Page 234 - Ebook health insurance IC27

The Insurance Times

(g) Health Data Repository - In health insurance industry, asymmetric
information, i.e, a situation where one party has more information when
one - leads to adverse selection. Individuals with high health care costs are
more likely to buy insurance.

The un availability of reliable information undermine the underwriting
capabilities of the insurance companies, leading to increased insurance costs.
Hence it is essential to build a dependable source of information at the
industry level with respect to claims, medical treatment costs and health
cases, which can be leveraged by insurers to ensure that the cover is rightly
priced and the insurance costs are under control.

Industry data on health insurance claims is now available on the IRDA and
the TAC website. A common health data repository supported by
standardized formats of capture of health data is a critical initiative for the
industry.

Q2. Write a note on claims-servicing?
Ans. An insurance policy promises to pay a claim when the insured event occurs as per

the terms of the policy. A claim also refers to the process by which the insured
demands the admissible insured amount from the insurance company.

Insurance company either pays directly to the hospital (cashless facility) or
reimburses the expenses associated with the illness, or disburses a fixed
benefit on occurrence of an illness depending on the product. Cashless
hospitalization is a service provided by an insurer wherein the insured is not
required to settle the hospitalization expenses at the time of discharge from
hospital.

238 Guide for Health Insurance