Amendments in new health insurance norms draw mixed reactions from advisors.
IRDA has made a few key amendments in health insurance norms. It has eased criteria for hospitals to qualify for tie-ups with insurance companies.
The new amendment allows a hospital which is registered with the local authorities under Clinical Establishments (Registration and Regulation) Act, 2010 to tie-up with insurance companies. In addition, any hospital meeting these minimum criteria will also qualify:
- at least 10 in-patients beds in towns having population of less than 10 lakh and15 in-patients beds in other places,
- maintain the daily record of patients,
- facility of qualified nursing staff facility and medical practitioner in-charge round the clock and
- fully equipped operation theatre.
Nisreen Mamaji of Moneyworks Financial Advisers says“Allowing hospitals registered with the local authority to tie-up with insurance companies will help cut down the claim settlement time and also provide cashless benefits to policyholders. Earlier, policyholders had to pay cash at the time of treatment and later submit necessary documents to settle their claims which often took 3 to 4 weeks.”
However, Nilesh Shah, a Coimbatore based Financial Adviser, is skeptical about this amendment. He says health insurance penetration could only be increased if uniform tariff card is applied for all hospitals across the nation.
The insurance regulator has recognised registered homeopathic practitioners as medical practitioners.
IRDA has made changes in some standard definition of commonly used terminology of health insurance regulation. Now, the definition of portability is called ‘switching from one insurer to another’. However, switching from one plan to another of the same insurer has been omitted in the new definition.
Nisreen said “Switching facility from one plan to another plan is already available. Hence, excluding it from new definition doesn’t create any difference in the health insurance segment.”
Now IRDA has allowed any number of lawful terminations of pregnancy throughout the policy life. Earlier only two lawful terminations were allowed. Pre-natal and post-natal care have been excluded from the new definition of Maternity Expenses. Nisreen observes that exclusion of pre-natal and post-natal care from the new definition would be a setback as it may prove expensive for policyholders.
IRDA has added adopted children under its ‘new born baby’ definition. The regulator has also added full recovery clause in the new definition of acute condition. Acute condition is a disease, illness or injury in which medical treatment is immediately needed.
Deductible, which is cost-sharing requirement under a health insurance policy, has been left to insurers to decide whether the deductible is applicable per year, per life or per event.
IRDA has also made some amendments in standard pre-authorisation form and claim form. Now pre-authorisation form includes the provision of capturing of contact details of attendant of insured person.