Page 133 - Ebook health insurance IC27

Sashi Publications

The aim of these treatment guidelines are to
 Reduce claim disputes substantially by providing a reference framework for payers

to process medical claims for these conditions and thus reducing the needs for queries
moving back and forth between payers and providers
 Enable increased automation of claims handling resulting in faster claim processing
and reduction of TATs(turn around time) for a significant proportion of claims
 Help in setting appropriate grades/levels of payout for different types of surgeries in
fixed benefit plans and setting scientific and reasonable sub-limits for different
procedures in reimbursement plans
 Provide a framework for development of appropriate price range for these conditions
in different situations.

Areas of
standardisation

Definitions Forms Non-medical
expenses

Need for standardisation of definitions

 The health insurance market has witnessed the introduction of various critical illness
products, which cover a list of designated diseases.

 Differences in the definitions of Critical Illnesses can create confusion in the minds of
consumers and the industry.

 Lack of standard definitions also means that products are difficult to compare.
 To bring uniformity in the understanding of critical illness definitions.

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