Page 161 - Ebook health insurance IC27

Sashi Publications

the insurer is liable for any claim that arose before cancellation.

(l) Renewability Clause - Generally, the industry's stand, as required by the
regulator, is that the health insurance products will ordinarily be renewed,
though the insurers will not be liable for cases of non-receipt of premium /
delayed receipt of premium / renewal notice. The company can revise the
premiums, terms and conditions of the product. The renewal is not automatic,
and the insured must pay the premium well before the due date.

Q18. What standardization initiatives have been taken in health insurance sector
in India? What is the aim of standardization of treatment, guidelines ?

Ans. In a unique multi-stakeholder initiative in India, the insurance industry, regulator,
hospitals and industry chambers (FICCI and CII), along with other stakeholders,
have come together to undertake certain standardization initiatives for the health
insurance industry, since 2007. Some of these are :

(i) Standardization of definitions - There do exist differences in the definitions of
certain terminology used in health insurance and in the nomenclature and definitions
of Critical Illness. These differences create confusions in the consumers and the
industry. Lack of standard definitions make the products difficult to compare, and
the availability of standard definitions would then ensure better comparability,
uniformity and understanding.

(ii) Standardization of forms - Most insurers and TPAs require much of the same
information in their pre-authorization and claim forms. However, they use different
formats and these make it difficult for the hospitals to handle so many forms, and
to understand them well. If the forms are standardized, they can be better
understood , and make the workings of hospitals complete and more accurate. So
standardized formats for pre-authorization and claims were developed and used
by all insurers and TPAs.

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