Page 225 - Ebook health insurance IC27

Sashi Publications
 During the policy period if he needs any services it must be given promptly.

7. Health data repository
 Data plays a very important role in health insurance
 Unless the data for previous claims are available it will be very difficult to price the

new product.
 The unavailability of reliable information undermines underwriting capability of

insurance companies leading to increased insurance costs
 It is important to build a credible source of information at the industry level with

respect to claims, medical treatment costs
 Insurance information bureau is now acting as the data repository and analyses the

trend of claims and expenses on various diseases.
 Existence of reliable data will help the insurers to provide right priced insurance

solutions to the customers.

Claims servicing

Contracts such as medical insurance that provide benefits on an indemnity basis typically
require that the insurance company be given a written proof of loss (that is, a claim form)
concerning occurrence, character and extent of the loss for which a claim is made.

The essence of the insurance contract is the payment of insurance claim to the insured
on happening of any specified event.

The benefit of insurance can only be known at the time of claim, hence the insurers must
be careful to settle the claim promptly.

Insurance company may directly pay the claim amount to a service provider or to the
policyholder or disburses a fixed benefit on occurrence of illness depending upon the
product.

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