Page 149 - IC38 GENERAL INSURANCE

B. IRDA Guidelines on Standardization in health insurance

With so many insurers providing numerous varied products and with different
definitions of various terms and exclusions, confusion arose in the market. It
became difficult for the customer to compare products and for third party
administrators to pay claims against products of individual companies.
Moreover, in critical illness policies, there was no clear understanding as to
what was a critical illness and what was not. Maintaining electronic data for the
health insurance industry was also becoming difficult.
To remove the confusion among insurers, service providers, TPAs and hospitals
and the grievances of the insuring public, various organizations like IRDA,
service providers, hospitals, Health Advisory Committee of the Federation of
Chambers of Commerce and Industry got together to provide some kind of
standardization in health insurance. Based on a common understanding, IRDA
issued Guidelines on standardization in health insurance in 2013.
The guidelines now provide for standardization of:

1. definitions of commonly used insurance terms
2. definitions of critical illnesses
3. list of excluded items of expenses in hospitalization indemnity policies
4. claim forms and pre-authorization forms
5. billing formats
6. discharge summary of hospitals
7. standard contracts between TPAs, insurers and hospitals
8. standard File and Use format for getting IRDAI for new policies
This has been a big step to improve the quality of service of the health
providers and the insurance industry and will also help in collection of
meaningful health and health insurance data.

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