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Ruby Jacob, 22 Feb 2013
IRDA has come calling for health insurance this time. The insurance sector regulator wants all health insurance providers to adhere to standard terms and procedures in health insurance policies.
After all these years overall health insurance industry service levels have not been laudable. One major cause of discontent in health insurance services is that terms used by different insurers and TPAs in health insurance policies are widely ambiguous.
Same terms in policies mean differently
Common terms you would come across in any health insurance policy- day care treatment, domiciliary treatment, pre-existing disease, room rent and even hospital, can have different interpretations depending on the insurance company.
If you did not pay special attention to definitions, terms and conditions while signing up for a policy your health insurance claim could end up being refused. Many insurance policy holders who had this experience in the past took it up with the regulator.
IRDA new guidelines
Current Guidelines on Standardization in Health Insurance being issued by IRDA will hopefully change this scenario. The regulator will attempt to do this by standardizing 46 commonly used terms in health insurance policies, 11 terms and exclusions in critical illness policies and standard list of exclusions in hospitalization.
For instance it defines hospital as an institution registered as one for in-patient care and day care treatment and having at least 10 inpatient beds in small towns or 15 beds in others, having round the clock qualified nurses and doctor/s, having operation theatre of its own and maintaining daily records of patients.
These guidelines apply to insurance companies providing health insurance products as well as TPAs. Insurers and TPAs have been directed by IRDA to use standardized forms for Pre-authorization and Claims. This will make pre-authorization and claims procedure uniform for all insurers.
Health insurance is a big component of securing one's personal finance life. Cost of getting good medical care is spiraling. Getting a mediclaim is important, as important as having life insurance. Health insurance scenario in India has a long way to go compared with our western counterparts but with increased awareness and participation the pace can be fastened.