Page 217 - Ebook health insurance IC27

Sashi Publications

prescribed Obligations under Rural & Social Sector which encourage insurers
for making products specifically for health insurance under micro insurance
regulations.

(c) Standardization initiatives - IRDA has supported and actively participated in
the pioneering initiatives through multi-stakeholder industry group, which worked
together in addressing issues which concern health insurance. This contains 21
common causes of hospitalization called Standard Treatment Guidelines.

Standard definitions of Critical illness enhancing the customer's understanding of
these terms and easier comparison of product offerings in the market, standardizing
the list of non-medical expenses smothering the interaction between the patients,
hospitals, TPAs, and insurers by minimizing ambiguities on what is payable under
health insurancepolicies,standardization ofimportant documentsofhealth insurance
system, like pre-authorization forms and claim forms etc. These help boost
operational efficiency in the system and yield better results for the industry's
development.

(d) Pre-Existing Diseases (PEDs) - It is estimated that majority of claim disputes in
non-life sector are related to medical (health) insurance and majority of these
pertain to pre-existing diseases. This prompted the General Insurance Council to
arrive at a standard definition for PEDs in 2008.

Pre-existing diseases will be " any condition, ailment or injury or related condition(s)
for which insured had signs or symptoms, and/or were diagnosed, and/or received
medical advice/treatment, within 48 months prior to the insurer's first policy with
the insurer.

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