In order to remove ambiguity and confusion regarding
the claim process, interpretation of health insurance terms and names and procedures related to critical illnesses across insurance companies, the Insurance Regulatory and Development Authority (Irda) of India has
come out with new guidelines.
The guidelines lay down standard definitions of 46 commonly-used
health insurance terms such as day-care treatment, co-payment, domiciliary hospitals, etc. They also standardise pre-authorisation and claim forms to "streamline processes at all stages".
The guidelines specify 11 diseases and procedures as critical illnesses.
"All products offering the 11 critical illnesses coverage should ensure that definitions of the stated 11 terms are in line with the stipulated definitions," say the guidelines.
Apart from these, the guidelines stipulate the hospitalisation expenses to be excluded from indemnity policies. The list of exclusions includes 199 items. However, insurers may include these expenses if the product design allows for them or they want to include these in their products.
"The standard listing of 199 excluded items, an area which has otherwise been fairly variable in its interpretation and implementation, has been finalised," said Irda.
Irda has also standardised the 'File and Use' application form as it feels that "the existing form used by non-life insurers is designed keeping in view largely the characteristics of non-life products other than health due to which essential information like the sum insured, the minimum and maximum age, term of the product, etc, that gets captured is minimal."
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