Page 26 - Insurance Times May 2020

provided to the policy-holder for his selection both at the
time of offering the proposal and during renewal. This list
will be restricted to the TPAs with whom the insurer has
service-level agreements. It will also be specific to different
products and the geographical location of the policy-holder
(as all TPAs do not have an effective pan-India presence).

This arrangement represents a significant step forward for
the policy-holder. She can utilise this option if she has had
prior experience with a particular TPA. However, for those
who are insuring for the first time or have not have made
any claims against an existing policy, this option is not of any
major significance. It will also be beneficial for the health
insurance sector as a whole, as TPAs previously relied only
on the insurer's clearance for servicing policies but will now
have to depend on customer preferences. Thus the TPAs will V) The Regulatory Sandbox (RS) Initiatives
also have to be more conscious of their customer-handling Regulatory Sandbox usually refers to live testing of new
and compliance of their service-quality levels. Presumably, products in a controlled environment. It is akin to a pilot
TPAs who are unable to meet expectations of customers will project with the insurer free to withdraw the product in
slowly be weeded out by insurers. case of failure. However, it must not adversely affect
customers who are already insured.
However, it represents a challenge for insurers in actual
implementation. Insurers with numerous offices pan-India The IRDAI (Regulatory Sandbox) Regulations, 2019 intend
such as the public-sector insurers typically divide their offices to strike a balance between orderly development of the
TPA-wise for convenient servicing and due to other insurance sector on the one hand and the protection of
administrative concerns. Numerous TPAs servicing the retail interests of policy-holders on the other. The idea is to
customers of a single office may cause organisational facilitate innovation. The RS will allow the participants, such
problems which the insurers will have to overcome. as the Regulator, innovators and willing customers, to
conduct field tests to collect evidence on the benefits and
IV) Health Coverage extended to cover many risks of innovations while simultaneously monitoring and
exclusions restricting the risks. The IRDAI has invited applications for
the RS for about a month last year. It is understood that
In September 2019, IRDAI introduced new rules which aim
many applications have been received out of which many
at making health insurance more universal in scope and
health insurance-related applications are under scrutiny.
coverage. The Guidelines on Standardisation of Exclusions Recent news indicates that many proposals involved the use
in Health Insurance Contracts specified that genetic of fitness apps for arriving at an appropriate premium. Some
diseases, psychological and neuro-developmental disorders, exciting innovations in this sector may be thus expected
menopause-related disorders, age-related macular shortly.
degeneration etc. are to be covered henceforth. Thus
treatment costs of persons suffering from speech disorders
and dyslexia will henceforth not be excluded. Injury or illness VI) Wellness and Preventive Features in Health
associated with hazardous activities, except those relating Insurance
to sporting activities will also not be excluded any longer. Towards the end of last year, the Regulator issued draft
Internal congenital diseases, genetic diseases and disorders guidelines on the above and mentioned that "Based on
will also be covered. fitness and wellness criteria stipulated and disclosed, insurers
may endeavour promoting wellness amongst health
Whilst this provision will be welcomed by many, it would insurance policyholders by offering:
mean that many claims previously not entertained or i) Health specific services provided by Network providers
rejected by insurers would now have to be paid. It will result or other empanelled hospitals / service providers for the
in higher claims outgo and possibly higher premia in the long following:
run, as insurers factor in possible claims. a) Outpatient consultations or treatments

26 The Insurance Times, May 2020