IRDA has issued new guidelines to bring more clarity and standardise common terms in health insurance policies. These will also enable insurance companies to provide better service to policyholders.
The comprehensive guidelines have standardised 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 IRDA also put out a standard list of 199 excluded items in hospitalisation 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 hospitalisation expenses,” said the IRDA circular.
When these guidelines will be applicable?
These new guidelines shall be effective from 1st July’2013 for Group Products and 1st October’2013 for all other products.
IRDA Guidelines on Health Insurance Policies
1- Standard Definitions for 46 commonly used terms in Health Insurance Policies : Annexure I
2- Standard Nomenclature and Procedures for Critical illnesses : Annexure II
3- Standard Pre-authorization and Claim Form : Annexure III
4- Standard List of excluded expenses in Hospitalisation Indemnity Policy : Annexure IV
5- Standard File and Use Application Form, Database Sheet and Customer Information Sheet : Annexure V, VI & VII
6- Standard Agreement between Insurer & TPA and Hospital & Insurer : Annexure VIII & IX