annual report 2008-09 - IRDA

ANNUAL REPORT 2008-09
Box Item 1
JOINT INITIATIVES IN HEALTH INSURANCE WITH
MULTI-STAKEHOLDER GROUPS UNDER CII AND FICCI
IRDA continues to encourage joint initiatives by multiple stakeholders for collaborative action on the multitude
of issues and concerns in the health insurance industry, with an aim to ensure orderly growth as also to
address challenges of ensuring accessibility, affordability and efficiency.
IRDA closely supported the activities of working groups formed by FICCI and CII on specific areas of health
insurance. Each of these multi-stakeholder groups addressed a critical issue of the overall approach so as to
ensure uniform and steady development of the health insurance segment in the country. IRDA is a common
thread across these working groups to ensure smooth coordination among the activities of the groups and also
to ascertain that there is no duplication of efforts across the industry’s various initiatives. Both the industry
chambers have recently completed their assigned tasks and have disseminated their reports. The feedback
on these is very encouraging.
The FICCI report on Health Insurance released in July 2009 includes Standard Treatment Guidelines for 21
common causes of hospitalization. These guidelines were developed by eminent clinical experts & other
professionals, forming part of the FICCI working group on health insurance, and is the first ever joint insuranceprovider
effort in India for this purpose. Similarly, the standard nomenclatures and definitions of 11 Critical
Illnesses which have been worked upon by another FICCI group will not only enhance the customer’s
understanding of these terms but also ensure easier comparison of insurance product available in the market.
Such standard of definitions bring the Indian industry at the forefront because only a handful of health insurance
markets worldwide have worked on such important issues. The third is the FICCI report, on standardizing the
list of non-medical expenses which is believed to smoothen the interaction between the patients, hospitals,
TPAs and insurers by minimizing the ambiguities on ‘what is payable’ under health insurance policies.
More recently, in Aug 2009, the CII working groups have also disseminated their recommendations. One of the
CII groups has deliberated on standardization of formats of important documents in the health insurance
system and has designed and finalized the IT-enabled standard formats for pre-authorization and claim forms,
which are intended to be used by all players in the industry. These forms will soon be implemented across
TPAs and insurers. This CII working group has also finalized and released a glossary of 20 standard definitions
of commonly used terms in health insurance. A prototype of customer information sheet to be attached with all
health insurance policies, mandated by the Authority in May 2009, has also emerged from the deliberation of
this CII group. The second CII working group developed a Health Insurance Buyer’s Guide designed to provide
information to prospective buyers of health insurance products. It familiarizes potential buyers with key concepts
and practices of health insurance and discusses various product options to the buyer, the purchase process
and acquaints prospective buyer with claims and renewal processes. Written in simple English, it can be
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