The regulator has standardized 46 terms and excluded 199 items from hospitalization policies.
IRDA has issued guidelines that standardizes terms in health insurance policies. The regulator has taken this move to provide better service to policyholders.
The guidelines have standardized definitions of 46 terms that are commonly used in health insurance policies and 11 critical illness terms to bring uniformity in sales, claims and settlement processes of insurers. The critical illnesses include cancer, first heart attack, open-heart valve surgery, coma, kidney failure, stroke, major organ transplant, paralysis of limbs and multiple sclerosis.
“We were waiting for these specifications from the regulator since a long time…the new guideline will help us work smoothly,” said Krishnamoorthy Rao, CEO Future Generali General Insurance.
“Standard terms would reduce ambiguity, enable all stakeholders to provide better services and enable customers to interact more effectively with insurers and third party administrators. All insurers shall adhere to the stipulated definitions, while defining these 46 core terms in all health insurance policies,” said the IRDA circular.
The insurance regulator has also put out a standard list of 199 excluded items in hospitalization indemnity policies. “However, insurers may include these exclusions, if the product design allows for, or if the insurer wants to include these as part of hospitalization expenses,” added the circular.
The guidelines will be effective from 1st July 2013, for group products and 1st October 2013, for other products.