IRDAI panel to study health insurance clauses

To add new modalities of treatments

The Insurance Regulatory and Development Authority of India (IRDAI) has formed a working group for standardisation of exclusions in health insurance contracts.

It has tasked the 10-member group to examine exclusions that are prevalent in the health insurance policies and identify the type of exclusions that cannot be allowed. The group chairman will be IRDAI Executive Director (Health) Suresh Mathur. The group is required to rationalise the exclusions by minimising their numbers thus enhancing the scope of the health insurance coverage provided.

The regulator, in an order constituting the working group on Tuesday, said the group needs to rationalise the exclusions that disallow coverage with respect to new modalities of treatments and technologically advanced medical treatment.

Other terms of reference of the working group are to study wordings/language of exclusions. This is to standardise the wordings of exclusion in a “simple and easily understandable language.”

The group has also been directed to study the scope for “allowing individual specific and/or ailment/disease specific permanent exclusions at the time of underwriting.” Such a move, the IRDAI order said, is to ensure the policyholders are not denied health insurance claims unrelated to the exclusions.

Besides Mr. Mathur, the working group would have as its members NABH CEO Harish Nadkarni; Chairman of CII Sub-Committee on Health Insurance Annaswamy Vaidheesh; New India Assurance Co General Manager R.M. Singh; Appointed Actuary of Bajaj Allianz Life Insurance Co. D. Sai Srinivas, Future Generali General Insurance Co. SVP and Head – Operations Shreeraj Deshpande; Medi Assist TPA Whole-Time Director Vikram Jit Singh Chhatwal; Star Health COO S. Prakash; IRDAI General Manager-Health D.V.S. Ramesh and Pankaj Sharma as its Convener.

Stating that it had been issuing guidelines on standardisation, the IRDAI said an increase in the number of companies offering health insurance has resulted in more such products too.

In this context, the regulator is keen on the insurers adopting a “uniform approach while incorporating the ‘exclusions’ as part of the product design as well as for the wording of the ‘exclusions’,” the order said.

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Printable version | Mar 26, 2020 3:03:47 PM | https://www.thehindu.com/news/cities/Hyderabad/irdai-panel-to-study-health-insurance-clauses/article24506412.ece

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