Page 214 - Ebook health insurance IC27

The Insurance Times

also be a regulatory requirement. Product terms and conditions may also be
regulated, like
(i) Standard products or minimum benefit coverage mandate.
(ii) Standardization of definitions and terms.
(iii) Caps on waiting periods and cost sharing provisions and
(iv) Requirements of fairness, transparency and disclosures.

(c) Prevention of mis-selling - Prescribing the correct qualifications, background,
market conduct requirements for intermediaries are some of the areas needed to
be regulated to prevent mis-selling.

(d) Grievance Redressal - Multiple channels are available to address customer
grievances -
(i) Insurer's internal review and grievance mechanism
(ii) Regulator's review and monitoring mechanisms
(iii) External reviews or Ombudsman mechanism
(iv) Consumer law, competition laws and company laws
(v) Contract laws and judicial mechanism.

Often, the regulators take up the onus to co-ordinate amongst these grievance
mechanisms, to monitor the data flowing from grievances and also intervene
wherever necessary. Grievance redressal is important for the consumer's
confidence in insurance system and regulators tend to monitor the smooth and fair
running of the mechanisms.

Q7. Trace the developments of health insurance regulation in India.
Ans. Early years of legislative controls on the insurance sector were consolidated and

updated as the Insurance Act,1938, which though revised from time to time, still

218 Guide for Health Insurance