Page 134 - Ebook health insurance IC27

The Insurance Times

Need for standardisation of forms

 If every company has a separate form, the hospital may have to keep 30-40 forms
of different insurers.

 If forms are standardised it would be easy to understand, and can be filled up more
completely and accurately.

 The pre-authorisation and claims form were standardised to prevent confusion in
the minds of TPA, hospital and insured.

Need for a standardisation of non-medical expenses

 Most of the insurers exclude non-medical expenses in the health insurance policy.
 The exclusion of expenses may differ from company to company.
 However in absence of any standard exclusion the insured may get confused while

comparing the product or while changing the company.
 Whether an expense is covered or not in an insurance policy is often disputed by the

insurer and consumer and it leads to litigation.
 If standard guidelines are set confusion may be reduced to a great extent.

(Usually definitions of any critical diseases may not be asked in the examination
but this has been given for understanding of the candidate)

Recommended Standard definitions

1. Cancer of specified severity
A malignant tumour characterised by the uncontrolled growth & spread of malignant
cells with invasion & destruction of normal tissues. This diagnosis must be supported by
histological evidence of malignancy & confirmed by a pathologist. The term cancer
includes leukemia, lymphoma and sarcoma.

138 Guide for Health Insurance