a relatively small book, a few large claims sometimes can have a disproportionate impact when you look at loss ratios. At the same time, when you look at the growth, there are other benefits. You would have seen also the expense ratio came down substantially. You've got to kind of a little bit balance both those things. In our case, the issue is contained to a few policies. Having said that, as part of our priorities we're working on a number of initiatives to ensure that we manage our portfolio for long-term sustainability. As I said before, right? Small book can be still volatile for a little while until it comes to a little bit of scale.

Ravi Vishwanath: Sure. Hi, Prithvi. Absolutely right. I think a few things here to kind of keep in mind on this. It is still a relatively small book, a few large claims sometimes can have a disproportionate impact when you look at loss ratios. At the same time, when you look at the growth, there are other benefits. You would have seen also the expense ratio came down substantially. You've got to kind of a little bit balance both those things. In our case, the issue is contained to a few policies. Having said that, as part of our priorities we're working on a number of initiatives to ensure that we manage our portfolio for long-term sustainability. As I said before, right? Small book can be still volatile for a little while until it comes to a little bit of scale.

Speaker #1: When you look at loss ratios, but at the same time, when you look at the growth, there are other benefits. So, you would have seen also that the expense ratio came down substantially.

Speaker #1: And, you know, so you've got to kind of balance both those things a little bit. In our case, the issue has been contained to a few policies.

Speaker #1: And having said that, as part of our priorities, you know, we're working on a number of initiatives to ensure that we manage our portfolio for long-term sustainability.

Speaker #1: As I said before, right, a small book can still be volatile for a little while until it comes to a little bit of scale.

Speaker #1: But, you know, we're not waiting for that. We're working on a number of initiatives. Some of these I can share with you. For example, we're implementing AI solutions across the board to review claims and minimize fraud, waste, and abuse in claims, especially outside our preferred network.

Ravi Viswanathan: We're not waiting for that. We're working on a number of initiatives. Some of these I can share with you. For example, we're implementing AI solutions across the board to review claims and minimize fraud waste reviews in claims, especially outside our preferred network. We're in-housing more and more claims to ensure we bring not only a policy view but also a health expertise view in these reviews, right? That's one of the unique things that as Narayana Health Insurance we can bring to the table that others may not have. We continue to sharpen our audits with our partners to ensure there is high quality in claims operations, for example, with TPAs. In terms of future growth as well, portfolio-wise, we continue to focus on SME and retail business as growth drivers. As you know, those have got better margins than, say, larger GMC accounts.

Ravi Vishwanath: We're not waiting for that. We're working on a number of initiatives. Some of these I can share with you. For example, we're implementing AI solutions across the board to review claims and minimize fraud waste reviews in claims, especially outside our preferred network. We're in-housing more and more claims to ensure we bring not only a policy view but also a health expertise view in these reviews, right? That's one of the unique things that as Narayana Health Insurance we can bring to the table that others may not have. We continue to sharpen our audits with our partners to ensure there is high quality in claims operations, for example, with TPAs. In terms of future growth as well, portfolio-wise, we continue to focus on SME and retail business as growth drivers. As you know, those have got better margins than, say, larger GMC accounts.

Speaker #1: We're in-housing more and more claims to ensure we bring not only a policy view, but also a health expertise view in these reviews, right?

Speaker #1: And that's one of the unique things that, as Narayana Health Insurance, we can bring to the table that others may not have. We continue to sharpen our audits with our partners to ensure there's high quality in claims operations.

Speaker #1: For example, with TPAs. And in terms of future growth as well, portfolio-wise, we continue to focus on SME and retail business as growth drivers.

Speaker #1: And as you know, those have got better margins than, say, larger GMC accounts. So it's a combination of all of these things. And as these measures start to deliver benefits and the book size grows—which is important—I feel confident the loss ratio will moderate to acceptable levels over a period of time.

Ravi Viswanathan: It's a combination of all of these things. As these measures start to deliver benefits and the book size grows, which is important, I feel confident the loss ratio will moderate to acceptable levels over a period of time. In the short term, we might still see some volatility in the book until it achieves a little bit of scale, because some of this is law of large numbers. I hope that answers your question.

Ravi Vishwanath: It's a combination of all of these things. As these measures start to deliver benefits and the book size grows, which is important, I feel confident the loss ratio will moderate to acceptable levels over a period of time. In the short term, we might still see some volatility in the book until it achieves a little bit of scale, because some of this is law of large numbers. I hope that answers your question.

Speaker #1: Levels over a period of time. But in the short term, we might still see some volatility in the book until it achieves a little bit of scale, because some of this is the law of large numbers.

Speaker #1: I hope that answers your question.

Speaker #2: Thank you, Prithviraj. I'll request to come back for a follow-up. Participants can click on the 'Ask a Question' tab. Participants, you can click on the 'Raise Hand' icon to ask a question.

Operator: Thank you, Prithviraj. I'll request to come back for a follow-up. Participants can click on Ask a Question tab. Participants, you can click on the Raise Hand icon to ask a question. Participants can click on the Raise Hand icon to ask a question. Next follow-up question is from the line of Prithviraj. Please go ahead.

Speaker #2: Participants can click on the raise hand icon to ask a question. Next follow-up question is from the line of Prithviraj. Please go ahead.

Speaker #3: Yeah, I just have one follow-up on this insurance business again. So, how much of the claims are coming to your own hospital chain, and how much of the claims are going to third-party hospitals at this point in time?

[Analyst] (Unifi Capital): Yeah, I just have one follow-up on this insurance business again. How much of the claims are coming to your own hospital chain, and how much of the claims are going to the third-party hospitals at this point in time? Is that a reason that explains the higher losses?

Speaker #3: And is that a reason that explains the higher losses?

Speaker #1: So, maybe I can take that and then others could chime in if you want. So, a couple of things on this, right?

Ravi Viswanathan: Maybe I can take that and others could chime in if you want. A couple of things on this, right? I don't think we're prepared at this point in time to disclose some of those numbers. Having said that, as Venkatesh was talking about for the clinics business, for example. Similarly, the insurance business has a lot in terms of brand visibility for the group. As these customers come in and as we get more and more engagement with these customers and introduce them to the entire gamut of services that Narayana Health provides. Over time, we believe that we feel confident that they will consider NH for all their advanced diagnostics and their hospitalization needs. We will continue to see a large portion of people coming to our hospital.

Ravi Vishwanath: Maybe I can take that and others could chime in if you want. A couple of things on this, right? I don't think we're prepared at this point in time to disclose some of those numbers. Having said that, as Venkatesh was talking about for the clinics business, for example. Similarly, the insurance business has a lot in terms of brand visibility for the group. As these customers come in and as we get more and more engagement with these customers and introduce them to the entire gamut of services that Narayana Health provides. Over time, we believe that we feel confident that they will consider NH for all their advanced diagnostics and their hospitalization needs. We will continue to see a large portion of people coming to our hospital.

Speaker #1: I don't think we're prepared at this point in time to disclose some of those numbers. Having said that, as Venkatesh was talking about for the clinics business, for example, similarly, the insurance business has a lot in terms of brand visibility for the group.

Speaker #1: And as these customers come in, and as we get more and more engagement with these customers and introduce them to the entire gamut of services that Narayana Health provides, over time we believe—and we feel confident—that they will consider NH for all their advanced diagnostics and hospitalization needs.

Speaker #1: And we will continue to see a large portion of people, or we will see a large portion of people, coming to our hospital. Having said that, in our group policies at the moment, we do offer people choice.

Ravi Viswanathan: Having said that, in our group policies at the moment, we do offer people choice and we're working hard to win these customers to our hospitals by making sure they get great service in the hospital, making sure that the overall experience they have is good and engaging deeply with them to ensure that our hospital is at the top of their mind when they're considering their hospitalization needs. That's kind of where we are. We do have a difference. Broadly what I can tell you is that on the retail side, a lot of our customers come to our hospitals by choice. On the group side, we are seeing those numbers improving, but we continue to work on that and to be top of mind for our customers to consider NH when they require hospitalization.

Ravi Vishwanath: Having said that, in our group policies at the moment, we do offer people choice and we're working hard to win these customers to our hospitals by making sure they get great service in the hospital, making sure that the overall experience they have is good and engaging deeply with them to ensure that our hospital is at the top of their mind when they're considering their hospitalization needs. That's kind of where we are. We do have a difference. Broadly what I can tell you is that on the retail side, a lot of our customers come to our hospitals by choice. On the group side, we are seeing those numbers improving, but we continue to work on that and to be top of mind for our customers to consider NH when they require hospitalization.

Speaker #1: And, you know, we're working hard to win these customers to our hospitals by making sure they get great service in the hospital, making sure that the overall experience they have is good, and engaging deeply with them to ensure that, you know, our hospital is at the top of their mind when they're considering their hospitalization needs.

Speaker #1: So that's kind of where we are. You know, we do have a difference, more, I mean, broadly what I can tell you is that on the retail side, a lot of our customers come to our come to our hospitals by choice.

Speaker #1: And on the group side, we are seeing those numbers improving, but we continue to work on that. We want to be top of mind for our customers so they consider NH when they require hospitalization.

Speaker #2: Thank you. Next question is from the line of Japreet Singh. Kali announced your company name; please proceed with your question.

Operator: Thank you. Next question is from the line of Japjit Singh. Kindly announce your company name and proceed with your question.

Operator: Thank you. Next question is from the line of Japrit Singh. Kindly announce your company name and proceed with your question.

Speaker #4: My question is: What is the current royalty of our UK business?

Japjit Singh: Hello, sir. My question is, what is the current ROCE of our UK business?

[Analyst 1]: Hello, sir. My question is, what is the current ROCE of our UK business?

Speaker #5: Can you kindly repeat the question? It wasn't very clear to us.

Sandhya Jayaraman: Can you kindly repeat the question? It wasn't very clear for us.

Speaker #4: What is the royalty of our UK business currently?

Japjit Singh: What is the ROCE of our UK business currently?

[Analyst 1]: What is the ROCE of our UK business currently?

Speaker #5: So I think it is too early to measure the royalty of the UK business at the moment. It's very early days for us. We have acquired that business.

Sandhya Jayaraman: I think it is too early to measure the ROCE of the UK business at the moment. It's very early days for us. We have just acquired that business. We can start reporting this maybe four quarters from now.

Speaker #5: So, we can start reporting this maybe four quarters from now.

Speaker #4: Is there any target by 2030? Any milestone that we will achieve, so that we can say the UK acquisition was a good capital allocation? Are there any targets?

Japjit Singh: Is there any target by 2030 or any milestone that we will achieve that we can say UK acquisition as a good capital allocation? Is there any targets?

[Analyst 1]: Is there any target by 2030 or any milestone that we will achieve that we can say UK acquisition as a good capital allocation? Is there any targets?

Speaker #5: Anish, do you want to take that question?

Sandhya Jayaraman: Anesh, you want to take that question?

Speaker #3: Yeah, thank you. Japreet, we'd like to have the international question in the second half, but since you've asked, I think, as we said during the acquisition time itself, you know, we don't have any particular definite number to disclose as a royalty target.

Anesh Shetty: Yeah, thank you. Japjit, we'd like to have the international question in the second half. Since you've asked, I think as we said during the acquisition time itself, we don't have any particular definite number to disclose as a ROCE target. Having said that, we believe that the assets were acquired at a very reasonable price, and there is a substantial opportunity for us to improve their earnings compared to where they are now and when we acquired it, without any significant further capital deployment in that market with the existing capital base that already exists.

Anesh Shetty: Yeah, thank you. Japrit, we'd like to have the international question in the second half. Since you've asked, I think as we said during the acquisition time itself, we don't have any particular definite number to disclose as a ROCE target. Having said that, we believe that the assets were acquired at a very reasonable price, and there is a substantial opportunity for us to improve their earnings compared to where they are now and when we acquired it, without any significant further capital deployment in that market with the existing capital base that already exists.

Speaker #3: Having said that, we believe the assets were acquired at a very, very reasonable price, and there is a substantial opportunity for us to improve their earnings compared to where they are now and when we acquired them.

Speaker #3: Without any significant further capital deployments in that market, with the existing capital base that already exists.

Speaker #2: Thank you. Next question is from the line of Sajal Kapoor. Kali announced your company name, and proceed with your question.

Operator: Thank you. Next question is from the line of Sajal Kapur. Kindly announce your company name and proceed with your question.

Operator: Thank you. Next question is from the line of Sajal Kapoor. Kindly announce your company name and proceed with your question.

Speaker #3: Yeah, hi. Hi team, this is Sajal from Anti-Fragile Thinking. Thanks for giving me this opportunity. My first question is: What evidence do we have today that owning both insurance and care delivery gives Narayana a structural underwriting advantage, rather than simply transferring economics between the insurer and the hospital?

Sajal Kapur: Yeah. Hi, team. This is Sajal from Antifragile Thinking, thanks for giving me this opportunity. My first question is: what evidence do we have today that owning both insurance and care delivery gives Narayana a structural underwriting advantage rather than simply transferring economics between insurer and the hospital?

Sajal Kapoor: Yeah. Hi, team. This is Sajal from Antifragile Thinking, thanks for giving me this opportunity. My first question is: what evidence do we have today that owning both insurance and care delivery gives Narayana a structural underwriting advantage rather than simply transferring economics between insurer and the hospital?

Speaker #3: And yeah, do you want me to take that?

Anesh Shetty: Sandhya, you want me to take that?

Speaker #5: Yeah, Anish.

Speaker #3: Yeah. So, hi Sajal, thank you for your question. Just to clarify, due to a prior travel commitment and some delays, Viren is unable to attend this call.

Sandhya Jayaraman: Yeah, Anesh.

Anesh Shetty: Yeah. Hi, Sajal. Thank you for your question. Just to clarify, sorry, due to a prior travel commitment and some delays there, Viren is unable to attend this call, so he sends his apologies. To your question, I think just keeping the underwriting advantage aside for now, if you look at our actual experience in a very short time, where we have the largest cluster of clinics is in Bangalore. The footfalls, the outpatient footfalls in those small clinics in aggregate represents a little over a third of what we see in our flagship hospital in Bangalore, including the HSR second hospital in Bangalore as well.

Speaker #3: So, he sends us his apologies. To your question, I think just keeping the underwriting advantage aside for now, if you look at our actual experience in a very short time, where we have the largest cluster of clinics is in Bangalore.

Speaker #3: And the footfalls—the outpatient footfall in those small clinics in aggregate—represents a little over a third of what we see in our flagship hospital in Bangalore, including the HSR second hospital in Bangalore as well.

Speaker #3: Now, when we look at the referral potential and what we're actually seeing being referred in, it is a phenomenal driver of activity volume and is empowering a lot of the growth we're seeing in our footfall and conversions, especially around the high-end complex procedures, robotic surgeries, et cetera.

Anesh Shetty: Now, when we look at the referral potential and what we're actually seeing being referred in, it is a phenomenal driver of activity, volume, and empowering a lot of the growth we're seeing in our footfall and conversions, especially around the high-end complex procedures, robotic surgeries, et cetera, the complex cardiac interventions and so on. To your second question about the underwriting model itself. Now, there is very little medical underwriting happening in the insurance industry as we speak. We have an ability to understand the consumption patterns through the people who are subscribers for our clinics. We render the bulk of their primary care, the bulk of their pharmaceutical needs, the bulk of their diagnostic and follow-up care. This really gives us an ability to understand where people are spending, what are they spending on, and how can we best position ourselves to cater to that.

Speaker #3: The complex cardiac interventions and so on. To your second question about the underwriting model itself, currently, there is very little medical underwriting happening in the insurance industry as we speak.

Speaker #3: We have the ability to understand the consumption patterns through the people who are subscribers to our clinics. We render the bulk of their primary care, the bulk of their pharmaceutical needs, and the bulk of their diagnostic and follow-up care.

Speaker #3: This really gives us the ability to understand where people are spending, what they are spending on, and how we can best position ourselves to cater to that.

Speaker #3: Now, obviously, this is a longer-term play. While we have started seeing very encouraging results with the clinics and the subscription plans, insurance, as Ravi mentioned, is still in the early days.

Anesh Shetty: Now, obviously, this is a longer-term play. While we have started seeing very encouraging results with the clinics and the subscription plans, insurance, as Ravi mentioned, is early days. It's a small book. These things will play out. The early signs do point to us having something interesting to work on where we do have an inherent structural advantage to somebody just selling an open-ended policy to anyone who fulfills certain criteria.

Speaker #3: It's a small book; these things will play out. But the early signs do point to us having something interesting to work on, where we do have an inherent structural advantage compared to somebody just selling an open-ended policy to anyone who fulfills certain criteria.

Speaker #3: No, that's helpful. Anish, I mean, just a quick follow-up on that one. So, some of the patients would have renewed their policy, right? And given their past behavior, we potentially understand them a little better in terms of what kind of system they have in terms of their own sort of mental and physical well-being, as well as their pattern of submitting a claim.

Sajal Kapur: No, that's helpful, Anesh. Just a quick follow-up on that one. Some of the patients would have renewed their policy, right? Given their past behavior, we potentially understand them a little better in terms of what kind of system they have in terms of their own sort of mental and physical well-being, as well as their pattern of submitting a claim, and how does that reflect in the pricing for the renewal? That's one. As a system, we are continuously learning because, yes, it's a smaller book and early days for us. How is that learning getting reflected in our underwriting decision-making for the new patients that were never part of our network?

Sajal Kapoor: No, that's helpful, Anesh. Just a quick follow-up on that one. Some of the patients would have renewed their policy, right? Given their past behavior, we potentially understand them a little better in terms of what kind of system they have in terms of their own sort of mental and physical well-being, as well as their pattern of submitting a claim, and how does that reflect in the pricing for the renewal? That's one. As a system, we are continuously learning because, yes, it's a smaller book and early days for us. How is that learning getting reflected in our underwriting decision-making for the new patients that were never part of our network?

Speaker #3: And how does that reflect in the pricing for the renewal? And that's one. And then, as a system, we are continuously learning, because yes, it's a smaller book and early days for us.

Speaker #3: How is that learning being reflected in our underwriting decision-making for the new patients who were never part of our network?

Speaker #4: Sure. I'll pass it on to Ravi. But just a quick comment—for a good number of our patients, given our role as both a provider and insurer, we actually are the only people who can underwrite them and price out the policy, as well as handle a renewal to reflect their changing health status.

Anesh Shetty: Sure. I'll pass it on to Ravi. Just a quick comment. For a good number of our patients, given our role as both a provider and insurer, we actually are the only people who can underwrite them and price out the policy as well as a renewal to reflect their changing health status. Ravi, do you want to take Sajal's question?

Speaker #4: But Ravi, do you want to take Sajal's question?

Speaker #6: Yes, certainly. So a few things, Sajal. So one thing, just to keep in mind and kind of be very clear about, right, is that in India, at the moment at least, you know, we can't change somebody's renewal premium.

Ravi Viswanathan: Yeah, certainly. A few things there, Sajal. One thing just to keep in mind and kind of be very clear about, is that in India, at the moment at least, we cannot change somebody's renewal premium based on, let's say, deterioration in their health, right? That's one thing to keep in mind, and we of course, do not do that. Having said that, let's think about how this benefits us over a period of time. There are two parts to this. One is while I may not be able to change prices at an individual level, what this gives me a very good sense of is what's happening at a portfolio level, at my overall group retail portfolio, and at a group policy level, I have a good sense of what the claims are going to be next year.

Ravi Vishwanath: Yeah, certainly. A few things there, Sajal. One thing just to keep in mind and kind of be very clear about, is that in India, at the moment at least, we cannot change somebody's renewal premium based on, let's say, deterioration in their health, right? That's one thing to keep in mind, and we of course, do not do that. Having said that, let's think about how this benefits us over a period of time. There are two parts to this. One is while I may not be able to change prices at an individual level, what this gives me a very good sense of is what's happening at a portfolio level, at my overall group retail portfolio, and at a group policy level, I have a good sense of what the claims are going to be next year.

Speaker #6: Based on, let's say, deterioration in their health, right? So that's one thing to keep in mind. And we, of course, don't do that. Having said that, let's think about how this benefits us, you know, over a period of time, right?

Speaker #6: There are two parts to this. One is, while I may not be able to change prices at an individual level, what this gives me is a very good sense of what's happening at a portfolio level, overall group, a retail portfolio, and at a group policy level. I have a good sense of what the claims are going to be next year.

Speaker #6: When you typically underwrite a group policy, right, you have some information and it's kind of imperfect—that most companies would underwrite with. In our case, we have a good idea of what claims have already happened.

Ravi Viswanathan: When you typically underwrite a group policy, you have some information, and it's kind of imperfect that most companies would underwrite with. In our case, we have a good idea of what claims have already happened and are unlikely to repeat next year, what claims have not happened yet but we know are going to happen next year, and price our renewal group at a group level accordingly and make changes at the price level as per the requirements at a portfolio level, right? That is a significant advantage that we have. As our policies come to renewals, we have just started getting into a renewal cycle on our retail book and have got three policies so far renewed on the group side and more to come. We see that this is becoming something that is becoming more and more valuable to us.

Ravi Vishwanath: When you typically underwrite a group policy, you have some information, and it's kind of imperfect that most companies would underwrite with. In our case, we have a good idea of what claims have already happened and are unlikely to repeat next year, what claims have not happened yet but we know are going to happen next year, and price our renewal group at a group level accordingly and make changes at the price level as per the requirements at a portfolio level, right? That is a significant advantage that we have. As our policies come to renewals, we have just started getting into a renewal cycle on our retail book and have got three policies so far renewed on the group side and more to come. We see that this is becoming something that is becoming more and more valuable to us.

Speaker #6: And unlikely to repeat next year. What claims haven't happened yet, but we know are going to happen next year. And price our renewal group at a group level accordingly, and make changes at a price level as per the requirements at a portfolio level, right?

Speaker #6: So that is a significant advantage that we have. And as our policies come up for renewal—right, we've just started getting into the renewal cycle—and, on our retail book, we have got, you know, three policies so far renewed on the group side.

Speaker #6: And more to come. And we see that this is becoming something that is becoming more and more valuable to us. The other part is the entire engagement that we do with customers.

Ravi Viswanathan: The other part is the entire engagement that we do with customers. If you think about it in a slightly different way from a customer's perspective, what do we bring to the table for the customer? We allow. Because we understand their health, unlike another insurance company, we can actually intervene earlier and we can send somebody to the hospital and recommend that do the surgery now. It is better for the customer. It is hopefully less complicated. It is quicker recovery. It is a lower cost to the insurance company as well. There is a number of things here that play that allow us to impact the life of the customer in a very positive way while also managing our overall book in a sustainable way. That is the unique thing that we have as an insurance company that is promoted by a hospital.

Ravi Vishwanath: The other part is the entire engagement that we do with customers. If you think about it in a slightly different way from a customer's perspective, what do we bring to the table for the customer? We allow. Because we understand their health, unlike another insurance company, we can actually intervene earlier and we can send somebody to the hospital and recommend that do the surgery now. It is better for the customer. It is hopefully less complicated. It is quicker recovery. It is a lower cost to the insurance company as well. There is a number of things here that play that allow us to impact the life of the customer in a very positive way while also managing our overall book in a sustainable way. That is the unique thing that we have as an insurance company that is promoted by a hospital.

Speaker #6: So, if you think about it in a slightly different way from a customer's perspective, right, what do we bring to the table for the customer?

Speaker #6: We allow because we understand their health. Unlike another insurance company, we can actually intervene earlier, and we can send somebody to the hospital and recommend that they do this surgery now.

Speaker #6: It's better for the customer. It's hopefully less complicated. It's a quicker recovery. And it is a lower cost for the insurance company as well. So, there are a number of things here at play that allow us to impact the life of the customer in a very positive way.

Speaker #6: while also managing our overall book in a sustainable way. And that is the unique thing that we have as an insurance company that is promoted by a hospital.

Speaker #6: The only insurance company is promoted by a hospital.

Ravi Viswanathan: The only insurance company that is promoted by a hospital.

Ravi Vishwanath: The only insurance company that is promoted by a hospital.

Speaker #3: That's helpful, thank you. And my second question is related to a classic tension. When the hospital benefits from doing more and the insurer benefits from doing less, how does Narayana decide what is optimal for the system as a whole?

Sajal Kapur: That's helpful. Thank you. My second question is related to a classic tension. When the hospital benefits from doing more and insurer benefits from doing less, how does Narayana decide what is optimal for the system as a whole?

Sajal Kapoor: That's helpful. Thank you. My second question is related to a classic tension. When the hospital benefits from doing more and insurer benefits from doing less, how does Narayana decide what is optimal for the system as a whole?

Speaker #4: In the short run, you know, there is a conflict. But in the long run, if the hospital does too much, the insurance arm will not be sustainable.

Anesh Shetty: In the short run, there is a conflict. In the long run, if the hospital does too much, the insurance arm will not be sustainable. If the hospital does too less, that's also not good for the long-term outcomes of the patient. In a short term, yes, one quarter or two, but in a long-term sustainable way, if you look at integrated care models all across the globe, it is a self-check mechanism where you render the right amount of care, not too much, not too less. More importantly, in our market, where there's abundant choice, if the insurance clients perceive that you're denying care or you're not rendering enough care, they will leave and go, which defeats the entire purpose.

Speaker #4: If the hospital does too little, then that's also not good for the long-term outcomes of the patient. So in the short run, yes, one quarter or two.

Speaker #4: But in a long-term sustainable way, if you look at integrated care models all across the globe, it is a self-check mechanism where you render the right amount of care—not too much, not too little.

Speaker #4: But more importantly, in our market where there's abundant choice, if the insurance company or the insurance clients perceive that you're denying care or you're not rendering enough care, they will leave and go.

Speaker #4: Which defeats the entire purpose.

Speaker #5: Thank you, Sajal. I'll request to come back for a follow-up. I request all the participants to kindly limit yourselves to two questions per participant. Next question.

Operator: Thank you, Sajal. I request to come back for a follow-up. I request all the participants, kindly limit yourself to two questions per participant. Next question.

Speaker #4: I request Ravi to take a pertinent question from the chat box. Ravi, if you could just see that question on question number one, out of all the patients admitted in the Narayana Hospital this quarter, sure.

R. Venkatesh: I request Ravi to take a pertinent question from the chat box. Ravi, if you could just see that question on the question number 1 out of the all patients admitted in the Narayana Hospital this quarter.

Speaker #4: Are you able to see that question?

Speaker #6: I am. I will just read that out for people's benefit and quickly answer that. We did cover this a little bit earlier as well.

Ravi Viswanathan: Sure.

Ravi Vishwanath: Sure.

R. Venkatesh: Are you able to see that question?

Ravi Viswanathan: I am. I will just read that out for people's benefits and quickly answer that. We did cover this a little bit earlier as well. Out of all the patients admitted in the hospital this quarter, what percentage originated through our insurance platform compared with traditional referral channels? The first part of the question. Again, we're not prepared at this point to share the percentages, although we track it very diligently. Again, the insurance book is still a small book, and it will take some time before we see really significant impact. That is, of course, the direction that we all are working towards. The second part of the question is, as a book matures in underwriting, do you expect underwriting profitability to improve through premium increases, better risk selection, or lower operating expenses? I would say that first of all three.

Ravi Vishwanath: I am. I will just read that out for people's benefits and quickly answer that. We did cover this a little bit earlier as well. Out of all the patients admitted in the hospital this quarter, what percentage originated through our insurance platform compared with traditional referral channels? The first part of the question. Again, we're not prepared at this point to share the percentages, although we track it very diligently. Again, the insurance book is still a small book, and it will take some time before we see really significant impact. That is, of course, the direction that we all are working towards. The second part of the question is, as a book matures in underwriting, do you expect underwriting profitability to improve through premium increases, better risk selection, or lower operating expenses? I would say that first of all three.

Speaker #6: So, out of all the patients admitted in the hospital this quarter, what percentage originated through our insurance platform compared with traditional referral channels? That’s the first part of the question.

Speaker #6: Again, we're not prepared. I'm just going to share the percentages, although we track it very, very diligently. But again, you know, the insurance book is still a small book.

Speaker #6: And it'll take some time before we see, you know, really significant impact. But that is, of course, the direction that we all are working towards.

Speaker #6: The second part of the question is: as a book matures in underwriting, do you expect underwriting profitability to improve through premium increases, better risk selection, or lower operating expenses?

Speaker #6: I would say that our prior—in order of, first of all, all three. And in order of priority, I think it's very important for us, and it's consistent with our overall approach as a group, to have the lowest possible operating expenses to give the maximum possible benefit back to the customer.

Ravi Viswanathan: In order of priority, I think it's very important for us, and it's consistent with our overall approach as a group to have the lowest possible operating expenses to give the maximum possible benefit back to the customer. That will continue to be a focus, and you would have seen a significant drop in our expense ratio from previous periods and something we'll be working on very closely. Better risk selection, just as a response to the earlier question we spoke a little bit about that. The premium increases will be a fact of life based on how the book performs. Our approach is going to be to be responsible in our pricing and keep doing that and make sure that we are not overpriced or underpriced and trying to be as correctly priced as possible in order to have a sustainable business.

Ravi Vishwanath: In order of priority, I think it's very important for us, and it's consistent with our overall approach as a group to have the lowest possible operating expenses to give the maximum possible benefit back to the customer. That will continue to be a focus, and you would have seen a significant drop in our expense ratio from previous periods and something we'll be working on very closely. Better risk selection, just as a response to the earlier question we spoke a little bit about that. The premium increases will be a fact of life based on how the book performs. Our approach is going to be to be responsible in our pricing and keep doing that and make sure that we are not overpriced or underpriced and trying to be as correctly priced as possible in order to have a sustainable business.

Speaker #6: That will continue to be a focus. And you'd have seen a significant drop in our expense ratio from previous periods, and that's something we'll be working on very, very closely.

Speaker #6: Better risk selection, just in as a response to the earlier conversation we spoke question we spoke a little bit about that. And the premium increases, you know, will be a factor of life.

Speaker #6: Based on how the book performs. And, you know, our approach is going to be to be responsible in our pricing. And, you know, keep doing that and make sure that we are not overpriced or underpriced and trying to be as, you know, as correctly priced as possible in order to have a sustainable business.

Speaker #6: Which means value proposition for the customer as well as, you know, sustainable pricing for ourselves. On the second part, maybe I'll defer to Sandhya or Anish on that.

Ravi Viswanathan: Which means value proposition for the customer as well as sustainable pricing for ourselves. On the second part, maybe I'll defer to Sandhya or Anesh on that, insurance sitting inside a listed company.

Ravi Vishwanath: Which means value proposition for the customer as well as sustainable pricing for ourselves. On the second part, maybe I'll defer to Sandhya or Anesh on that, insurance sitting inside a listed company.

Speaker #6: Insurance sitting inside the listed company.

Speaker #2: Yeah, sure. So the question is, it sits inside the listed company and therefore suppresses consolidated return metrics. Has the board internally defined a maximum acceptable period of cumulative investment, after which the strategy would be reassessed?

Anesh Shetty: Yeah, sure. The question is, it sits inside the listed company and therefore suppresses consolidated return metrics as the board internally defined a maximum acceptable period of cumulative investment after which the strategy would be reassessed. It's a combination of both time and cumulative investment. As Viren mentioned, we did set out broadly the terms in terms of the amount of investment we were willing to make into this. Things are on track, especially ahead of plan with the clinic, slightly behind with the insurance. Every few quarters or so, we'll continue to reassess if the ecosystem benefits do materialize. The early results are encouraging with the clinics. Insurance is too small to judge now. We'll continue to watch and reassess every few quarters or so.

Speaker #4: It's a combination of both time and cumulative investment, as Vireen mentioned. We did set out broadly the terms in terms of the amount of investment we were willing to make into this.

Speaker #4: Things are on track, especially ahead of plan with the clinic, slightly behind with the insurance. But every, you know, few quarters or so, we'll continue to reassess if the ecosystem benefits do materialize.

Speaker #4: The early results are encouraging with the clinics. Insurance is too small to judge now. We'll continue to watch and reassess every few quarters or so.

Speaker #5: Thank you. Next audio question is from Rajat Agarwal. Kindly announce your company name and proceed with your question.

Operator: Thank you. The next audio question is from Rajat Agarwal. Kindly announce your company name and proceed with your question.

Operator: Thank you. The next audio question is from Rajit Aggarwal. Kindly announce your company name and proceed with your question.

Speaker #6: Hi, in your presentation, you mentioned there are three projects which have been postponed: two to FY29 and one to FY30. So, what are the reasons for these postponements?

Rajat Agarwal: Hi. In your presentation, you mentioned there are three projects which have got postponed from FY28 to FY29. Two to FY29, one to FY30. What are the reasons for this postponement, if you can share? Also Southwest Bangalore, the 100 beds which are supposed to come during the current financial, which quarter do we expect them to operationalize?

[Analyst 2]: Hi. In your presentation, you mentioned there are three projects which have got postponed from FY28 to FY29. Two to FY29, one to FY30. What are the reasons for this postponement, if you can share? Also Southwest Bangalore, the 100 beds which are supposed to come during the current financial, which quarter do we expect them to operationalize?

Speaker #6: If you can share. And also, for Southwest Bangalore, the 100 beds which are supposed to come during the current financial year, which quarter do we expect them to be operationalized?

Speaker #3: Yeah, I'll take this. See, among all the projects which we have listed out, most of the projects are within the acceptable timeline. Even if there is a slight delay, they are within that six-month window period of acceptable timeline.

R. Venkatesh: Yeah, I'll take this. See, among all the projects which we have listed out, most of the projects are within the acceptable timeline. Even if there is a slight delay, they are within that 6-month window period of acceptable timeline. There are a couple of asset-light partner model projects which are running a bit slower, specifically because from the partner side, in terms of certain licensing issues or delayed licensing. Which obviously we are in constant discussion with them, it should get sorted in the next month or so. They should cut those delay by a considerable period of time. This is minor delay. Other than that, most of these projects are within the acceptable limits.

Speaker #3: There are a couple of asset-light partner model projects which are running a bit slower, specifically because, from the partner side, there are certain licensing issues or delayed licensing. Obviously, we are in constant discussion with them.

Speaker #3: And it should get sorted in the next month or so, so they should cut those delays by a considerable period of time. So this is a minor delay.

Speaker #3: But other than that, most of these projects are within the acceptable limits. And when it comes to the project in southwest Bangalore, as you said, we are at the end stage of these constructions.

R. Venkatesh: When it comes to the project in Southwest Bangalore, as you said, we are at the end stage of this construction, and we are hopeful to start it by the end of Q2. This is also fully in line with our plans, and we hope to have this start by end of Q2.

Speaker #3: And we are hopeful to start it by the end of Q2. So this is also fully in line with our plans, and we hope to have this start by end of Q2.

Speaker #6: Okay, thank you.

Ravi Viswanathan: Okay. Thank you.

Ravi Vishwanath: Okay. Thank you.

Speaker #5: Thank you. Next question is from the line of Om. Kindly announce your company name and proceed with your question. Om, you may go ahead.

Operator: Thank you. Next question is from the line of Om. Kindly announce your company name and proceed with your question.

Speaker #4: Yeah, so my question was more for Ravi on the insurance side, right? So Ravi was explaining in an earlier participant's call where the insurance business is having a...

[Analyst]: Hi.

[Analyst 3]: Hi.

Operator: Om, go ahead.

[Analyst]: Hi. Yeah. My question was more to Ravi on this insurance side, right? Ravi was explaining in earlier participants calls where the insurance business is having

[Analyst 3]: Hi. Yeah. My question was more to Ravi on this insurance side, right? Ravi was explaining in earlier participants calls where the insurance business is having

Speaker #5: Om, sorry to interrupt. The audio is not clear. Can you speak a little louder?

Operator: Om, sorry to interrupt, your audio is not clear. Can you speak little louder?

Speaker #4: Am I audible now? Yeah. So my question was mainly to Ravi, with regarding to, you know, insurance having an impact on the overall profitability as of now playing.

[Analyst]: Am I audible now?

[Analyst 3]: Am I audible now?

Operator: Yes.

[Analyst]: Yeah. My question was mainly to Ravi with regarding to insurance having an impact on the overall profitability as of now playing. Ravi was explaining that for now this will be going a little bit of maybe couple of more quarters, this impact will be. I just wanted to understand from Ravi that how long do you see that the scaling of insurance books will have impact on profitability. By when we expect that that will start contributing on this.

[Analyst 3]: Yeah. My question was mainly to Ravi with regarding to insurance having an impact on the overall profitability as of now playing. Ravi was explaining that for now this will be going a little bit of maybe couple of more quarters, this impact will be. I just wanted to understand from Ravi that how long do you see that the scaling of insurance books will have impact on profitability. By when we expect that that will start contributing on this.

Speaker #4: And Ravi was explaining that for now, this will be going on for a little bit, you know, maybe a couple more quarters—this impact will be.

Speaker #4: So I just wanted to understand from Ravi, how long do you see that the scaling of insurance books will have an impact on profitability?

Speaker #4: And by when do we expect that that will start contributing on this?

Speaker #6: Right. I'll attempt to answer that. At this point, you know, we don't make future forecasts. But I think the important thing here is a couple of things.

Ravi Viswanathan: Right. I'll attempt to answer that. At this point we don't make future forecasts. I think the important thing here is a couple of things. As I laid out in the earlier response, there are a number of things that we will continue to do to make sure that the portfolio itself is something that is managed sustainably. That includes a number of things around underwriting and claims, as well as the type of business that we are writing. The nature of insurance business and the way that it is currently accounted is that you are able to book a fraction of your revenue in the period and then but you have to book the entire expenses. Growth comes with and does have impact on P&L. These are all things that we look at closely and monitor.

Ravi Vishwanath: Right. I'll attempt to answer that. At this point we don't make future forecasts. I think the important thing here is a couple of things. As I laid out in the earlier response, there are a number of things that we will continue to do to make sure that the portfolio itself is something that is managed sustainably. That includes a number of things around underwriting and claims, as well as the type of business that we are writing. The nature of insurance business and the way that it is currently accounted is that you are able to book a fraction of your revenue in the period and then but you have to book the entire expenses. Growth comes with and does have impact on P&L. These are all things that we look at closely and monitor.

Speaker #6: As I laid out in the earlier response, there are a number of things that we will continue to do to make sure that the portfolio itself is something that is managed sustainably. That includes a number of things around underwriting and claims, as well as the type of business that we are writing.

Speaker #6: The nature of the insurance business, and the way that it is currently accounted for, is that you are able to book a fraction of your revenue in the period, but you have to book the entire expenses.

Speaker #6: So growth comes with, you know, it does have an impact on P&L. But these are all things that we, you know, look at closely and monitor.

Speaker #6: I think the important thing for us is to have a long-term, sustainable portfolio, and over time, to engage with our customers across primary care that we provide them, as part of the insurance offering and as part of the value-added services.

Ravi Viswanathan: I think the important thing for us is to have a long-term sustainable portfolio and over time to engage with our customers across primary care that we provide them as part of the insurance offering and as part of the value-added services so that the entire integrated care approach comes in and we're able to see as a group the value of having hospital clinic insurance together, working with customers to help them get well, stay healthy. That's kind of how we're going to be approaching this. We are obviously very focused on a sustainable business. At this point in time, I think given the size of the portfolio, the volatility, it's a little bit too soon to talk about when is it going to get to various levels. It's something that we'll keep working on and keep updating in each quarter.

Ravi Vishwanath: I think the important thing for us is to have a long-term sustainable portfolio and over time to engage with our customers across primary care that we provide them as part of the insurance offering and as part of the value-added services so that the entire integrated care approach comes in and we're able to see as a group the value of having hospital clinic insurance together, working with customers to help them get well, stay healthy. That's kind of how we're going to be approaching this. We are obviously very focused on a sustainable business. At this point in time, I think given the size of the portfolio, the volatility, it's a little bit too soon to talk about when is it going to get to various levels. It's something that we'll keep working on and keep updating in each quarter.

Speaker #6: So that the entire integrated care approach comes in, and we are able to see, as a group, the value of having hospital, clinic, and insurance together, working with customers to help them get well and stay healthy.

Speaker #6: So that's kind of how we're going to be approaching this. We are, of course— you know, we are obviously very focused on a sustainable business.

Speaker #6: At this point in time, I think, given the size of the portfolio and the volatility, it's a little bit too soon to talk about, you know, when it's going to get to various levels.

Speaker #6: But it's something that we'll keep working on and keep updating each quarter.

Speaker #4: Got it, Raviji. Just to add on to the same, so earlier we had a bit of more targeted segment was the retail. Now, as you indicated, that we have been also looking somewhere on the group and the other segment of, you know, the sector as well.

[Analyst]: Got it, Ravi. Just to add on to the same. Earlier we had a bit of more targeted segment was the retail. Now as you indicated that we have been also looking somewhere on the group and the other segment of the sector as well. Where do you see this shaping up in two to three years? I'm not talking about from profitability point of view. Just want to get a view from scalability perspective. Do you see Narayana Health Insurance becoming a prominent player in terms of the other competitors as well for the health insurance sector?

[Analyst 3]: Got it, Ravi. Just to add on to the same. Earlier we had a bit of more targeted segment was the retail. Now as you indicated that we have been also looking somewhere on the group and the other segment of the sector as well. Where do you see this shaping up in two to three years? I'm not talking about from profitability point of view. Just want to get a view from scalability perspective. Do you see Narayana Health Insurance becoming a prominent player in terms of the other competitors as well for the health insurance sector?

Speaker #4: Where do you see this shaping up in Q2 to three years? I'm not talking about from a profitability point of view, just want to get a view from a scalability perspective.

Speaker #4: Do you see Narayana Health Insurance becoming a prominent player, in terms of the other competitors as well, in the health insurance sector?

Speaker #6: I don't know what you mean by prominent. I mean, if you think about the impact that we will have on the lives of our customers, and our ability to provide an entire integrated approach across everything that our customers require from a healthcare perspective, then as Narayana Health, I think we would be very, very, very prominent in the life of that customer.

Ravi Viswanathan: I don't know what you mean by prominent. If you think about the impact that we will have on the lives of our customers and be able to provide an entire integrated approach across everything that our customer requires from a healthcare perspective, then as Narayana Health, I think we'd be very prominent in the life of that customer. That's what we're trying to build. Okay. I think that's our focus. In terms of channels and distribution our focus, I would imagine, would continue to be on those areas where we think we can make the most impact in the life of our customer, which for us at the moment appears to be retail coverage as well as SME.

Ravi Vishwanath: I don't know what you mean by prominent. If you think about the impact that we will have on the lives of our customers and be able to provide an entire integrated approach across everything that our customer requires from a healthcare perspective, then as Narayana Health, I think we'd be very prominent in the life of that customer. That's what we're trying to build. Okay. I think that's our focus. In terms of channels and distribution our focus, I would imagine, would continue to be on those areas where we think we can make the most impact in the life of our customer, which for us at the moment appears to be retail coverage as well as SME.

Speaker #6: And that's what we're trying to build. Okay. I think that's our focus. But in terms of channels and distribution, our focus, I would imagine, would continue to be on those areas where we think we can make the most impact.

Speaker #6: In the life of our customer, which for us at the moment appears to be retail coverage, as well as SME, these are areas where there are a lot of people who are left uncovered.

Ravi Viswanathan: These are areas where there is a lot of people who are left uncovered for whom having insurance will make a real difference in their life, will stop pushing them into below the poverty line should there be a catastrophe or not be able to access care. That's what we are focused on. In terms of prominence, I don't think we look at it as a market share thing. It's about how can I provide a complete integrated service across clinics, hospitals, and insurance to our customers so that we can be super prominent in their life. If we make that impact and do that over a period to as many people as we can, then I think we've made a real difference.

Ravi Vishwanath: These are areas where there is a lot of people who are left uncovered for whom having insurance will make a real difference in their life, will stop pushing them into below the poverty line should there be a catastrophe or not be able to access care. That's what we are focused on. In terms of prominence, I don't think we look at it as a market share thing. It's about how can I provide a complete integrated service across clinics, hospitals, and insurance to our customers so that we can be super prominent in their life. If we make that impact and do that over a period to as many people as we can, then I think we've made a real difference.

Speaker #6: Who are the people for whom having insurance will make a real difference in their life—will stop pushing them below the poverty line should they require, you know, care in the case of a catastrophe or if they're not able to access care?

Speaker #6: That's what we are focused on. But in terms of prominence, I don't think we look at it as a market share thing. It's about how we can provide a complete, integrated service across clinics, hospitals, and insurance to our customers, so that we can be super prominent in their lives.

Speaker #6: And if we make that impact and do that over a period of time, you know, to as many people as we can, then I think we've made a real difference.

Speaker #4: That's very well. And to achieve that, we will be strictly sticking to the integrated Narayana integrated ecosystem, right? So we are only targeting that area.

[Analyst]: That's very well. To achieve that, we will be sticking to the Narayana integrated ecosystems, right? We are only targeting on that area. We are not going to pursue this as a separate entity.

[Analyst 3]: That's very well. To achieve that, we will be sticking to the Narayana integrated ecosystems, right? We are only targeting on that area. We are not going to pursue this as a separate entity.

Speaker #4: We are not going to pursue this as a separate entity.

Speaker #6: You are. The question that you asked was over a period of time, right? So, look, we are always going to be looking at opportunities.

Ravi Viswanathan: The question that you asked was over a period of time, right? Look, we are always going to be looking at opportunities and looking at what makes sense, the lens is always going to be an overall integrated lens. That is the unique thing that we bring to this market. That's what we're going to be focusing on. All opportunities, all ideas, new things that we'll invent are all on the table to help us drive that goal.

Ravi Vishwanath: The question that you asked was over a period of time, right? Look, we are always going to be looking at opportunities and looking at what makes sense, the lens is always going to be an overall integrated lens. That is the unique thing that we bring to this market. That's what we're going to be focusing on. All opportunities, all ideas, new things that we'll invent are all on the table to help us drive that goal.

Speaker #6: And looking at what makes sense. But the lens is always going to be, you know, an overall integrated lens. That is the unique thing that we bring to this market.

Speaker #6: And that's what we're going to be focusing on. You know, all opportunities, all ideas, new things that we'll invent are all on the table to help us drive that goal.

Speaker #4: Thank you, Ravi ji. All the best.

[Analyst]: Thank you, Ravi. All the best.

[Analyst 3]: Thank you, Ravi. All the best.

Speaker #5: Thank you. Arzan, if you could click on the raise hand icon to ask a question. Next follow-up question is from the line of Japreet Singh.

Operator: Thank you. Participants, you may click on the Raise Hand icon to ask a question. Next follow-up question is from the line of Japjit Singh.

Operator: Thank you. Participants, you may click on the Raise Hand icon to ask a question. Next follow-up question is from the line of Japrit Singh.

Speaker #7: But just on the UK ROC, will it be better than what we have achieved in India and the climate business? The UK ROC will be better than that?

Japjit Singh: Just on the UK ROCE, will it be better than what we have received in India and Cayman business? The UK ROCE will be better than that?

[Analyst 1]: Just on the UK ROCE, will it be better than what we have received in India and Cayman business? The UK ROCE will be better than that?

Speaker #2: Yeah, Japreet, yeah. Thank you for your question. We'd like to take the—

Anesh Shetty: Yeah. Japjit, thank you for your question. We'd like to take the.

Anesh Shetty: Yeah. Japrit, thank you for your question. We'd like to take the.

Speaker #5: Sorry to interrupt. Japreet, can you please mute your line from your side? Please go ahead.

Operator: Sorry to interrupt. Japjit, can you please mute your line from your side? Go ahead.

Operator: Sorry to interrupt. Japrit, can you please mute your line from your side? Go ahead.

Speaker #2: Yeah, we'd like to take the UK questions in the second half. But since you've asked, it's still early days. Japreet, to answer that question, definitely.

Anesh Shetty: Yeah. We'd like to take the UK questions in H2, but since you've asked. It's still early days, Japjit, to answer that question definitively. Like we said before, we do perceive a very good opportunity to increase margins disproportionate to the capital we've deployed. It's a country that has a lot of favorable economics in terms of how the business is structured and especially our advantage of being a low-cost provider. To your specific question, it's too early to have a definitive number and a definitive timeline compared to where we are currently.

Anesh Shetty: Yeah. We'd like to take the UK questions in H2, but since you've asked. It's still early days, Japrit, to answer that question definitively. Like we said before, we do perceive a very good opportunity to increase margins disproportionate to the capital we've deployed. It's a country that has a lot of favorable economics in terms of how the business is structured and especially our advantage of being a low-cost provider. To your specific question, it's too early to have a definitive number and a definitive timeline compared to where we are currently.

Speaker #2: But like we said, you know, before, we do perceive a very good opportunity to increase margins for the capital we have. I mean, you know, disproportionate to the capital we've deployed.

Speaker #2: It's a country that has a lot of favorable economics, you know, favorable economics in terms of how the business is structured, and especially our advantage being a low-cost provider.

Speaker #2: But to your specific question, you know, it's too early to have a definitive number and a definitive timeline compared to where we are currently.

Speaker #7: So, a second question is: there is a significant increase in our cash equivalents in the balance sheet. Where has this cash come from, and how is it going to be utilized?

Japjit Singh: Second question is, there is a significant increase in our cash equivalents in the balance sheet. Where this cash has come from and where it is going to utilize?

[Analyst 1]: Second question is, there is a significant increase in our cash equivalents in the balance sheet. Where this cash has come from and where it is going to utilize?

Speaker #4: Yes. Japreet, you're asking about the cash balance that we are holding on the balance sheet, right? You're asking where we are going to deploy that cash, correct?

Sandhya Jayaraman: Yeah. Japjit, you're asking the cash balance that we are holding in the balance sheet, right? You're asking where we are going to deploy that cash, right?

Sandhya Jayaraman: Yeah. Japrit, you're asking the cash balance that we are holding in the balance sheet, right? You're asking where we are going to deploy that cash, right?

Speaker #7: Yes, yes.

Speaker #4: Okay, so this will get deployed into the projects that we have committed over the next two years. We have committed ₹3,000 crores. A part of that will be our own borrowing in nature.

Japjit Singh: Yes, yes.

[Analyst 1]: Yes, yes.

Sandhya Jayaraman: Okay. This will get deployed into the projects that we have committed over the next two years. We have committed INR 3,000 crore. A part of that will be our own contribution and a part of it will be borrowing in nature. We will deploy that cash towards projects.

Speaker #4: So, we will deploy that cash towards projects.

Speaker #7: Like, where this cash has come from—where is the significant increase in the cash, like from '25 to '26—where has this come from, like?

Japjit Singh: Where this cash has come. There is significant increase in the cash from 2025 to 2026. Where this has come from?

[Analyst 1]: Where this cash has come. There is significant increase in the cash from 2025 to 2026. Where this has come from?

Speaker #4: The cash has entirely come from the performance of the operating business in India and came in.

Sandhya Jayaraman: The cash has entirely come from the performance of the operating business in India and Cayman.

Speaker #7: Okay, thank you.

Speaker #5: Thank you.

Japjit Singh: Okay. Thank you.

[Analyst 1]: Okay. Thank you.

Speaker #4: I think we can take the questions on the chat, Neerav, and then move to the UK. So we can finish off all the India questions on the chat.

Operator: Thank you.

Sandhya Jayaraman: I think we can take the questions on the chat, Nirav, and then move to UK so we can finish up all the India questions on the chat.

Speaker #5: Sure, ma'am.

Speaker #6: There's a question on whether your HSR hospital is on track, and also, are there any plans for expanding presence into North Bangalore? See, HSR is mostly on track.

Operator: Sure, ma'am.

Nishant Singh: There's a question on is your HSR hospital on track and also any plans for expanding presence into North Bangalore. See, HSR is mostly on track. In terms of the North Bangalore, we have already announced our projects for the first round of expansion. Whenever we come to the second round of expansion, this North Bangalore will be one of our priority areas along with other parts of Bangalore where we are not present currently. The second question is insurance. We've got India and we've already covered for insurance.

Speaker #6: In terms of North Bangalore, we have already announced our projects for the current, for the first round of expansion. Whenever we come to the second round of expansion, North Bangalore will be one of our priority areas, along with other parts of Bangalore where we are not present currently.

Speaker #6: The second question is, for India, we have already covered insurance.

Speaker #4: Yeah, India insurance we have covered.

Speaker #6: There's a question on ALOS. ALOS during quarter one was 4.3. Where do you see it settling down?

Sandhya Jayaraman: Yeah, insurance we've covered.

Nishant Singh: There's a question on ALOS. ALOS during Q1 was 4.3. Where do you see it settling down?

Speaker #3: I am Dr. Rupert here. Our intention is to get it down somewhere between 3.9 and 4. That's a journey, because that's one of the areas of efficiency we have been working on for the last couple of quarters.

Emmanuel Rupert: Hi, Dr. Rupert here. Our intention is to get it down somewhere between 3.9 and 4. That's a journey because that's one of the areas of efficiencies we have been working on for the last couple of quarters. We want to do that. Some of the complexities of the work which we do have a different length of stay. We are trying to balance out all of these things to get to that kind of a number. Overall, the effort across all the hospitals is to reduce the ALOS. We also have a sizable number of medical patients who require a little bit of a length of stay. It's quite a balance, but we hope to get down to somewhere close to 4 as soon as possible.

Speaker #3: And we want to do that. But some of the complexities of the work which we do do have a different length of stay. So we are trying to balance out all of these things to get to that kind of a number.

Speaker #3: But overall, the effort across all the hospitals is to reduce the ALOS. But we also have a sizable number of medical patients who require a little bit of a length of stay.

Speaker #3: So it's quite a balance, but we hope to get down to somewhere as close to 4 as possible.

Speaker #6: There's a question on the overall losses and loss funding for the insurance clinic business put together. This we've already covered.

Nishant Singh: There's a question on the overall losses, loss funding for insurance clinic business put together. This we've already covered.

Speaker #4: 21 foot.

Sandhya Jayaraman: Answered.

Speaker #6: The rest are mostly for international businesses.

Nishant Singh: The rest are mostly for international businesses.

Speaker #4: Yes.

Speaker #6: Can you provide some color on the trend in patient transaction volumes across your clinics this quarter?

Sandhya Jayaraman: Yes.

Nishant Singh: Can you provide some color on the trend in patient transaction volumes across your clinics this quarter?

Speaker #4: Do we want to answer that?

Sandhya Jayaraman: Narayana, you want to answer that?

Speaker #6: Yes, certainly. So, I mean, in terms of the overall transactions that we have across clinics, I mean, this is something that continues to be positive.

Ravi Viswanathan: Certainly. In terms of the overall transactions that we have across clinics, this is something that continues to be positive. Just give me a moment and I'll just pull up some of the numbers here for you. Right. In terms of overall transactions, in terms of OP consults, these have grown by about 30% year on year. In the quarter we did about 66,000 consultations across our clinic network. That is something that has been pretty encouraging. A very high percentage of our customers, again, we're not sharing the exact number, but a very high percentage, well over a significant number of the revenue of the clinics comes from these numbers. That's been very encouraging. Our clinic business continues to grow. We are opening two more clinics this quarter and breaking ground on more data.

Ravi Vishwanath: Certainly. In terms of the overall transactions that we have across clinics, this is something that continues to be positive. Just give me a moment and I'll just pull up some of the numbers here for you. Right. In terms of overall transactions, in terms of OP consults, these have grown by about 30% year on year. In the quarter we did about 66,000 consultations across our clinic network. That is something that has been pretty encouraging. A very high percentage of our customers, again, we're not sharing the exact number, but a very high percentage, well over a significant number of the revenue of the clinics comes from these numbers. That's been very encouraging. Our clinic business continues to grow. We are opening two more clinics this quarter and breaking ground on more data.

Speaker #6: Just give me a moment and I'll just pull up the some of the numbers here for you. Right. So in terms of overall transactions, in terms of OP consults, these have grown to grown by about 30% year on year.

Speaker #6: And in the quarter, we did about 66,000 consultations across our clinic network. So that is something that has been pretty encouraging. A very high percentage of our customers—again, we're not sharing the exact number—but a very high percentage, well, a significant portion of the revenue of the clinics, comes from these members.

Speaker #6: And so that's been very encouraging. Our clinic business continues to grow. We are opening two more clinics this quarter and breaking ground on more later.

Speaker #6: So we are quite excited about the direction that the clinic business is going, both at the clinic level as well as with the support it is providing to the hospital, as well as to our insurance business.

Ravi Viswanathan: We are quite excited about the direction that the clinic business is going, both at a clinic level as well as the support that it's providing to the hospital as well as our insurance business. The entire integrated story that we've been building for the last couple of years is starting to play out and we're pretty excited with the direction of that.

Ravi Vishwanath: We are quite excited about the direction that the clinic business is going, both at a clinic level as well as the support that it's providing to the hospital as well as our insurance business. The entire integrated story that we've been building for the last couple of years is starting to play out and we're pretty excited with the direction of that.

Speaker #6: So the entire integrated story that we've been building for the last couple of years is starting to play out, and we're pretty excited with the direction on that.

Speaker #6: Now, this is a question on the domestic market, which Anish can answer. How do you see competition? Because every other—expand your network in states like UP, PR, where organized players like Max, Medanta, Fortis—they have no presence.

Nishant Singh: This is a question on the domestic market to which Anesh can answer. How do you see competition because every other hospital is adding beds and why don't you expand your network in states like Uttar Pradesh where organized players like Max, Medanta, Fortis, they have no presence?

Speaker #2: Yeah, thank you. Yeah, sure. Thank you for the question, whoever asked it. We continue to evaluate, you know, all opportunities in India, especially states that are under-penetrated, like you mentioned.

Anesh Shetty: Yeah, sure. Thank you for the question, whoever asked it. We continue to evaluate all opportunities in India, especially states that are under-penetrated like you mentioned. Having said that, our focus now with the current wave of capital deployment and expansion is in the clusters where we are already strong, already have an established presence, and we have a track record of delivering and establishing a brand. We have outlined over the next, I think three years or so, three financial years or so, how that capital deployment will look like. Once we start phase II, following some progress on phase I, we will consider newer markets and newer geographies. We currently do not have a presence in the states mentioned.

Speaker #2: Having said that, our focus now, with the current wave of capital deployment and expansion, is on the clusters where we are already strong, already have an established presence, and have a track record of delivering and establishing a brand.

Speaker #2: We have outlined over the next, I think, three years or so—three financial years or so—how that capital deployment will look like. And once we start phase two, following some progress on phase one, we will consider newer markets and newer geographies.

Speaker #2: We currently do not have a presence in the states mentioned.

Speaker #6: There's a question which Sander will answer. Is the Cuban FI27 beta margin decline temporary due to integration costs, or should we consider this the new normal for the consolidated business?

Nishant Singh: There's a question which Sandhya will answer. Is the Q1 FY27 EBITDA margin decline temporary due to integration costs, or should we consider this the new normal for the consolidated business?

Speaker #4: So I'd like to take this in three parts, actually. If you look at the India business per se, including combining the losses from the clinic business—even if you set that off—the net margin has expanded by 400 bps year on year.

Sandhya Jayaraman: I'd like to take this in three parts actually. If you look at the India business per se, including combining the losses from the clinic business, even if you set that off, the net margin has expanded by 400 bps year on year. There, I think there is no shrinking. In fact, it's a very strong performance. Cayman Hospital has come back to its earlier levels and has been, because of the ramp-up, and is operating at optimal margins. There are three places where there is a cash burn. One is Cayman Insurance, India Insurance. Cayman Insurance we'll speak about when we come to the Cayman segment. India Insurance we've already spoken about, and both of these are in the improving trajectory, and we will definitely be able to recoup margins over a period of time. Similarly for UK.

Speaker #4: So, there, I think there is no shrinking. In fact, it's a very strong performance. Came in hospital, has come back to its earlier levels, and has been because of the ramp-up, and is operating at optimal margins.

Speaker #4: There are three places where there is a cash burn. One is Cayman Insurance. India Insurance. Cayman Insurance, we'll speak about when we come to the Cayman segment.

Speaker #4: India insurance—we've already spoken about it. Both of these are on an improving trajectory, and we will definitely be able to recoup margins over a period of time.

Speaker #4: Similarly, for the UK, the UK has also caused a dilution in the margins, which again, we will speak about when we come to the UK segment.

Speaker #4: Overall, we are positive that the margin trajectory will be in the upward direction from here, given that all the efforts we are taking will start to bear fruit in the medium term for us.

Sandhya Jayaraman: UK has also caused a dilution in the margins, which again, we will speak about when we come to the UK segment. Overall, we are positive that the margin trajectory will be in the upward direction from here, given that all the efforts that we are taking will start to bear fruit in the medium term for us.

Speaker #6: Then somewhat related.

Speaker #2: I think, Nishant, given the time, we're making progress. Let's take questions on the other divisions, and where there's a gap, we can take the chat questions as well.

Nishant Singh: Still somewhat related.

Anesh Shetty: Nishant, given the time we're making progress.

Speaker #6: Sure.

Anesh Shetty: Nishant, given the time we're making progress.

Nishant Singh: Sure.

Anesh Shetty: I think let's take questions on the other divisions, and where there's a gap, we can take the chat questions as well.

Speaker #5: Thank you. Next follow-up question is from the line of Prithvi Raj. Please go ahead.

Nishant Singh: Sure.

Speaker #2: Yeah. Anish, you know, moving on to Cayman and the UK, if you look at the insurance business in Cayman, I mean, it's good to see that quarterly losses have come down on a sequential basis.

Operator: Thank you. Next follow-up question is from the line of Prithwiraj. Please go ahead.

[Analyst] (Unifi Capital): Yeah. Anesh, moving on to Cayman and UK. If you look at the insurance business in Cayman, it's good to see that quarterly losses have come down on sequential basis. However, in the last call, you mentioned that one-third of the contracts will get repriced starting from July. Can we assume that we are behind worse for Cayman insurance losses and it should start improving significantly as this repricing starts kicking in in July and Jan? Should we look at breakeven anytime soon?

Speaker #2: But, however, in the last call, you mentioned that one-third of the contracts will get repriced starting from July. So, can we assume that we are behind the curve for Cayman insurance losses and it should start improving significantly as this repricing starts kicking in in July and January?

Speaker #2: And should you look at breakeven anytime soon?

Speaker #5: Yeah, thanks, Prithvi. So, on the exercise of renewals in July, we're very happy to note that we had a 100% acceptance and renewal rate, which is quite unusual.

Anesh Shetty: Yeah. Thanks, Prithviraj. On the exercise of renewals in July, we're very happy to note that we had a 100% acceptance and renewal rate, which is quite unusual for a new insurer. That means we're confident that people are happy with what we're offering. They're happy to accept the price increases to a more sustainable level, and we're confident we'll have a similar result in the January cycle as well. That cycle has gone on successfully. It's not reflected in the quarter results you're seeing because that kicks in from July, but it will be in the Q2 cycle. Having said that, to your question, yes. You will always have some abnormal swings in some quarters in insurance because you can have a few large claims here and there.

Speaker #5: For a new insurer, that means we're confident that people are happy with what we're offering. They're happy to accept the price increases to a more sustainable level.

Speaker #5: And we're confident we'll have a similar result in the January cycle as well. So that cycle has gone on successfully, and it's not reflected in the quarterly results you're seeing because that kicks in from July.

Speaker #5: But it will be in the Q2 cycle. Having said that, to your question, yes, you know, you will always have abnormal swings in some quarters in insurance because you can have a few large claims here and there.

Speaker #5: But if you look at a rolling two- or three-quarter basis, we would agree with you that our intention is fully to see that the worst is behind us in the previous quarter.

Speaker #5: Barring some abnormal swing that could happen with a few large claims for some complex cases, I think we agree with your conclusion.

Anesh Shetty: If you look at a rolling two or three quarters basis, we would agree with you that our intention is fully to see that the worst is behind us in the previous quarter, barring some abnormal swing that could happen with a few large claims for some complex cases. I think we agree with your conclusion.

Speaker #2: And moving on to the Cayman hospitals, I mean, the growth this quarter in USD terms is a bit soft. You know, it's 5-6%.

Speaker #2: So, the whole point of getting into insurance is that, you know, it will also add more footfalls to the hospitals. So, is there any specific reason for this low growth in Cayman hospitals this quarter, or is it more to do with a couple of surgeries getting delayed, which explains this?

[Analyst] (Unifi Capital): Moving on to the Cayman Hospital. The growth this quarter in USD terms is a bit soft in at 5%, 6%. The whole point of getting into insurance is that it will also add more footfalls to the hospitals. Is there any specific reason for this low growth in Cayman Hospital this quarter, or it is more to do with couple of surgeries getting delayed, which explains this?

Speaker #4: So, you know, feasibly, it is a softer quarter. Having said that, if you look at the volume metrics, we are seeing a healthy double-digit increase in our—whether we see year-on-year discharges or outpatient footfall, et cetera.

Anesh Shetty: Seasonally it is a softer quarter. Having said that, if you look at the volume metrics, we are seeing a healthy double-digit increase whether we see year-on-year discharges or outpatient footfall, et cetera. A lot of it is because of the integrated care strategy playing out. Having said that, we do look forward to the growth being a little more in the hospital and as you said, which should result from the insurance company growing. The insurance company is not small anymore. We are looking at a $60 million

Speaker #4: A lot of it is because of the integrated care strategy playing out. Having said that, we do, you know, look forward to the growth being a little more in the hospital end, as you said, which should result from the insurance company growing.

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Q1 2027 Narayana Hrudayalaya Ltd Earnings Call

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