New Delhi: Insurance regulator IRDA today
said that it will soon come out with draft norms that define
terms like critical illness and hospitalisation cost, among
others, a move that will reduce the scope for disputes between
insurers and hospitals.
"I carry with me the draft regulations (on health
insurance policies). It will be out very soon," IRDA Chairman
J Harinarayan said at a Ficci Health Insurance Conference
He said that the Insurance Regulatory and Development
Authority (IRDA) would lay down a standard definition for
major critical illnesses under health insurance, which would
reduce confusion between Third Party Administrators (TPAs),
insurers and policyholders.
"..I have written to Union Health Secretary Sujatha Rao,
bringing to her notice the work that has been done and
suggesting that perhaps the health ministry might like to look
at the advisability and prescribe some standard procedure as
they think appropriate," he added.
The draft regulation would include standard nomenclature
and procedures for critical illness, standard preauthorisation
and claim forms, and the standard list for excluded expenses
in hospitalisation, Harinarayan said.
An expert committee constituted by industry body Ficci
has identified 11 critical illnesses, including cancer,
stroke, kidney failure, and major organ and bone transplant,
The claim ratio of the health insurance industry is over
100 per cent, which means that insurance companies are paying
more than the premiums they receive.
Harinarayan said that it should be around 70 per cent for
the sustainability of the industry.
The health insurance premium for 2007-08 was at Rs 2,757
crore, while the payout was Rs 2,904 crore. Again, for fiscal
year 08-09, the premium was Rs 3,975 crore and the payout was
Rs 4,087 crore.
In FY`10, the premium was Rs 7,802 crore and the payout
was Rs 7,426 crore.