Page 27 - Insurance Times May 2020

b) Pharmaceuticals This will help to remove many disparities in wordings and
c) Health check-ups/diagnostics ambiguities in the interpretation of standard clauses in the
health insurance industry and benefit customers hugely.
Including discounts on all the above by redeemable
vouchers. IRDAI is also planning to standardise the health claim
ii) redeemable vouchers to obtain protein supplements
settlement procedure and ensure payment in a time-bound
and other consumable health boosters / supplements.
manner, through a common portal. T.L. Alamelu, member
iii) redeemable vouchers for membership in yoga centres (non-life), IRDAI was quoted as having indicated the plans
or gymnasiums for participating in fitness activities." of IRDAI in this respect at an insurance summit organised
by Assocham in Kolkata on February, 14th, 2020. IRDAI has
However, all wellness features are to be filed with the already formed a committee to examine the matter and the
product at the initial stage itself. However, the insurers were platform is to be developed by the Insurance Information
not to publish the trade names or logos or merchandise in Bureau. This platform will bring all the stakeholders in the
any of their advertisements but may refer to the product health insurance space -insurers, the insured and hospitals
etc. in generic terms. on a common platform to standardise claim settlements and
ensure timely pay-outs. It is intended that both cashless and
The IRDAI has also said that the costs towards wellness reimbursement claims will be routed through this portal.
services is to be factored into the pricing of the health
insurance product and shall be disclosed in the relevant The charges for some standard procedures also present a
insurance advertisements. Therefore, transparency will be lot of disparity between different hospitals. T.L. Alamelu was
maintained in the pricing of wellness products. However, quoted as having said that "There is a mismatch (in pricing).
what remains to be seen is after incorporation of these IRDAI is thinking how to handle it. In this context, the
wellness features how much it impacts the price of the General Insurance Council's talks with TPAs are on course
insurance products and the customer response in this to standardise charges for some procedures such as cataract
regard. and hysterectomy." This is a positive step in the right
direction and the Regulator would be in a better position
VII) New Regulatory initiatives on the anvil to negotiate with the dominant hospital lobby on behalf of
According to IRDAI's draft proposal, released in January of the entire insurance industry, to the benefit of all
this year, "The objective of the guidelines on 'Standardisation stakeholders.
of General Clauses in Health Insurance Policy Contracts' is
to standardise the common general clauses incorporated in It is quite clear that these initiatives of the Regulator will
indemnity based Health Insurance (excluding Personal bring in immense relief to the customers and also help in
Accident (hereinafter referred to as PA) and Domestic / regulating the health sector.
Overseas Travel) products covering Hospitalisation,
Domiciliary hospitalisation and Daycare treatment to Conclusion
simplify the wordings of general clauses in the policy The health insurance sector in India has grown and evolved
contracts and ensure uniformity and greater transparency." to a large extent over the years. It is heartening to note
The Regulator proposes to make these guidelines apply to that the current crop of Regulatory initiatives has
all individual and group health insurance policies ultimately. encompassed diverse areas in the health insurance sector.
While this is a welcome step for customers, it opens up
challenges for insurers in many ways. Yet another area in
which the Regulator could bring in standardisation is by
mandating a standard benefit based critical illness policy,
across the entire insurance industry, which will not only
generate confidence in customers but also ensure complete
financial protection for them. The aspect of medical
insurance in overseas travel policies also requires a fresh look
by the Regulator.
(References for this article has been sourced from the IRDA
website and different newspaper.) T

The Insurance Times, May 2020 27