annual report 2009-10 - IRDA

ANNUAL REPORT 2009-10I.4.6.5 The recent stand-off between non-life PSUsand their network hospitals owing to continuouslyrising claims cost for insured availing cashlesstreatment resulted in review of cashless facility in someof the network hospitals. In order to ensure that noinconvenience is caused to existing policyholders,IRDA has instructed all insurance companies toensure that, at times when there is a change inpreferred provider network of hospitals, policyholdersare always informed about the nearest possiblealternative hospitals where cashless facility is availableand that the interests of the policyholders are notadversely affected at any point of time.I.4.6.6 IRDA has been receiving health insurance datafrom non-life insurance companies and TPAs. Lifeinsurance companies have also been directed nowto submit health insurance data for health insurancepolicies underwritten by them on half yearly basis w.e.f1 st April, 2010. The data submitted to IRDA byinsurance companies and TPAs will be used to buildan industry database for Health Insurance. In fact,insurance companies are already utilisingcomprehensive data analysis made available on thewebsite by the Insurance Information Bureau (IIB).I.4.6.7 As a measure to ensure policyholders are notunfairly denied renewal, the Authority is insisting uponhaving “no exit age” for all new health insuranceproducts filed. Also on the anvil are initiatives, likeprovision for continuation of coverage to members andfamily in respect of group health insurance products,portability and establishment of a Health InsuranceCouncil.Initiatives through Trade BodiesI.4.6.8 IRDA continues to support the activities ofWorking Groups formed by FICCI and CII on specificareas of health insurance. Both the industry bodiesorganise annual health insurance events and releasetheir reports comprising of the recommendations ofthe Groups. Currently these multi-stakeholder groupsare mainly working on standard framework for groupproduct pricing; framework for enhancing quality inhealthcare through health insurance throughsynergistic efforts of the regulatory bodies, NationalAccreditation Board for Hospitals & HealthcareProviders (NABH), insurance companies andproviders; standardisation of billing formats;standardisation of TPA/Insurer and TPA/HospitalContracts.I.4.6.9 As more people buy health insurance to meetthe requirement of funding healthcare for themselvesand their families, the necessity of close monitoringof the pricing mechanism of health products by theAuthority becomes important. While, insisting on thesustainability and viability of the products with respectto the rates and discounts filed under File & Useprocedures, the Authority also requires the insurancecompanies to submit their past experience on similarproducts and its analysis to support the pricemechanism filed by them.BOX ITEM 4INNOVATIONS IN HEALTH INSURANCEWe as Indians spend about 80 per cent of all health expenditure in the country from our personalresources. Hence the importance of adequate planning for health contingencies cannot beoveremphasised especially, given the steep escalation in healthcare costs, expensive health technologyand pharmaceuticals. With increasing demand, the health insurance industry has come up withinnovative products to enable policyholder to plan comprehensive protection against health eventualitiesby combining hospitalisation indemnity products with supplementary covers or additional policies tomeet specific needs of the policyholder.There are products available that provide Daily Hospital Cash benefit in the form of fixed daily allowancewhich could be used to cover the incidental costs associated with hospitalisation (like travel and staycosts of an attendant). These benefits are available either on standalone basis or as optional componentof a packaged health insurance policy.44